Former Medicare Chief Warns About Medicare Advantage Pay Rates
Donald Berwick, who ran Medicare during the Obama administration, says Medicare Advantage plans run by private insurers need a lot more regulation. He suggests a two-pronged system fix that would take the overpayments out of MA and use that money to cover vision, dental, and hearing service in traditional Medicare, Stat says.
Stat:
A Former Medicare Official Says The Program Is In Trouble, And Medicare Advantage Is Largely To Blame
Medicare is in trouble, and it’s largely the fault of the Medicare Advantage program that is run by private insurers, according to Donald Berwick, who ran Medicare during the Obama administration. (Wilkerson, 10/17)
Modern Healthcare:
Elevance Health Challenging Medicare Advantage Ratings For 2025
Elevance Health took a hit on its Medicare Advantage star ratings for 2025 and plans to do something about it, President and CEO Gail Boudreaux told investor analysts Thursday. The for-profit Blue Cross and Blue Shield licensee is the latest Medicare Advantage insurer to push back on the lower quality scores the Centers for Medicare and Medicaid Services announced last week. UnitedHealthcare parent company UnitedHealth Group already sued the agency and Humana is appealing to CMS before taking other actions. (Berryman, 10/17)
Modern Healthcare:
Medicare Advantage Insurers Partner With Providers
Health systems are forging partnerships with certain Medicare Advantage plans, even as increasingly frequent battles over reimbursement rates and pay policies cause them to break ties with others. Disputes over pay rates, claim denial policies and care quality benchmarks have led some health systems to drop out of Medicare Advantage networks. However, health systems are willing to partner with certain Medicare Advantage plans that disclose reasonable claim denial and prior authorization processes, invest in MA-tailored joint ventures and renegotiate reimbursement rates, system executives said. (Kacik and Hudson, 10/17)
More health industry updates —
The Boston Globe:
Some Brigham And Women’s Hospital Nurses May Face Hefty Penalties For Noncompliant Health Insurance, Union Says
Brigham and Women’s Hospital nurses on Thursday urged the hospital to cover any potential tax penalties they incur after learning two of their health insurance plan options do not comply with state law, according to the nurses’ union. Noncompliance could result in hefty punitive costs for 2,000 nurses and their families, according to a news release by the Massachusetts Nurses Association. In a statement, the hospital said it is in the process of requesting waivers of the requirements. (Tannenbaum, 10/17)
Bloomberg:
PAI Partners Said To Raise Offer For Sanofi’s Consumer Unit
PAI Partners has submitted an improved offer for Sanofi’s consumer health business, according to people familiar with the matter, an unexpected twist in one of the biggest deals in Europe this year. The private equity firm has raised its bid by about €200 million ($217 million) for the Opella unit and pledged to keep the operation’s headquarters and other key sites in France, the people said. PAI Partners also said in the revised proposal that it will keep jobs through an investment of at least €60 million over five years, the people said. (Gopinath, Nair, Kirchfeld, and Barbaglia, 10/17)
Stat:
California Developers Target 340B Drug Discounts, AIDS Healthcare Foundation
Californians are about to vote on an aggressive policy proposals to reform a drug discount program that is a key source of revenue for hospitals and health clinics. The group behind it? Apartment builders. (Wilkerson, 10/18)
CBS News:
Sutter Health Plans To Build $67.8 Million Specialty Care Center On Elk Grove Campus
Sutter Health announced plans to construct a $67.8 million specialty care center at its Elk Grove location. The new specialty care center is projected to bring 44 more physicians to the Sutter Elk Grove Care Complex on Laguna Boulevard and expand its Sutter Urgent Care Center. (Downs, 10/17)
Modern Healthcare:
Lifespan Rebranded As Brown University Health
Lifespan, Rhode Island’s largest health system, officially rebranded as Brown University Health Thursday. The health system said in a news release the rebranding will help raise its national profile and solidify its position as a leading healthcare provider in the state. The system includes three teaching hospitals, three community hospitals, a psychiatric children’s hospital, a community-based behavioral health service and a physicians group. (Eastabrook, 10/17)
