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But the business experience in the retail health clinic space has largely disappointed. Walmart and the problem of volume vs. priceIn 2019, Walmart announced a bold initiative to open 4,000 in-store health clinics by 2029. "Primary health care is a low margin business," said Arielle Trzcinski, a principal analyst covering health care at research firm. "Compared to what they see in traditional retail, health care is a fundamentally different business," Trzcinski said, citing the challenges of navigating insurance companies and administrative burdens that health care brings. In-store health clinics can be profitable and viable, and retailers are experimenting with piecemeal approaches tailored to the local market.
Persons: Bobbi Radford, Radford, haven't, CVS's MinuteClinic, Karla Lemon, CVS's, I've, That's, Timothy Hoff, Hoff, didn't, Colleen Sanders, Sanders, Arielle Trzcinski, Forrester, Trzcinski, America Sanders, Virgil Brantz, Brantz Organizations: CVS, Walmart, Walgreens, Northeastern University, Insurance, Washington , D.C, Aetna, Retailers, Washington, Hartford HealthCare, Health Clinic, Arizona State University, Little Clinics, Kroger Locations: Batavia , Ohio, VillageMD, Southern California, New England, Conway , South Carolina, Washington ,, MinuteClinic, USA, America, Connecticut, Hartford, Phoenix, Atlanta, Little
CVS Health on Wednesday reported first-quarter revenue and adjusted earnings that missed expectations and slashed its full-year profit outlook, citing higher medical costs that are dogging the U.S. insurance industry. The drugstore chain expects 2024 adjusted earnings of at least $7 per share, down from a previous guidance of at least $8.30 per share. The company said its new outlook assumes that higher medical costs in its insurance business during the first quarter will persist throughout the year. Medicare Advantage, a privately run health insurance plan contracted by Medicare, has long been a key source of growth and profits for the insurance industry. Excluding certain items, such as amortization of intangible assets and capital losses, adjusted earnings per share were $1.31 for the quarter.
Persons: LSEG, Karen Lynch, Caremark, Tyson Foods, CVS's Caremark, Cuban's Organizations: CVS Health, CVS, Aetna, UnitedHealth, Medicare, LSEG, Blue, Amazon Pharmacy, Oak Street Health Locations: California
Taking Account of Rising Health Care Costs
  + stars: | 2024-04-18 | by ( Josh Ocampo | ) www.nytimes.com   time to read: +1 min
Navigating the health care system in the United States can often feel like being lost in a maze. For that reason, Chris Hamby, an investigative reporter, has devoted much of his five-year career at The New York Times to guiding readers through such dizzying questions. His latest article, which was published online this month, explored the complex subject of insurance bills. Last year, Mr. Hamby began investigating MultiPlan, a data firm that works with several major health insurance companies, including UnitedHealthcare, Cigna and Aetna. After a patient sees an out-of-network medical provider, the insurer often uses MultiPlan to recommend how much to reimburse the provider.
Persons: Chris Hamby, Hamby, MultiPlan Organizations: The New York Times, Times Locations: United States, Cigna, Aetna
UnitedHealth Group struck a deal in March to buy the nine-state doctor group of the struggling hospital system Steward Health Care. AdvertisementDoctors are hot commoditiesIt's tough to lump the many buyers of medical practices together, as they're pursuing different strategies. Insurers like UnitedHealthcare and CVS' Aetna are required by federal law to spend most of the money they collect in premiums on medical care. Plus, running a modern medical practice is expensive, requiring investments in staffing, technology, and electronic health records. Advertisement"The corporate practice of medicine is the reason why healthcare costs are out of control," Li said.
