Latest news with #MCOs
Business Upturn
6 days ago
- Business
- Business Upturn
IEX crashes 26% today: What is market coupling and why it's hitting Indian Energy Exchange so hard
By Aditya Bhagchandani Published on July 24, 2025, 12:19 IST Shares of Indian Energy Exchange Ltd. (IEX) plummeted 26% on July 24, hitting a low of ₹139.02, following the Central Electricity Regulatory Commission's (CERC) decision to implement market coupling norms for the Day Ahead Market (DAM). This sharp decline marks one of the worst single-day performances for the stock, with over 4.4 crore sell orders pending on the NSE at the lower circuit. As per the latest CERC announcement, market coupling in the DAM segment will be implemented by January 2026. Under this framework, all buy and sell orders from various power exchanges will be aggregated and matched by Market Coupling Operators (MCOs) to discover a uniform market clearing price, thereby eliminating the competitive edge of any single platform. IEX, which currently commands around 85% market share in the spot electricity market, stands to lose its pricing advantage due to this move. Analysts view this as a structural shift in the power trading ecosystem. Brokerage Bernstein maintained a 'market perform' rating but slashed its target price to ₹122, citing the regulatory overhang as a major concern. The stock opened 23% lower and remains in the F&O ban, restricting new derivative positions. IEX is also expected to announce its quarterly results later today, which will be closely watched for further direction. Ahmedabad Plane Crash Aditya Bhagchandani serves as the Senior Editor and Writer at Business Upturn, where he leads coverage across the Business, Finance, Corporate, and Stock Market segments. With a keen eye for detail and a commitment to journalistic integrity, he not only contributes insightful articles but also oversees editorial direction for the reporting team.
Business Wire
26-06-2025
- Business
- Business Wire
MSI Launches Cyber Insurance Program for Managed Care Organizations
TAMPA, Fla.--(BUSINESS WIRE)--MSI TM, one of the largest independent managing general agencies (MGAs) in the United States, announced today the launch of MSI Cyber for Managed Care Organizations, a cyber insurance program dedicated to managed care organizations (MCOs) of all sizes. Designed by MSI, this tailored solution offers dedicated capacity combined with coverage that specifically addresses the complex risks facing health insurers today. Due to the highly sensitive data that managed care organizations collect and manage, they remain an attractive target for cybercriminals. In addition, MCOs as a class have been generally underserved in the cyber market, especially on a primary basis, due to their perceived risk and overall complexity. 'Our new cyber program for managed care organizations reflects our ongoing mission to bring forward-thinking solutions to underserved sectors,' said Rajiv Matta, Chief Innovation Officer of MGA Programs at MSI. 'At MSI, innovation means building solutions that address real, unmet needs in the market. This cyber program is an example of our commitment to delivering much needed specialized solutions.' As a Lloyd's approved coverholder with delegated underwriting authority, MSI is offering a cyber solution that reflects the needs of health insurers, including: Limits up to $25 million for primary and excess placements for privacy and cyber liability with technology errors and omissions and miscellaneous professional liability Access to flexible risk management services and a market-leading breach response panel, including forensic analysts, privacy and defense counsel, and breach coaches Underwriting experts with highly specialized knowledge that is essential to understanding the risk profile of MCOs Tim LeMarbre, Senior Vice President, Cyber Product Leader at MSI, and Tammy Kocher, Vice President, Head of Cyber Underwriting at MSI, will lead and underwrite this new program, bringing a combined 40 years of underwriting experience. 'MSI Cyber for Managed Care Organizations was developed with a deep understanding of the evolving threats and challenges that managed care organizations face,' LeMarbre said. 