ZorroCard Round Up (10/7/24)

Hey all,

We took Thursday off for Rosh Hashanah. Today we have two stories about how Medicare Advantage (MA) is an albatross around the neck of the government and insurers. Probably because the only way to make money consistently in MA is through slight of hand and other surreptitious means. While PBM reform is super important, I hope congress starts to focus more on reforming MA since it is a gift to many insurers, not the members or providers who care form them. Enjoy the round up and your week!

Jacob Brody (Co-Founder & CEO, ZorroCard)

The Frontier Psychiatrist and (Lenacapavir for HIV Prevention): My friend Dr. Owen Muir underscores that Lenacapavir offers near-total HIV prevention, but, of course, the one catch is the price tag. Despite its potential to prevent HIV, high costs and limited accessibility ensure that this lifesaving medication remains out of reach for those who need it most. In a world where we could virtually eliminate HIV, it seems 100% HIV prevention is possible but not profitable. Full Article.

Healthcare Uncovered (Medicare Advantage’s Wall Street Fallout): Medicare Advantage, once Wall Street’s golden child, is now being ditched by insurers like Humana, CVS, and Cigna, leaving millions of enrollees scrambling for new plans. Why? Investors realized that despite many insurers’ best efforts to deny care, seniors are using more healthcare than expected, cutting into profits. Humana’s stock is tanking, executives are panicking, and the company is shedding customers to win back investor love. It’s a tough time to be in the Medicare Advantage game. Full Article

KFF Health News and (Medicare Advantage Overcharges): The Medicare Advantage industry has mastered the art of lobbying and delay, ensuring that CMS doesn’t get around to collecting billions in overpayments. UnitedHealth and others, accused of inflating diagnoses to boost profits, claim innocence while funding PR campaigns to protect their cash flow. CMS, meanwhile, continues to waffle on recovering taxpayer dollars, raising the question: who’s really being protected here? Critics are unimpressed, calling for stricter oversight. Full Article