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Symbol ALHC
Name Alignment Healthcare, Inc.
Currency USD
Sector Health Care
IndustryGroup Health Care Equipment & Services
Industry Health Care Providers & Services
Market NASDAQ Global Select
Country United States
State CA
City Orange
Zipcode 92868
Website http://www.alignmenthealthcare.com
The potential for reform in Medicare Advantage (MA) is gaining bipartisan interest, with discussions around quality bonus payments, risk adjustment, and the Health Equity Index (HEI). While the Trump administration may favor MA expansion, concerns about health equity and budget cuts loom, creating uncertainty about future policies. The political landscape suggests a complex interplay between healthcare priorities and fiscal conservatism, leaving stakeholders wary of potential disruptions.
New York City has ended coverage for GLP-1 weight-loss drugs, citing an error in their inclusion, while continuing to cover them for diabetes. Meanwhile, Michigan has filed a lawsuit against PBMs Optum Rx and Express Scripts for alleged collusion with opioid manufacturers, seeking accountability for their role in the opioid crisis. Additionally, health plans are previewing their Medicare Advantage offerings for 2025, with various expansions and new benefits aimed at diverse populations.
Alignment Healthcare reported a net loss of $26 million despite a 57.7% year-over-year increase in Medicare Advantage membership, reaching 182,300 members. The company raised its full-year membership and revenue guidance, projecting 184,000 to 186,000 members, while aiming for adjusted EBITDA profitability by 2025. CEO John Kao expressed confidence in achieving a $40 million adjusted EBITDA in 2025, bolstered by a five-star rating from CMS for one of its Medicare Advantage plans.
Medicare Advantage plans received $7.5 billion in risk-adjusted payments, raising concerns over potential upcoding by major insurers like UnitedHealth Group and Humana. A federal report revealed that $4.2 billion stemmed from at-home visits, which accounted for only 13% of chart reviews in 2022, with many diagnoses lacking follow-up care. The report urged stricter oversight from CMS, highlighting that 75% of payments were linked to just 13 conditions, primarily identified through at-home assessments.
Cohere Health has appointed Robert (Bob) Shepardson as Chief Financial Officer to guide its financial strategy during a period of significant growth and market expansion. With over 35 years of experience in healthcare and technology, Shepardson aims to enhance Cohere's innovative solutions for health plan clients. Previously, he served as CFO of Amwell and has a strong background in leading high-growth companies through pivotal financial milestones.
Alignment HealthCare is expanding its Medicare Advantage services in Nevada through a partnership with Intermountain Health, effective January 1, 2025. This collaboration will provide Medicare members in Clark and Washoe counties access to over 65 clinic locations, including 35 senior primary care clinics, enhancing healthcare access for the region's growing senior population. Members enrolling during the annual period can access comprehensive care services, including primary, specialty, and urgent care, while benefiting from innovative plans tailored to various health needs.
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