'We are proud to unveil a dedicated, high-capacity solution with the flexibility to deploy our significant limits wherever it is needed in an insurance program.' This launch builds on MSI's goal of expanding its suite of more than 20 products and solutions across personal, commercial, and professional lines to address the evolving needs of its customers, agents, and brokers. MSI Cyber for Managed Care Organizations is the first of multiple cyber programs that the company plans to offer, leveraging the extensive underwriting experience of its cyber team. For more information about MSI Cyber for Managed Care Organizations, please visit our website. About MSI MSI, the brand name for Millennial Specialty Insurance, LLC, is one of the largest independent managing general agencies (MGAs) in the United States and an indirect subsidiary of The Baldwin Insurance Group, Inc. ('Baldwin') (NASDAQ: BWIN). Offering more than 20 insurance products and solutions across personal, commercial, and professional lines, MSI thrives on solving challenges, delivering responsive service, and providing an easy insurance experience to its distribution partners and more than 1.5 million customers. Combining deep underwriting expertise with (re)insurer risk capacity, MSI creates specialized insurance solutions that empower our distribution partners to meet customers' unique needs. MSI is committed to delivering exceptional service and rapid resolutions to customers throughout the policy lifecycle and to building insurance better. Founded in 2015, MSI joined The Baldwin Group in 2019. For more information, please visit About The Baldwin Group The Baldwin Group, the brand name for The Baldwin Insurance Group, Inc. (NASDAQ: BWIN) and its affiliates, is an independent insurance distribution firm providing indispensable expertise and insights that strive to give our clients the confidence to pursue their purpose, passion, and dreams. As a team of dedicated entrepreneurs and insurance professionals, we have come together to help protect the possible for our clients. We do this by delivering bespoke client solutions, services, and innovation through our comprehensive and tailored approach to risk management, insurance, and employee benefits. We support our clients, colleagues, insurance company partners, and communities through the deployment of vanguard resources and capital to drive our organic and inorganic growth. The Baldwin Group proudly represents more than three million clients across the United States and internationally. For more information, please visit This press release may contain various 'forward-looking statements' within the meaning of the Private Securities Litigation Reform Act of 1995, which represent Baldwin's expectations or beliefs concerning future events. Forward-looking statements are statements other than historical facts and may include statements that address Baldwin's future operating, financial or business performance or Baldwin's strategies or expectations. In some cases, you can identify these statements by forward-looking words such as 'may,' 'might,' 'will,' 'should,' 'expects,' 'plans,' 'anticipates,' 'believes,' 'estimates,' 'predicts,' 'projects,' 'potential,' 'outlook' or 'continue,' or the negative of these terms or other comparable terminology. Forward-looking statements are based on management's current expectations and beliefs and involve significant risks and uncertainties that could cause actual results, developments and business decisions to differ materially from those contemplated by these statements. Factors that could cause actual results or performance to differ from the expectations expressed or implied in such forward-looking statements include, but are not limited to, those described under the caption 'Risk Factors' in Baldwin's Annual Report on Form 10-K for the year ended December 31, 2024 and in Baldwin's other filings with the U.S. Securities and Exchange Commission (the 'SEC'), which are available free of charge on the SEC's website at: including those risks and other factors relevant to Baldwin's business, financial condition and results of operations. Should one or more of these risks or uncertainties materialize, or should underlying assumptions prove incorrect, actual results may vary materially from those indicated. All forward-looking statements and all subsequent written and oral forward-looking statements attributable to Baldwin or to persons acting on Baldwin's behalf are expressly qualified in their entirety by reference to these risks and uncertainties. You should not place undue reliance on forward-looking statements. Forward-looking statements speak only as of the date they are made, and Baldwin does not undertake any obligation to update them in light of new information, future developments or otherwise, except as may be required under applicable law.
