Healthcare Payers / Providers

This morning’s House Energy and Commerce Health Subcommittee hearing on “needed” pharmacy benefit manager (PBM) reforms attempted to reinvigorate the past bipartisan and bicameral consensus for legislative changes to rein in the PBMs, but until…

As the budget resolution process and subsequent reconciliation strategy unfolds, Medicaid reforms that have posed headline enrollment and payment risk to Medicaid insurers [CNC, MOH, ELV], dual eligible insurers [UNH, HUM, ELV, CVS],hospitals [ARDT, CYH,…

Today’s reaction to the WSJ report that UnitedHealth (UNH) is under civil investigation by the DOJ for Medicare False Claims Act violations strikes us as overwrought, with ultimate financial liabilities (still 1-2 years away) unlikely…

While hospices [CHE, ADUS, private Gentiva, Compassus] are receiving a reprieve for now from more intensive oversight and the threat of termination from Medicare after CMS announced it was going to sideline the statutorily mandated…

We expect Humana (HUM) to ultimately prevail in its lawsuit against HHS to secure higher 2025 Medicare Advantage (MA) star ratings, but it may take longer than we originally expected (as early as March-April). While…

As we await the House’s budget reconciliation strategy this week, the Senate FY25 budget resolution proposal released late Friday bolsters our expectations for Medicaid work requirements, which we see as one the most likely Medicaid-related…

With the briefing in a federal lawsuit having concluded and Congress on the hunt for legislative savings, the question is when, not if, CMS’s minimum nurse staffing rule is killed, eliminating the overhang and potential…

We lean against yesterday’s OMB directive for temporarily pausing federal funding for grants, loans and programs applying largely to Medicaid’s payments to the states for Medicaid insurers (CNC, MOH, ELV, UNH, CVS) or for reimbursements…

While investors in insurers and providers seem most concerned about the fate of the expiring enhanced ACA subsidies, which we still expect to be revised but ultimately extended later this year, other – albeit smaller…

We doubt Medicare Payment Advisory Commission’s (MedPAC) FY/CY26 Medicare payment recommendations for home health agencies, inpatient rehab facilities, skilled nursing facilities, hospices, dialysis centers, hospitals, and physician offices, which were voted on Thursday in nearly…