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A Medicare program that kicked off April 1 promises healthcare upstarts more patients and revenue.
But little-known details about the program show that it won t be easy for companies to profit.
Experts say the companies will have to improve care and lower medical costs to succeed.
Clover Health, Iora Health, Oak Street Health, VillageMD, and a number of other hot healthcare upstarts are all participating in a brand-new federal program that promises them thousands of new patients and a big boost to their top lines.
Clover Health Expects Slower Medicare Member Growth And Lower Revenue Than Previously Projected
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When “SPAC King” Chamath Palihapitiya announced his special purpose acquisition company IPOC was merging with Medicare Advantage insurer Clover Health last October, he told investors the “business already has 200,000 lives under contract for 2021” through a new Medicare program known as direct contracting. It was part of his pitch for taking Clover public, calling the program “a very low cost acquisition channel” to scale the company “by an order of magnitude.”
Fast forward seven months later and now Clover executives said during the first quarter earnings call on Monday that the company expects to have just half that number or even less enrolled in direct contracting by the end of the year. Nashville, Tennessee-based Clover did report a company record for quarterly revenue, but the Medicare Advantage insurer faces other
By Peter Hancock & Capitol News Illinois
• 3 hours ago
Officials from multiple state agencies said Friday that they are cutting ties with a residential school that serves children in state care with mental and developmental disabilities after an independent review documented reports of mistreatment of youth at the facility.
Northern Illinois Academy, in Aurora, is an 87-bed private residential facility that serves children with co-occurring mental illnesses or autism, mood disorders and developmental delays. It is owned and operated by Sequel Youth and Family Services and receives funding from the Department of Children and Family Services, the Department of Healthcare and Family Services and the Department of Human Services.
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The Centers for Medicare and Medicaid Services (CMS) has confirmed that the agency began sending warning letters to hospitals it deems out of compliance with the Hospital Price Transparency Rule in April 2021. This represents the first enforcement action under the Rule since it went into effect on January 1, 2021.
In a December 2020 Medicare Learning Network update, CMS stated that it planned to audit a sample of hospitals for compliance with the Rule staring in January and that it would also investigate any complaints it received regarding hospitals not in full compliance with the Rule. CMS previously indicated that enforcement of the Rule would generally occur in the following order: 1) written warning; 2) corrective action plan; and 3) civil monetary penalty.
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The Illinois State Board of Education will sever its relationship with a therapeutic day school in Aurora after an investigation revealed understaffing and mistreatment of students with disabilities.
The state board of education announced in a press release on Friday that it will make school districts relocate students from Northern Illinois Academy, an 87-bed private youth residential program facility and therapeutic day school in Aurora, to another state-approved facility following a report by Equip for Equality, an advocacy organization for people with disabilities.
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This year, the state spent over $152 million on therapeutic day schools for students with disabilities who were transferred from a public school district due to the complexity of their needs or the inability of school districts to serve them. Next year, the state plans to spend nearly $174 million.