Forbes
14-05-2025
- Business
- Forbes
Trouble At The Top: Epic Faces Mounting Antitrust Allegations Even As It Grows
Epic Systems is perhaps the most successful health technology company in the world. Its electronic health record (EHR) platform is now used by the majority of large health systems in the U.S. Its customers are vocal in their support and are often passionate defenders of the platform's reliability, configurability, and comprehensiveness. And its commercial success continues: according to newly released KLAS Research data, Epic gained even more market share in 2024, widening the gap between itself and competitors. Epic won nearly 70% of hospital deals in 2024. But with that dominance has come increasing scrutiny. Not from regulators yet, but from the companies who say they are being locked out of the future of healthcare innovation. This week, CureIS Healthcare filed a sweeping lawsuit in federal court accusing Epic of unlawful efforts to block competition. CureIS alleges that Epic has systematically interfered with its business, pressured mutual customers to abandon its products, misappropriated trade secrets, and engaged in false advertising - all in an effort to expand Epic's control over adjacent healthcare IT markets. The complaint paints a picture of a company using its EHR and revenue cycle management hegemony as a springboard to colonize other sectors of the healthcare technology landscape. And CureIS isn't alone. Particle Health, a startup focused on health data interoperability, filed a separate antitrust lawsuit against Epic last year, similarly alleging that the Verona-based company is using its market power to restrict third-party access to health data and thwart efforts at interoperability that could benefit patients and the broader health system. Together, the lawsuits suggest that while Epic may be beloved by its customers, its tactics regarding smaller, adjacent vendors may be stirring deeper questions about fair competition and innovation. CureIS is not a household name, but for more than a decade it has provided software that help Medicaid and Medicare managed care organizations (MCOs) clean up and reconcile enrollment, claims, and billing data - an often messy corner of healthcare IT. These tools, such as EnrollmentCURE and RecoveryCURE, rely on data integrations with technology platforms like Epic's EHR and RCM systems to function effectively. According to CureIS's complaint, Epic has deliberately prevented those integrations, blocking CureIS from accessing the data its products require. The lawsuit alleges that Epic pressured mutual customers to terminate their contracts with CureIS, sometimes even after those customers had acknowledged that Epic's competing offerings were inferior or incomplete. Among other issues, the complaint claims that Epic used confidential information shared under non-disclosure agreements to develop its own versions of CureIS products. CureIS says Epic induced customers to share detailed architecture and implementation documents, only to later promise to replicate the functionality internally—often using that very documentation as a roadmap. More seriously, the lawsuit alleges that Epic imposed an 'Epic-First' policy, in which 'any entity utilizing Epic's EHR or RCM software must use Epic's versions of other products too, if it has a version of the product in question.' CureIS argues that this conduct not only harmed its own business but also left customers with worse tools and less flexibility, ultimately undermining efficiency and innovation in a sector that already struggles with outdated workflows and fragmented systems. CureIS's complaint echoes themes raised earlier this year by Particle Health, which similarly claims that Epic's business practices are impeding fair access to patient data and suppressing interoperability. Particle's focus is on the 'last mile' of health data—getting information from disparate systems to where it's needed most. The company argues that Epic's control over the nation's health records gives it undue influence over what data is shared, how it's shared, and who can participate in that exchange. The core concern in both suits is not just Epic's size, but how that size and market power is allegedly being used. In both cases, plaintiffs argue that Epic is no longer simply competing on the merits of its core products, but actively leveraging its power to prevent others from doing so. This dynamic would be easier to dismiss if Epic's platform weren't, by most accounts, genuinely effective. The company is trusted by its users in a way that few software platforms are. It routinely scores top marks for customer satisfaction. It delivers deeply integrated functionality. And for hospital IT departments besieged with too many vendors that don't deliver, Epic has become a true partner. That customer devotion has helped fuel a virtuous cycle. Epic is now expanding beyond EHR and RCM into a broad suite of tools