Persons: , UnitedHealth's Optum, That's, UnitedHealth, there's, They're, Farzad Mostashari, UnitedHealth's chokehold, Chas Roades, Yashaswini Singh, Singh, Roades, Nick Jones, they're, Optum, Jones, Mitch Li, Li, Michelle Cooke, Cooke, she's, Ben Bowman, Bowman Organizations: Service, UnitedHealth, Health Care, CVS Health, Walgreens, Physicians, Research, US Justice Department, CVS, Aetna, Brown University, Harvard Medical School, Oregon Medical Group, JAMA, Amazon, The Washington Post, Federal Trade Commission, US Department of Justice, Department of Health, Human Services, Oregon State, Corvallis Clinic Locations: Oregon, New York, UnitedHealth, Optum, California, The, Atlanta
Medicare can start covering certain weight loss drugs for the first time — as long as they are approved for an added health benefit, the Centers for Medicare and Medicaid Services said Thursday. Medicare prescription drug plans administered by private insurers, known as Part D, currently cannot cover those drugs for weight loss alone. A provision of a 2003 law established that Medicare Part D plans can't cover drugs used for weight loss, but the program does cover obesity screening, behavioral counseling and bariatric surgery. A CMS spokesperson told CNBC last week that Medicaid programs would be required to cover Wegovy specifically for its new cardiovascular use. Around 1 in 5 state Medicaid programs currently cover GLP-1 drugs for weight loss.
Persons: Ozempic, Eli Lilly Organizations: Novo Nordisk, Medicare, Centers, Services, Drug, Food and Drug Administration, CVS, Aetna, International Foundation of Employee, CNBC, FDA Locations: London, Britain, U.S
The blockbuster drug — one of a handful of weight loss treatments to skyrocket in popularity over the last year — is now approved in the U.S. for heart health, too. The spokesperson added that state Medicaid programs would be required to cover Wegovy for its new cardiovascular use. But Gremminger said the standard of care for the long-term use of weight loss drugs is "in flux." State employees will no longer have insurance coverage for GLP-1s when used for weight loss at the beginning of next month. Both drugmakers have launched programs to help patients, with or without commercial insurance coverage, afford their weight loss treatments.
Persons: Klesty, John Crable, Wegovy, Jaime Almandoz, Joe Buglewicz, Shawn Gremminger, Hartley, Gremminger, Dale Folwell, We've, Folwell, Phelan M, Eli Lilly, Ceci Connolly, Julie Stich Organizations: Reuters, Novo Nordisk, CNBC, Medicare, Services, FDA, CVS, Aetna, International Foundation of Employee, Drug Administration, University of Texas Southwestern Medical Center, Washington Post, Getty, National Alliance of Healthcare, Taft, Nordisk, Nordisk's Ozempic, GOP, Carolina, Republican Governors Association, AP, Alliance of Community Health, U.S . Health, IFEBP, BMI Locations: U.S, Novo, Dallas, North Carolina, Orlando , Florida
She has amenities, like a 24-hour gym and an on-site community clinic, at arm’s reach. The complex seeks to be a model for communities nationwide by linking stable housing to better health. Aetna, a managed care organization that operates in the region, invested $26.7 million in the $80 million project, called H3C, whose “H” stands for health and the “3C” represents commerce, culture and community. Tenants and others in the community will have access to a medical clinic operated by DePaul Community Health Centers on the ground floor. Researchers at the Louisiana Public Health Institute will study patients’ health outcomes, and consultants at Health Management Associates will use the anonymized data to determine more effective ways that health systems can work with developers.
Persons: Ce’Yann Irving, I’m, , Irving Organizations: Catholic Charities, Community, Gulf Coast Housing Partnership, DePaul Community Health Centers, Louisiana Public Health Institute, Health Management Associates Locations: Central City, New Orleans, arm’s, Gulf, Coast
In the past several years, Amazon, CVS Health, and Walgreens each spent billions to own primary-care companies. CVS bought Oak Street Health. Here's how the bets that Amazon, CVS, and Walgreens made are playing out. CVS is building more Oak Street clinics despite lossesAn Oak Street Health location in Elgin, Illinois during its grand opening. CVS is hoping to help Oak Street clinics get profitable quicker by driving more patients their way.
