Literature Review

The Medicare Gold Rush Is Slowing DownWall Street JournalDecember 6, 2023The popularity of private Medicare plans has been a huge driver of profits for insurance companies in recent years. There are signs the gold rush isn’t quite what it once was. ... The most immediate red flag came from the industry leader, UnitedHealth. During an investor day last week, it predicted its Medicare Advantage enrollment would grow by 450,000 to 550,000 seniors in 2024. That translates to around 5% growth next year, a significant slowdown from the 11% it grew so far this year, according to TD Cowen analyst Gary Taylor. As UnitedHealth executives were presenting in New York, The Wall Street Journal reported that the second-largest Medicare plan provider, Humana, was in merger talks with Cigna. While Cigna’s interest in Humana surely attests to insurers’ continued desire to expand into the Medicare market, some investors took it as a sign that Humana isn’t so sure about the strength of the business going forward. 

Government expects to recover more than $3B from healthcare fraud, misspent funds in fiscal year 2023Healthcare DiveDecember 4, 2023The HHS’ Office of the Inspector General is expected to recover more than $3.44 billion in fiscal year 2023 as a result of investigations into fraud and misspent funds in Medicare, Medicaid and other government health programs, according to the agency’s latest report.

Hospices Seek Special Focus CONs to Reach Underserved PopulationsHospice NewsDecember 1, 2023Some states with certificate of need regulations have special focus policies that allow hospice providers to expand services among underserved communities. But navigating these CON processes can be a challenge. ... A difficulty in seeking these types of special focus CONs is proving an unmet need among specific populations, according to André Lee, co-founder and administrator of Nashville-based Heart’n Soul Hospice.

Why Are Nonprofit Hospitals Focused More on Dollars Than Patients?