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Michigan Passes Law to Allow Blue Cross Blue Shield of Michigan to Operate as a Mutual Insurer

March 19, 2013 by Craig

Here is the story from the Detriot Free Press.  This change will give Blue Cross Blue Shield of Michigan more flexibility to acquire and expand it’s business, however, it will be required to pay more in state taxes to Michigan.

Posted in Michigan | Leave a Comment »

AHIP Launches Campaign to Slow Cuts to Medicare Advantage in 2014

March 7, 2013 by Craig

This story is reported by “The Hill”.  AHIP will be running TV spots in Washington DC and then will be expanding the campaign to other markets where Medicare advantage is strong.

Posted in CMS | Leave a Comment »

Medicare Advantage Cuts Will Impact Health Insurer’s Bottom Line

March 7, 2013 by Craig

Here is a story from CNBC quoting Matthew Borsch of Goldman Sachs on the impact on earnings of the planned 2014 cuts to insurer’s reimbursements for Medicare Advantage.

Posted in CMS | Leave a Comment »

Sequester’s Impact Medicare’s Primary Care Physicians

March 5, 2013 by Craig

Here is an article from Peter Lipson, a contributor to Forbes.  He is of the opinion that the sequester’s 2% cut to Medicare providers beginning in April will put more pressure on Doctors (especially primary care doctors) to leave the Medicare system.

I think it’s pretty certain that this will add more pressure on the primary care doctors, but I’m unsure if this will be the tipping point that causes a mass exodus of PCP’s. . .Thoughts?

Posted in CMS | 8 Comments »

Medicare Cuts to Take Effect on April 1st, 2013

March 4, 2013 by Craig

The 2% Medicare cuts which are a part of the Sequestration are scheduled to take effect on April 1st, 2013 in the absence of any legislative action taken by the Congress and President in the interim.  Here is a link to the story from the AMA.

Posted in CMS | Leave a Comment »

Highmark Closes on Jefferson Regional Medical Center

March 2, 2013 by Craig

Here is the story from the Pittsburgh Tribune-Review.  Highmark is the largest health insurer in Pennsylvania and an affiliate of the BlueCross and BlueShield Association.  The closing of the deal with Jefferson, valued at $350 million, gives Highmark an anchor hospital in the South Hills of Pittsburgh.  Highmark is also trying to finalize an approximately $1.1 billion acquisition of the West Penn Allegheny health system.  The West Penn deal is pending regulatory approval of the PA State DOI.

Posted in Highmark, Pennsylvania | Leave a Comment »

CMS Issues Proposed Rule on Minimum Medical Loss Ratio for Medicare Advantage

February 28, 2013 by Craig

The Affordable Care Act mandated that Medicare advantage plans maintain an 85% loss ratio for claims and “activities that promote member health”.  CMS issued proposed rules on implementing this ACA requirement.  Here is a link to the press release from CMS.  Here is a link to the proposed rule.

This rule would impact both Medicare advantage and Medicare Part D plans.  The proposed rule indicated that CMS would grade the 85% loss ratio requirement on a “contract” basis (this is the “H” number or “S” number assigned by CMS), as opposed to a county/state/regional basis which is what is being used for the commercial, small group and individual markets.

Of the 605 MA and PDP contracts (544 MA contracts and 61 PDP contracts), CMS is estimating that approximately 14% would be required to pay remittances based on proposed regulations.  They estimated that $717 million would be due from MA plans and $141 million would be due from PDP plans, based on historical data.

Posted in CMS, Health Care Reform, Uncategorized | 6 Comments »

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