Persons: Andy Jassy, Thos Robinson, It's, JP Morgan, Berkshire Hathaway, Business Insider's Eugene Kim, Kim, they've, it's, VillageMD hasn't, Jefferies, Brian Tanquilut, Tanquilut, Lydia Ramsey, Mike Pykosz, Pykosz, Aetna, Michael Cherny Organizations: CVS Health, Walgreens, Amazon, CVS, Oak Street Health, Business, Aetna, Medical, Washington Post, Summit Health, Oak, Health Locations: Oak, VillageMD, Haven, Florida, Elgin , Illinois
Just a few years ago, a crop of venture-backed health insurance startups embarked on planting a flag in the crowded but lucrative health plan business for seniors. Bright Health, which has exited the insurance business entirely as of this year, sold its Medicare Advantage plans in December. However, there are signs that the Medicare Advantage business isn’t as much of a goldmine as it used to be. It takes an enormous amount of capital to grow big in the insurance business, Fidel said. Its Medicare Advantage membership totals about 4 million.
Persons: haven’t, Stephens, underscoring, Oscar Health, Clover, Cowen, Gary Taylor, didn’t, Scott Fidel, it’s, they’ll, Fidel, UnitedHealthcare Organizations: Alignment Healthcare, Medicare, Business, Bright, Oscar, Services, Humana, CVS Health, Aetna, CVS Locations: California, New Jersey
CVS, which owns health insurer Aetna, on Wednesday slashed its full-year profit outlook, citing the potential for higher medical costs to bite into its profits. Last month, Humana said it saw an even bigger jump in medical costs in the fourth quarter. Higher medical costs may be a larger problem for Humana than they are for CVS and other insurers. They added that there is no other part of Humana's business that could meaningfully dampen the hit from higher medical costs on the insurance side. Another insurance giant that has been seeing higher medical costs, UnitedHealth Group, also has large health-care services and pharmacy operations that diversify its earnings streams.
Persons: Humana Organizations: CVS, Aetna, Medicare, Elevance, Humana, UBS, UnitedHealth
The Woonsocket, Rhode Island-based company also trimmed its full-year adjusted earnings forecast, citing the possibility of higher medical costs. For the three months ended Dec. 31, CVS Health earned $2.05 billion, or $1.58 per share. CVS Health officials said in November that investors should ground their expectations for 2024 adjusted earnings at the low end of a range of $8.50 to $8.70 per share. CVS Health now foresees 2024 adjusted earnings of at least $8.30 per share. Pharmacists and technicians — mostly for Walgreens and other big retailers like CVS Health — were involved.
Persons: That’s, Organizations: CVS, CVS Health, Zacks Investment Research, Revenue, CVS Health Corp, Company, Medicare, FactSet, Pharmacists, Walgreens, Rite Aid Locations: Woonsocket , Rhode Island
CVS Health on Wednesday reported fourth-quarter revenue and adjusted earnings that topped expectations, but the company cut its full-year profit outlook, citing higher medical costs that are dogging the broader insurance industry. The company lowered its 2024 adjusted earnings forecast to at least $8.30 per share, down from a previous guidance of at least $8.50 per share. Analysts surveyed by LSEG were expecting full-year adjusted earnings of $8.49 per share. CVS also cut its unadjusted earnings guidance to $7.06 per share, down from at least $7.26 per share. Excluding certain items, such as amortization of intangible assets and capital losses, adjusted earnings per share were $2.12 for the quarter.
Persons: LSEG Organizations: CVS Health, CVS, Aetna, LSEG, Oak Street Health
"I think you should still buy Baba in light of the fact the Chinese government is panicking about their stocks," Jim Cramer said, referencing recent stimulus efforts in the country . CVS Health : Despite lowering its 2024 adjusted earnings outlook due to higher medical costs, shares of CVS Health climbed more than 3% Wednesday. "Aetna is better than people think, and I think that [CEO] Karen Lynch is better than people think," Jim said. New York Community Bancorp : Moody's Investor Service downgraded the regional bank's credit rating to junk, roughly a week after NYCB reported a surprise fourth-quarter loss and cut its dividend payout. However, "you can't boost confidence once you cut your dividend," Jim said, adding that "you can't buy" shares of NYCB right now.
