In late April, the Social Security and Medicare Trustees released two reports on the financial state of their respective programs, and you’ve probably guessed, the outlook is grim. Without accounting for the adverse economic or health consequences of COVID-19, the organizations find Medicare Part A, which covers inpatient hospital care, skilled nursing facility, hospice, lab tests, surgery, and home health care, will face insolvency in six years. Considering COVID-19 is dealing heavy blows to healthcare services as a whole, it’s fair to say the pandemic is draining funds even faster.
However, there is temporary relief for the market. The CARES Act passed by Congress promised $100 billion for health care providers, including Medicare or Medicaid enrolled suppliers and providers and suspended Medicare “sequestration”—the current annual 2% reduction in Medicare payments—from May 1, 2020 to December 31, 2020. There is also a 20% increase in payments for patients hospitalized by COVID-19 and a significant expansion in the eligibility for accelerated and advance Medicare payments, particularly for those hospitals experiencing significant cash flow challenges.
Those changes might have helped push along a few Managed Care deals in May. One deal was announced by Newlight Partners LP, which purchased Chicago-based Zing Health Holdings, Inc., a physician-led Medicare Advantage HMO plan designed for Medicare-eligible beneficiaries. Its approach is based on a patient-oriented delivery system consisting of primary care providers, registered nurses, social workers, behavioral health specialists, and community-based health care workers across a growing network of providers. No exact terms of the deal were disclosed, but Newlight expects to invest up to $150 million into Zing Health.
Memorial Healthcare System, one of the largest public healthcare systems in the United States and the largest system in South Florida, announced the second deal. The health system acquired Broward Guardian, a Medicare accountable care organization (ACO) comprised of independent primary care physicians. Currently, there are 42 ACO participants and 795 ACO providers and suppliers with approximately 9,000 Medicare beneficiaries attributed to Broward Guardian ACO. Memorial will expand Broward Guardian’s network of primary care physicians across South Florida, helping the independent physicians coordinate care for Medicare patients.
The two May deals follow Molina Healthcare, Inc.‘s (NYSE: MOH) acquisition of the Magellan Complete Care (MCC) subsidiary from Magellan Health (NASDAQ: MGLN) for $850 million in late April. MCC manages full-service Medicaid and Medicare health plans including Magellan Complete Care in Arizona, Florida, and Virginia; Senior Whole Health in Massachusetts and New York; and TMG by Magellan in Wisconsin. The company reported $2.7 billion in revenue in 2019. With the addition of MCC’s approximately 155,000 members, Molina will serve more than 3.6 million members in government-sponsored healthcare programs in 18 states.
