UnitedHealth Group’s “unusual and unacceptable” first-quarter results have led the company’s top executives to change their tone regarding CMS’ Medicare Advantage V28 risk adjustment model. The V28 model is a phased-in change that began in 2024 and will continue through…
Author: Jakob Emerson
Elevance Health is reaffirming that shareholders’ adjusted net income guidance for full year 2025 will be $34.15 to $34.85 per diluted share. The company said in an April 17 regulatory filing that its first quarter results will reflect medical cost…
UnitedHealth Group is feeling “better than pretty good” about the potential for pharmaceutical tariffs and the resulting possible impact on its businesses. President Donald Trump has threatened tariffs on pharmaceutical imports, with U.S. Commerce Secretary Howard Lutnick saying April 13…
UnitedHealth Group posted nearly $6.3 billion in net income during the first quarter of 2025, but the company reduced its year-end earnings outlook amid rising use of physician and outpatient services among its Medicare Advantage membership and “unanticipated changes in…
Differential coding practices led to a significant increase in Medicare Advantage risk scores and an estimated $33 billion in additional payments to plans in 2021, according to a March study published in the Annals of Internal Medicine. The study analyzed…
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CMS’ payment increase of 5.03% in 2026 “will likely significantly support the recovery” of Medicare Advantage plans as they continue to face rising medical costs, according to Fitch Ratings. Increased government scrutiny, reduced base payments and rising utilization in the…
California faces the biggest potential coverage losses if federal Medicaid work requirements are enacted, according to an April 14 analysis from the Urban Institute. About five million adults nationwide could lose Medicaid coverage next year under a federal work requirement…
As consumers seek convenient ways to manage their health, digital health solutions – also known as health and wellness apps – have seen a significant surge. These tools, which offer a variety of services, including support for weight loss and…
California lawmakers are allocating an additional $2.8 billion to Medi-Cal following rising costs, the Sacramento Bee reported April 10. Gov. Gavin Newsom’s administration said that the unexpected costs within the Medi-Cal program are due to expensive drugs, leftover COVID-19 era…
CVS Health has named Benjamin Kornitzer, MD, as Aetna’s chief medical officer. Most recently, Dr. Kornitzer was chief medical officer at agilon health, a primary care physician services company primarily serving Medicare Advantage patients. He also previously served as CMO…