that serve payers, pharmaceutical companies, laboratories and even consumers. By doing so, it is building out network effects that reinforce its central role in the healthcare ecosystem, connecting stakeholders who all increasingly rely on Epic's infrastructure to operate, communicate, and exchange data. From its Cosmos data platform, which aggregates clinical data for research, to its health plan integration features, Epic is creating a flywheel where each new product reinforces demand for others. But that same flywheel, in the eyes of its critics, can look like a walled garden—one where innovation flows only from the center, and others must knock (or sue) to get in. The lawsuit comes against a broader regulatory and legal backdrop that is increasingly skeptical of dominant tech platforms, and how they might be leveraging their power. CureIS explicitly cites Epic's alleged information blocking as a violation of the 21st Century Cures Act and the associated federal regulations implemented by the Office of the National Coordinator for Health IT. These rules prohibit "actors"—including health IT developers—from interfering with the access, exchange, or use of electronic health information. The complaint accuses Epic of exactly that: denying CureIS and mutual customers the data access necessary for CureIS's software to function, despite customer authorization, and without any valid exception under the rule. In a post-Cures Act environment, such conduct isn't just anticompetitive—it may be illegal under federal information blocking provisions. Outside of healthcare, courts are increasingly drawing hard lines around similar forms of platform dominance. In a major ruling last year, Judge Amit Mehta found that Google's $20 billion in annual payments to Apple to remain Safari's default search engine constituted illegal anticompetitive behavior. More recently, the U.S. Department of Justice signaled it is seeking structural remedies that could force a breakup between Google's Chrome browser and its search advertising business. Apple, too, has drawn judicial ire: despite a prior court order requiring it to loosen App Store restrictions that prevent developers from steering users to alternate payment options, a federal judge recently found that Apple continues to flout the order, delaying compliance in ways that sustain its control over app monetization. Together, these cases underscore a growing legal recognition that platform power, when abused to entrench incumbency and exclude competition, is not only harmful but actionable. "Epic believes in free and fair competition, and we also believe our customers are in the best position to choose the right solutions to meet their needs—whether with Epic or by adopting other products and services," an Epic spokesperson said in a request for comment. After two lawsuits alleging unlawful tactics that implicate antitrust concerns, however, the pattern is increasingly difficult to ignore. The company declined to answer specific questions about the case, including whether an 'Epic-First' policy exists. As Epic pushes further into adjacent markets including telehealth, CRM, prior authorization, and more, vendors and investors alike are watching closely. If the company is truly replicating third-party functionality and using integration as a chokepoint, or representing 'vaporware' as a reason to avoid competitors, it raises fundamental questions about the rules of the road in digital health. These questions are especially urgent in light of Epic's market trajectory. Epic continues to win the majority of hospital deals and gain even more ground, especially among large hospitals and health systems. With nearly universal adoption among top-tier academic centers and continued wins among regional health systems, Epic's position is not just dominant—it's bordering on infrastructural. That kind of power brings responsibility not just to customers, but to the broader healthcare innovation ecosystem. Epic's platform is central to how care is delivered, how value is measured, and how data flows. Whether it is also central to how innovation happens—or whether it is increasingly a bottleneck—is now a question for courts, policymakers, and the market to weigh. Epic's size and success could make it a gravitational center that lifts up the innovation ecosystem around it. But if its conduct instead undermines startups that offer real value - especially in underserved areas like Medicaid managed care - then lawsuits like CureIS's may be just the beginning. Healthcare needs platform players that enable innovation, not just defend territory. Epic may be at a crossroads: the company's core EHR product is the reason it continues to gain market share, yet its insistence on leveraging that EHR to advance its growth efforts may bring the type of scrutiny and lawsuits that threaten that success.
Forbes
22-04-2025
- Health
- Forbes
What Does Medicaid Have To Do With Older Adults Anyway?
