Dive Brief:
- Neighborhood Health Plan, the insurance affiliate of Partners HealthCare, is expected to see big financial operating losses in its upcoming quarterly report to be released Friday.
- The organization has seen operating losses for the last several quarters, most recently reporting an operating loss of $89 million in the quarter that ended June 30.
- Neighborhood Health CEO Deborah Enos, who is leaving the position in February and has already started work with Gov.-elect Charlie Baker's health care transition team, said the group has a plan to deal with the losses.
Dive Insight:
As the Boston Business Journal points out, every Managed Medicaid Organization—or groups that manage the health of Medicaid patients by putting a cap on the total spend—is expected to lose income in 2014. One possible reason is the fact that so many patients use Sovaldi, an expensive Hepatitis C drug. Others say that the state's reimbursement rates aren't high enough for how sick the patients have actually been.
Managing Medicaid patients is going to become even more challenging in the coming years. The Affordable Care Act's Medicaid expansion, for one, has opened the door for more beneficiaries to seek primary-care services. There's also a decline in the number of physicians who are accepting Medicaid patients.
Want to read more? You may enjoy this story on how 15 state Medicaid programs are reducing 'super utilizer' costs.