Persons: Jim Cramer, Aetna, Karen Lynch, Jim, NYCB, Morgan Stanley, Uber, Roblox Organizations: CVS, CVS Health, Aetna, York Community Bancorp, Moody's Investor Service, CNBC, Club, Technologies Locations: Wells Fargo
The New York insurance company has struggled to find its footing for years. At the top of the list is this little-known Trump-era policy, which offered employers a new way to give workers health benefits. Oscar has struggled with deep lossesBertolini is the former CEO of the insurance company Aetna. The company raised its health plans' prices and renegotiated contracts with healthcare providers and vendors — including its pharmacy-benefit manager — to lower expenses. In the future, Oscar plans to design specific health plans that cater to those types of customers.
Persons: , Joshua Kushner, Mario Schlosser, Oscar, it's, Mark Bertolini, It's, Bertolini, Trump, Ari Gottlieb, Elijah Nouvelage, haven't Organizations: Service, Business, New, Morgan Healthcare, Aetna, Reuters, HRAs Locations: New York, ICHRAs
Meanwhile, Jim Cramer's interview with an influential member of President Joe Biden's cabinet proved encouraging for Club holding Nvidia . It's been a two-session roller-coaster ride that illustrates the importance of staying disciplined and not chasing stocks while they're surging for non-fundamental reasons. Traders were trying to front-run the official announcement, pushing Linde stock up 4.53% Tuesday, to an all-time high of $426.72 per share. As a subscriber to the CNBC Investing Club with Jim Cramer, you will receive a trade alert before Jim makes a trade. Nvidia CEO Jen-Hsun Huang at the Consumer Elctronics Show (CES) in Las Vegas, USA, 04 January 2017.
Persons: Linde, Jim Cramer's, Joe Biden's, It's, Pfizer's, drugmaker Seagen, there's, Gina Raimondo, Jim, Biden, Raimondo, " Raimondo, Cigna, Humana's, , Humana, Aetna's, Jim Cramer, Jen, Hsun Huang, Huang, Andrej Sokolow Organizations: Club, Nvidia, LIN, Linde, Nasdaq, Traders, . Commerce, U.S, Bank of America, Wall Street Journal, Humana, CNBC, Consumer, Audi, Getty Locations: China, U.S, Wall, Las Vegas, USA
That's a major reason why we took a stake in the company in April 2022 and a key growth area for the health insurance industry overall. As a subscriber to the CNBC Investing Club with Jim Cramer, you will receive a trade alert before Jim makes a trade. Jim waits 45 minutes after sending a trade alert before buying or selling a stock in his charitable trust's portfolio. THE ABOVE INVESTING CLUB INFORMATION IS SUBJECT TO OUR TERMS AND CONDITIONS AND PRIVACY POLICY , TOGETHER WITH OUR DISCLAIMER . NO FIDUCIARY OBLIGATION OR DUTY EXISTS, OR IS CREATED, BY VIRTUE OF YOUR RECEIPT OF ANY INFORMATION PROVIDED IN CONNECTION WITH THE INVESTING CLUB.
Persons: Jim Cramer, Cigna, I've, Jim, It's, That's, Joe Biden, Biden, Lina Khan, Jim Cramer's, Ty Wright Organizations: Street, Humana, Express, Aetna, CVS Health, Cigna, Federal Trade Commission, Justice Department, FTC, CNBC, Bloomberg, Getty Locations: U.S, Louisville , Kentucky
The giant health insurers Cigna and Humana are reportedly considering a merger. While they offer different kinds of health insurance, the deal is likely to face antitrust scrutiny. Still, Cigna and Humana did toy with a deal way back in 2014 before they pursued deals with other partners. Later, to sidestep antitrust scrutiny, health insurers eyed mergers with other pieces of the healthcare system outside of insurance. Cigna and Humana would face a more skeptical Justice DepartmentAny deal between health insurers the size of Cigna and Humana would have to get past the Justice Department's antitrust enforcers.