We soon will learn what Congress and the Trump Administration have in store for Medicaid. But while the state/federal program has become a high-profile target, it is widely misunderstood. And so are the consequences of major Medicaid changes for older adults, people with disabilities, and their families. Yes, Medicaid provides medical insurance for low-income working age people and their children. But Medicaid spends more than half its budget on medical and long-term care for frail, low-income older adults and younger people with disabilities. And about one-quarter of all Medicaid benefits, more than $200 billion, goes to long-term care for about 9 million frail older adults and people with disabilities. While Medicaid is a public insurance program, 94 million recipients get their benefits from private managed care organizations, or MCOs. A few are run by non profits but the vast majority are owned by insurance companies. Those managed care companies often are responsible for both medical and long-term care for those known as dual eligibles, who qualify for both Medicaid and Medicare. About 60 percent of Medicaid LTSS beneficiaries received care through MCOs. While many think Medicaid long-term care is provided only in nursing homes, 85 percent of Medicaid LTSS recipients get their care at home. For most, Medicaid's limited assistance supplements care provided by family members. And there is more you may not know: While some believe Medicaid long-term care is plagued by wealthy enrollees who hide their assets to become eligible for public care, the vast majority of Medicaid LTSS recipients have been poor their entire lives. And those few who had assets when younger likely burned through their savings after long spells of costly medical and long-term care. Keep all this mind as you watch Congress battle over the fate of Medicaid cuts. House Republicans want to make $800 billion in program reductions over the next decade but Senate Republicans appear far less enthusiastic. President Trump's position remains unclear. Those cuts could come through three basic mechanisms, with lots of versions of each: annual caps on the federal contribution to Medicaid, reducing the federal share of Medicaid spending, or imposing work requirements on beneficiaries. The annual caps would be most draconian but appear least likely, given pushback from Republican governors. Under current law, the federal government pays its share of Medicaid costs no matter how much those costs grow. In other words, the feds pay an average of 70 percent of a state's Medicaid costs, no matter how high they are or how fast they rise. But GOP lawmakers want to limit that contribution though either block grants or per-capita caps. Either way, the federal government would pay only a fixed dollar amount of Medicaid costs, rather than a percentage of its expenses. Block grants could be adjusted each year by Congress, rather than rising automatically. The first Trump Administration proposed a per-enrollee cap, though it went nowhere. Another option would lower the federal contribution percentage. Currently, the feds pay a minimum of 50 percent of a state's Medicaid costs. Congress could reduce the federal share or, more likely, eliminate the minimum 50 percent federal match, which would save about $500 billion over 10 years. Thanks to a complex formula, several high-income (mostly Democratic) states fall below that 50 percent threshold. Any version of these changes would sharply reduce the amount the federal government pays for Medicaid, forcing states to either raise taxes to fund more themselves, cut benefits, or limit eligibility to save money. Shrinking federal funding could have important implications for Medicaid LTSS. For instance, states are mandated by law to pay for long-term care in nursing homes but not for home care benefits, which are an optional benefit. If Medicaid funding is cut, states still must provide nursing home care but could drop or reduce optional home care. A work requirement would focus on beneficiaries rather than on federal payments. The first Trump Administration made work requirements optional, but this time Congress could mandate such a requirement. The mandate would exempt older adults and people with disabilities, but what about their family caregivers? It matters because many family caregivers likely are on Medicaid. Nearly 40 percent of White and more than half of Black family caregivers report spending more than 40 hours a week aiding a frail relative. A 2021 survey by the Rosalynn Carter Institute found 40 percent of employed family caregivers had to reduce their hours to support a loved one and nearly one in five quit their jobs. And those most likely to do so are low-income workers who might get caught up in a Medicaid work requirement. Some versions of prior federal legislation would protect family caregivers, while others would not. And even with some protection, such a law would raise many difficult questions. Imagine two siblings caring for their mother. Which of them would be exempt from the Medicaid work requirement? While many of the Medicaid cuts on the table would not directly affect older adults, people with disabilities, and their families, they are likely to have powerful indirect impacts. Keep it in mind as you watch what Congress does to the program.
