Better Health Group’s Post

In the latest episode of "You Can't Make This SH#T Up": “By selling to Health Care Service Corp., it could actually be viewed as a pro-competitive transaction by regulators in terms of making the largest nonprofit Blue more competitive in the Medicare Advantage market.” - Scott Fidel, a managing director at the investment bank Stephens. Wait what?!? Did he say this would be "pro-competitive"? And the reasoning....? “The nonprofit Blues have tended to be generally less competitive in Medicare Advantage compared to their competitiveness in the commercial market.” So because the Blues have been less competitive in MA compared to their commercial business, regulators should scrutinize merger less?

When a consumer can clearly see their options & their costs, they have the opportunity to make informed & fiscally savvy choices. It’s then that everybody wins. #surest #innovation

📰 My latest Substack article, diving into Centene's impressive Q2 2024 earnings report. 📈 Despite challenging headwinds, Centene Corporation, under the leadership of Sarah London, has delivered one of its best quarters yet. Here are some key highlights: 💎 Revenue Growth: 5.2% increase through the first half of 2024 to over 80 billion. 💎 EPS Growth: 15% rise compared to Q2 2023, with EPS at $2.42, up from $2.10. 💎 Stock Performance: Almost 9% rally on Friday driven by strong EPS growth and a 34% surge in the ACA/Marketplace membership.. Sarah London's strategic shift away from vertical integration is proving to be a winning move, focusing on core strengths while divesting non-core assets. Here are some major takeaways from the earnings call: 🏥 Medicaid - Addressed acuity misalignment, Centene sees a brighter second half of 2024 as their PMPM rates will move upward. - Significant wins in Florida, Kansas, and Michigan. - Exciting LTSS launch in Arizona, with Oklahoma, Delaware, and North Carolina in launch mode. 👨⚕️ ACA/Marketplace - The Ambetter brand is shining as Centene is the largest domestic ACA/Markeplace provider with membership growth of 34%. - Premium subsidies are driving this explosive growth, with total enrollment now at 4.4 million beneficiaries - Premiums revenue hit $8.5 billion in Q2, a 49% increase quarter-over-quarter. 👵 Medicare (Wellcare) - Rebuilding the brand with an eye on growth in 2025/2026. - Focus on the dual-eligible market as a potential growth area. - STAR ratings improvements with the CMS adjustment but must feel good about their meta data for CAHPS/HEDIS -Strong PDP business positioning post-IRA as they feel good about their 2025 bids 💰 Investments/Divestments - Continued share repurchases with $851 million in Q2. - Divesting in non-core businesses like Magellan Rx, PantherRx , Apixio, etc. are now paying off for the company This quarter truly showcased Centene's execution on their longer term strategy. Impressive cause when everyone zigged....They zagged. Full article below: #Healthcare #Medicaid #ACA #Marketplace #Medicare #Centene #Earnings

💼💰 HCSC, an independent licensee of the Blue Cross Blue Shield Association, intends to seal the acquisition of Cigna’s Medicare businesses for $3.3 billion, the payer announced. The purchase includes the major payer’s Medicare Advantage plans, Medicare Supplemental Benefits plans, Medicare Part D plans, and CareAllies—which is a combination of Cigna assets that supports providers in value-based contracts. HCSC leadership saw this acquisition as an opportunity to enlarge its Medicare footprint. #HCSC #Cigna #Medicare #Acquisition #Healthcare #Business #News #HealthInsurance #Industry #HealthcareAcquisition #BusinessGrowth #Milestone #ExcitingNews #FinancialNews #HealthcareBusiness #HealthcareNews #BreakingNews #HealthcareFinance

Super interesting deal here for both Health Care Service Corporation and Cigna Healthcare. HCSC is still struggling to determine its growth path and Cigna can’t gain traction in any market besides the large, commercial self-funded group business. Unsure if this significantly helps either… #healthcare #healthinsurance #mergersandacquisitions