Persons: Biden, , Justice that's, BofA, David Balto, Cigna, That's, Balto, Barak Richman, there's, Matthew Cantor, Constantine Cannon, divestitures aren't, Molina wouldn't, Cantor Organizations: Humana, Service, Reuters, Bloomberg, Street, Department, Justice, Cigna, UnitedHealth Group, Equity, Federal Trade Commission, Justice Department, Express, CVS Health, Aetna, Kindred, Biden Administration, FTC, Duke University Locations: Cigna, Aetna, Delaware
REUTERS/Andrew Kelly/File Photo Acquire Licensing RightsNov 29 (Reuters) - Cigna (CI.N) and Humana (HUM.N), two of the biggest U.S. health insurers, are in talks for what could be the largest merger announced in 2023, according to a source familiar with the matter. A Humana and Cigna combination would give the merged company the scale to rival UnitedHealth Group (UNH.N) and CVS Health (CVS.N). In July 2016, the Justice Department filed lawsuits against two health insurance mergers on the same day, saying they would lead to less competition and higher prices for Americans. Health insurers have been facing higher medical costs as people return for procedures they had put off during the pandemic. Humana in February said that it would sell its commercial business but keep its Medicare Advantage products.
Persons: Andrew Kelly, Cigna, Cigna's, Aetna, Bill Baer, Andre Barlow of Doyle, Barlow, Mazard, Bernstein, Lance Wilkes, Craig Garthwaite, Manas Mishra, Diane Bartz, Deena Beasley, Caroline Humer, Bill Berkrot Organizations: Humana Inc, REUTERS, Street Journal, UnitedHealth, CVS Health, Humana’s, Medicare, Affordable, Justice Department, Humana, U.S ., Reuters, Northwestern University, Thomson Locations: Queens , New York City, U.S, Cigna, Bengaluru, Washington, Los Angeles
Advanced Micro Devices — The chipmaker dipped more than 1% after issuing softer-than-expected revenue guidance for the fourth quarter. Match Group — The dating service platforms owner shed 8.3% on weaker-than-estimated revenue guidance for the fourth quarter. Wayfair — The online furniture retailer tumbled 12% after third quarter revenue missed analyst expectations. Yum reported $2.91 billion in revenue, while analysts had expected $3.06 billion in revenue, according to estimates from LSEG. Caesars Entertainment – The gaming stock rose 5% before the bell after topping Wall Street's third-quarter earnings expectations.
Persons: General Motors, Wayfair, Goldman Sachs, ZoomInfo, FactSet, Estee Lauder, , Kraft Heinz, Paycom, Fred Imbert, Alex Harring, Jesse Pound, Samantha Subin, Sarah Min Organizations: Street Journal, Ford, General, Barclays, CVS, Technologies, Humana, Kraft Heinz, FactSet, Yum China, , Caesars Entertainment, LSEG Locations: Aetna, China, LSEG
The way Dan Miller told it, his startup Spora Health was crushing it, providing high-quality care to "thousands" of people online. The startup had secured at least one big contract, with Apple, according to three former Spora employees and another source close to Spora. Four of them told Insider they either no longer worked with Spora or hadn't seen Spora patients in a year. Two doctors listed on Spora's website as "featured Spora providers" also told Insider that they no longer worked for the startup. Another former clinician said she only ever treated a handful of Spora patients.
Persons: Dan Miller, Miller, Spora, it's, UnitedHealthcare, Aetna didn't, paychecks, hadn't, he's, It's, , we've, " Miller, Shelby Livingston, Rob Price, Emmalyse Brownstein, Ryan Pickrell, Gloria Dawson, Stephanie Hallett, Alcynna Lloyd, Hayley Peterson Organizations: Company, TechCrunch, Spora, US Securities and Exchange Commission, Apple, Aetna, Stanford Graduate School of Business, Human Ventures, MaC Venture, SEC Locations: Spora, Level's, slivingston@insider.com
PremiumsFrederic Cirou | Photoalto | Getty ImagesThe premium is the sum you pay an insurer each month to participate in a health plan. It's perhaps the most transparent and easy-to-understand cost component of a health plan — the equivalent of a sticker price. The average co-insurance rate for consumers is 19% for primary care and 20% for specialty care, according to KFF data. For example, would you struggle to pay a $1,000 medical bill if you require health care? If so, a health plan with a larger monthly premium and a smaller deductible may be your best bet, Sun said.
