Healthcare Payers / Providers

KEY TAKEAWAYS: We expect the proposed YoY change in the CY26 benchmarks for Medicare Advantage (MA) plans is likely to be relatively flat, with a range between -1% and +1% that excludes coding trend, but…

We could see some short-term positive news for retail, mail-order and specialty pharmacies (WBA, CVS, WMT, UNH, CI) if the Supreme Court decides not to hear the appeal of PhRMA v. McClain, a development that…

Key Takeaways: The risk overhang from potential Medicaid reforms to managed care organizations, hospitals, behavioral facilities, and other providers focused on these low-income enrollees will likely grow as the Trump administration staffs up and Congress…

President Trump’s surprise and unorthodox nomination of Dr. Mehmet Oz to be CMS administrator, whom we presume will likely be confirmed, affords somewhat of a blank slate for others in the administration to fill in…

With likelihood growing that Congress focuses on emergency spending and a short-term continuing resolution funding the government into Q1 next year during this lame duck period, we expect that translates to Congress punting on nearly-annual,…

Key Takeaways:  We still expect nursing homes and their post-acute care REIT landlords to secure a reprieve from the Biden CMS rule imposing minimum nurse staffing requirements on these long-term facilities. However, we see that…

Key Takeaways: We continue to expect that UNH’s acquisition AMED will be completed, despite reports that the DOJ is preparing to sue to block the $3.3B deal on antitrust concerns. While clearly a setback, this…

Key Takeaways: We think investors exposed to insurers in the ACA exchange markets (OSCR, CNC, MOH, ELV) are underestimating the odds that the next Congress temporarily extends some of the enhanced Obamacare subsidies to focus…

Key Takeaways: CMS largely met reimbursement and policy expectations with its CY25 final Medicare payment rules for hospital outpatient departments (HOPDs), ambulatory surgery centers (ASCs) and physician firms. This is despite the improvement, relative to…

Key Takeaways:  CMS offered slight improvements in dialysis center payments, relative to this summer’s proposal, in its CY25 final rule released Friday, but we do not view this as material for providers or addressing other…