🚀 Excited to share my latest Substack article on Centene's impressive performance in 2023! Despite facing significant headwinds like Medicaid redeterminations, challenging STAR ratings, and overall Medicare space turbulence, Centene showcased remarkable resilience and growth. 📈 ⚡ Highlights: ➡ Top Line Growth: Achieved a 6.25% increase, reaching over $153 billion. ➡ EPS Growth: Posted a 15% growth in earnings per share. ➡ Strategic Capital Allocation: Prioritized reinvestment in their business, repurchasing 22.9 million shares for $1.58 billion, steering clear of M&A for focused growth. 🔑 Key Takeaways: ➡ Divestiture Strategy: Centene's continued the strategic shift to sell non-core assets, like Circle Health, underscores their commitment to strengthening their core Medicaid, ACA, and Medicare Advantage businesses. ➡ Medicaid Leadership: As the largest Medicaid provider, Centene is navigating redetermination challenges effectively, with proactive state-level engagements to address risk pool changes. ➡ ACA Market Dominance: Centene continues to lead the ACA market, with membership and market share growth reflecting a strong position and an expected $2.5 billion tailwind from ACA enrollments. ➡ Medicare Advantage (Wellcare): Continue to focused on rebuilding efforts and improving STAR ratings, with a strategic shift towards D-SNP to better serve dual-eligible members. 🔍 2023 was a testament to Centene's execution, ending the year with a stronger cash position and reduced debt. As we look into 2024, the focus will be on enhancing STAR ratings and further solidifying their presence in the Medicare Advantage space. 📜 Join my substack for regular updates on healthcare below! #marketaccess #healthcare #digitalhealth https://lnkd.in/g-dJRJqW

Maximizing revenue for state early intervention (Part C) programs is a critical task amidst workforce challenges! State early intervention (Part C) programs face the complex task of developing robust funding systems that include Medicaid, private insurance, state, and IDEA grant funds. Implementing effective and efficient payment systems is crucial, especially as states navigate the challenges of recruiting and retaining early intervention professionals. Hutton Health Consulting was in Delaware this week, wrapping up our comprehensive 360 review of their early intervention funding system. Brad Hutton and I had the privilege of presenting and discussing our recommendations for revenue enhancement and funding efficiencies with the dedicated state team. #Earlyintervention

Humana announced it will be exiting 13 #Medicare Advantage markets by 2025, affecting around 560,000 beneficiaries (~10% of Humana's MA membership). This follows the recent news of Centene Corporation announcing their exit of 6 states through its Wellcare Medicare MA subsidiary next year. As the Medicare Advantage landscape continues to face rising costs and regulatory pressures, it's likely we haven't seen the last of market exits. It will be interesting to see how other carriers adapt and strategize heading into next year, and which can gain market share in the affected areas. https://lnkd.in/gssVeeHF

📣 I have spent some time digesting the earnings for the "Big Six Payors" over the past couple weeks and have ranked my favorite earnings while also giving a glimpse of what I will be watching for 2024! ➡ Elevance- emerged as a diversified powerhouse, overcoming challenges like the BCBS of Louisiana deal loss with robust earnings across varied business lines. Their strategic acquisitions and minimal exposure to Medicare Advantage headwinds positioned them as a frontrunner for 2024 and beyond. ➡ UnitedHealth Group (UNH)- while enduring Medicare Advantage headwinds and OptumHealth's economic pressures, still boasts significant growth. The focus for UNH is on stabilizing its Medicare Advantage sector and leveraging the OptumHealth franchise to find strong unit economics in their value based care model. ➡ CVS Health- stands out for its strategic diversification and significant Medicare Advantage enrollment growth, making it a model of vertical integration success if it can execute in 2024. Michael Burry (investor from The Big Short) is bullish on CVS, but can they onboard their 800,000 new MA members and use their assets to deliver quality care? ➡ Cigna- shines in earnings yet faces challenges in diversification and strategic expansion. With ambitious revenue growth targets and plans to sell its Medicare Advantage business, Cigna is at a pivotal point to redefine its strategy for sustained growth beyond the commercial/employer insurance market and PBM space. ➡ Centene- demonstrated resilience amidst Medicaid redeterminations and Medicare Advantage STAR rating headwinds. Their strategic position in government-focused health plans sets the stage for a promising 2024, despite the challenges faced in 2023. ➡Humana- Unexpected year signals a crucial period of reevaluation and strategic integration. With a focus on improving communication and leveraging its integrated assets, Humana is on a path to recovery and growth. ⭐ Oscar Health- although not a "Big Six Payor", deserves a special mention for its remarkable turnaround and financial performance, setting a precedent for startup growth in the healthcare sector. Subscribe to my substack for regular updates on the healthcare industry. Below if the full year earnings debrief along with some general thoughts on 2024. #marketaccess #healthcare #digitalhealth