Persons: Frederic Cirou, Karen Pollitz, Luis Alvarez, you've, KFF, Pollitz, McClanahan, there's, Winnie Sun, She's, Sun, Carolyn McClanahan Organizations: Sdi, Photoalto, Kaiser Family Foundation, CNBC, Digitalvision, Getty, Kaiser Family Foundation Health, Network Health, Sun Group Wealth Partners, CNBC's FA Locations: Aetna, Irvine , California, CNBC's
Ozempic Boom Is an Opportunity for Health Insurers
  + stars: | 2023-10-20 | by ( David Wainer | ) www.wsj.com   time to read: 1 min
WSJ’s Daniela Hernandez breaks down the science of how diabetes drugs work—and how they could change psychiatry. Photo illustration: Elizabeth SmelovYou would think a new class of high-price weight loss drugs taken by millions of Americans would be a problem for health insurers. But it is more complicated than that: Some insurance giants actually stand to profit from the Ozempic craze. The industry has been calling out the costs of GLP-1 drugs, which are used for both diabetes and obesity. But federally supported Medicare and Medicaid still don’t cover the drugs for obesity, and much of the commercial market is self-insured.
Persons: WSJ’s Daniela Hernandez, Elizabeth Smelov, Aetna
Why so many drug stores are closing
  + stars: | 2023-10-16 | by ( Nathaniel Meyersohn | ) edition.cnn.com   time to read: +3 min
Now, they are closing thousands of stores, leaving gaps in communities for medicines and essentials. It comes amid walkouts by Walgreens pharmacists and technicians around the country and at CVS stores in Kansas City over low pay and understaffed stores. Drug store strugglesRite Aid’s bankruptcy reflects long-term struggles in the retail pharmacy industry. Walgreens and other drug stores have closed thousands of stores in recent years. But this strategy requires fewer brick-and-mortar retail stores.
Persons: Angus Mordant, Justin Sullivan, drugstores, , David Silverman, ” Silverman, Drugstores Organizations: New, New York CNN, Rite Aid, Bloomberg, Getty Images Rite, Walgreens, CVS, Walmart, Fitch, Aetna, Pharmacy, McKinsey . Rite, American Medical Association Locations: New York, Kansas City, drugstores
Humana CEO Bruce Broussard will step down next year after more than a decade leading the health-insurance giant. Humana has tapped Jim Rechtin, head of Envision Healthcare, to be its next CEO. Weaving together insurance benefits with care delivery is meant to make healthcare easier for people to navigate and improve patients' health, Broussard said. One example is Humana's recent push into behavioral healthcare, Broussard said. That startup will eventually become part of Humana, Broussard said.
Persons: Bruce Broussard, Jim Rechtin, Broussard, , Rechtin, " Broussard, Rafael Henrique, Humana Organizations: Healthcare, Humana, Indiana's DePauw University, Harvard, Getty, Aetna, Oak Street Health, Iora, One, General Atlantic Locations: The Louisville , Kentucky, DaVita, Group's California, Kentucky, UnitedHealth
That Pfizer (PFE.N) shot and one developed by GSK (GSK.L) in May became the first two RSV vaccines to win U.S. approval, for use in people aged 60 and over to prevent severe illness. Still, infants and older adults have a higher risk of developing severe RSV. RSV leads to 58,000 to 80,000 hospitalizations among children under age 5, and 60,000 to 160,000 hospitalizations among adults age 65 and older each year, according to the CDC. Early data suggests that the RSV shots are protective for at least two years, but it is not yet clear how often older adults will need to be revaccinated. Can I get the RSV shot alongside my COVID and flu shots?
Persons: Pfizer's, Synagis, it's, Jeffrey Duchin, you've, Michael Erman, Bhanvi, Caroline Humer, Bill Berkrot Organizations: . Centers for Disease Control, Prevention, Pfizer, GSK, CDC, FDA, Sanofi, AstraZeneca, Infectious Diseases Society of America, CVS, Humana, Thomson Locations: U.S, Aetna, New York, Bengaluru Edtiting
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