Los Angeles Times
02-04-2025
- Health
- Los Angeles Times
John Oliver sued by healthcare boss he rebuked on air over ‘bowel movement' comments
A former health insurance boss has taken legal action against 'Last Week Tonight' host John Oliver, filing a defamation lawsuit against the Emmy winner. Dr. Brian Morley, a hospital administrator and former medical director for AmeriHealth Caritas in Iowa, filed his lawsuit Friday in the U.S. District Court for the Southern District of New York. Morley's complaint stems from a Medicaid-themed episode of 'Last Week Tonight' that aired in April 2024. The lawsuit, reviewed by The Times, alleges Oliver and 'Last Week Tonight' producer Partially Important Productions linked Morley to a drastic decrease in Medicaid services and accused him of thinking 'it's ok if people have s— on them for days.' An attorney for Morley did not comment to The Times on Wednesday and a representative for Oliver did not immediately respond to a request for comment. The episode central to Morley's lawsuit aired April 14, 2024, and saw Oliver explore the state of Medicaid, examining healthcare companies' cost-cutting measures and their toll on patients across various states. During the segment, which aired on HBO and is available on YouTube, Oliver explained the role of managed care organizations (MCOs) in the healthcare system and shared a news outlet's video about dwindling patient care. The 2018 news snippet featured a cerebral palsy patient in Iowa named Louis whose care was negatively impacted by MCO involvement. Oliver followed that part of the segment with an audio snippet of Morley's comments about patient care from a 2017 administrative hearing. In the clip, Morley can be heard saying: 'People have bowel movements every day where they don't completely clean themselves and we don't fuss over [them] too much. People are allowed to be dirty. You know, I would allow him to be a little dirty for a couple of days.' The quote garnered a strong reaction from the 'Last Week Tonight' studio audience and led Oliver to say he thought Morley's comments were taken out of context. He explained that he first thought 'there is no way a doctor, a licensed physician, would testify in a hearing that he thinks it's OK if people have s— on them for days.' Oliver continued his segment stating his team obtained the full hearing and that Morley 'said it.' 'He meant it and it made me want to punch a hole in the wall,' Oliver said. The segment returned to the 2018 video of Louis and his mother, both responding negatively to Morley's comments. The 'Last Week Tonight' host had some choice words for Morley — which were cited in Friday's lawsuit. In his complaint, Morley says, 'Defendants' false accusations were designed to spark outrage, and they did. 'The false accusations Defendants made were so heinous that John Oliver felt justified in telling his millions of viewers: 'F— that doctor with a rusty canoe. I hope he gets tetanus of the balls,'' the complaint said. 'Oliver's feigned outrage at Dr. Morley was fabricated for ratings and profits at the expense of Dr. Morley's reputation and personal well-being.' Morley accused Oliver and 'Last Week Tonight' of making him the 'face' of the dramatic decrease in Medicaid care and increased cost-cutting. The lawsuit also raised concerns about how 'Last Week Tonight' allegedly misrepresented Morley's 2017 comments and 'knew and disregarded' various details of the hearing in the April episode. The lawsuit alleges that the 'Last Week Tonight' team 'conveyed the false and defamatory meanings' that Morley denied care to 'Louis and/or the alleged 'similar' individual subject' of his testimony and that he allegedly said it was acceptable for patients who wear diapers or who cannot bathe themselves to 'be left sitting in their own bowel movements for days.' The complaint says that the 'Last Week Tonight' team obtained and reviewed 'an unabridged audio recording' of the 2017 hearing and that one of the show's senior news producers allegedly confirmed to Morley that they had reviewed the hearing. According to the lawsuit, Morley made his 'bowel movement' comments in regard to a 'hypothetical average person, who is independently mobile and can toilet transfer' but who might not have been able to clean themselves entirely after a bowel movement. 'Last Week Tonight' allegedly did not disclose that detail, according to the lawsuit. He accused the show's producers of 'negligence, knowledge of falsity, and/or a reckless disregard for the truth.' Morely also alleges that a 'Last Week Tonight' news producer 'refused' to meet when he offered to explain his comments. The defendants also allegedly refused Morley's October 2024 request that they 'retract their false and defamatory statements.' Morley seeks an unspecified amount in damages including legal fees and additional relief. He also requests that judges order 'Last Week Tonight' to remove the 'false and defamatory statements from all platforms' and keep them from republishing. He is seeking a trial.
