Medicare & Medicaid
Winners will be those who get and act on clinical data before patients get sick - and that’s a huge IT lift, says Dr. Don Rucker, former ONC head and current chief strategy officer of 1upHealth.
Short-term disparity between rates and medical cost trend may have reached its widest point in Q3, CEO says.
The star rating drop will cause Centene to lose an estimated $73M in gross revenue, lawsuit says.
Respondents say they are strongly considering not stocking the drugs because of potential low reimbursements from PBMs.
UnitedHealth has also filed a lawsuit, and Elevance says it is considering its options.
CEO Gail Boudreaux says cut points are a large factor driving the decline of plans rated four stars or higher.
UnitedHealth and now Elevance cite the Medicaid timing mismatch as a headwind to earnings.
Coverage applies to specific facilities, including the Indian Health Service, the 17th largest healthcare system in the nation, director says.
Total direct federal costs of covering AOMs would increase from $1.6 billion in 2026 to $7.1 billion in 2034, CBO finds.
Changes in methodology in 2024 and 2025 added Tukey outlier deletion that is used to set cut points for CAHPS measures.