Latest news with #UnitedHealthcare
Yahoo
a day ago
- Business
- Yahoo
5 Revealing Analyst Questions From Myriad Genetics's Q1 Earnings Call
Myriad Genetics' first quarter results were met with a significant negative market reaction, reflecting investor concerns over a combination of volume softness in key product lines and a reset in full-year expectations. Management attributed the revenue decline primarily to underperformance in its GeneSight pharmacogenomic test, which was affected by UnitedHealthcare's policy change, as well as slower-than-anticipated growth in hereditary cancer screening among unaffected individuals. CEO Sam Raha described the quarter as 'challenging,' highlighting both external payer headwinds and internal operational hurdles, such as workflow disruptions related to electronic medical record (EMR) integrations. The company's leadership openly acknowledged the complexity and execution challenges facing the business. Is now the time to buy MYGN? Find out in our full research report (it's free). Revenue: $195.9 million vs analyst estimates of $200.4 million (3.1% year-on-year decline, 2.3% miss) Adjusted EPS: -$0.03 vs analyst estimates of -$0.05 ($0.02 beat) Adjusted EBITDA: -$100,000 vs analyst estimates of -$1.92 million (-0.1% margin, 94.8% beat) The company dropped its revenue guidance for the full year to $815 million at the midpoint from $850 million, a 4.1% decrease Adjusted EPS guidance for Q2 CY2025 is $0 at the midpoint, below analyst estimates of $0.02 EBITDA guidance for the full year is $23 million at the midpoint, below analyst estimates of $29.85 million Operating Margin: -14.8%, down from -13.8% in the same quarter last year Market Capitalization: $491.3 million While we enjoy listening to the management's commentary, our favorite part of earnings calls are the analyst questions. Those are unscripted and can often highlight topics that management teams would rather avoid or topics where the answer is complicated. Here is what has caught our attention. Doug Schenkel (Wolfe Research) pressed CEO Sam Raha on how long it would take to simplify Myriad's business and clarify key performance metrics. Raha estimated several months for a thorough strategic review and emphasized oncology as the cornerstone of future growth. Puneet Souda (Leerink Partners) questioned whether other payers might follow UnitedHealthcare in dropping coverage for GeneSight. CFO Scott Leffler responded that no similar moves have occurred among other payers and that some incremental coverage wins were achieved. David Westenberg (Piper Sandler) asked for more detail on why EMR integration issues are taking multiple quarters to resolve in hereditary cancer screening. COO Mark Verratti explained that workflow disruptions, account-by-account customization, and patient education requirements are slowing adoption, but efforts are underway to resolve these bottlenecks. Tejas Sawant (Morgan Stanley) sought clarity on the sensitivity requirements for the MRD (minimal residual disease) assay and the broader impact of new oncology product launches. CEO Raha described ongoing clinical studies targeting low-shedding cancers and reaffirmed timelines for product rollouts and evidence generation. Tycho Peterson (Jefferies) inquired about Myriad's liquidity position and the underlying assumptions in the updated guidance. Leffler confirmed that available cash and credit lines are sufficient for 2025, with no material deterioration in reimbursement rates expected. In upcoming quarters, the StockStory team will be watching (1) the pace at which EMR workflow solutions drive volume recovery in hereditary cancer testing, (2) the commercial rollout and adoption of new pipeline products, such as the combined carrier screening and AI-enabled oncology assays, and (3) the effectiveness of cost-control initiatives in supporting margin improvement and liquidity. Progress on payer coverage and revenue cycle management will also be important for tracking Myriad's return to sustainable growth. Myriad Genetics currently trades at $5.09, down from $7.25 just before the earnings. At this price, is it a buy or sell? The answer lies in our full research report (it's free). Market indices reached historic highs following Donald Trump's presidential victory in November 2024, but the outlook for 2025 is clouded by new trade policies that could impact business confidence and growth. While this has caused many investors to adopt a "fearful" wait-and-see approach, we're leaning into our best ideas that can grow regardless of the political or macroeconomic climate. Take advantage of Mr. Market by checking out our Top 6 Stocks for this week. This is a curated list of our High Quality stocks that have generated a market-beating return of 183% over the last five years (as of March 31st 2025). Stocks that made our list in 2020 include now familiar names such as Nvidia (+1,545% between March 2020 and March 2025) as well as under-the-radar businesses like the once-micro-cap company Tecnoglass (+1,754% five-year return). Find your next big winner with StockStory today. Error in retrieving data Sign in to access your portfolio Error in retrieving data Error in retrieving data Error in retrieving data Error in retrieving data
Yahoo
2 days ago
- Business
- Yahoo
Multi-millionaire Trump official Dr. Oz appears not to know how credit cards work
Centers for Medicare and Medicaid Administrator Dr. Mehmet Oz appeared to let slip that he doesn't quite grasp how credit cards work. The former revered heart surgeon-turned-television host appeared on Fox News' Ingraham Angle to discuss America's largest health insurance companies pledging to streamline prior authorization. After giving a confusing analogy that compared approving procedures to credit card transactions, Oz made an unintentional admission: he doesn't know how one works. 'We've insisted on a dashboard. They have to be public about what they're doing,' he told Laura Ingraham on Wednesday. 'We want to know, for example, by the end of this year, can you do these examinations instantaneously?' 'Like a credit card,' Oz, who boasts an estimated $200 million net worth, continued. 'When you put it into the machine to buy something, they don't prior authorize you. You either have money in the bank or you don't.' Credit card companies do prior authorization on every transaction to determine whether money can be spent, which includes checking if the card is valid, that there's enough credit available, and if there are any signs of fraud. Individuals also borrow and spend money on their payment cards that they do not physically have in the bank. Oz was seemingly trying to illustrate that medical approvals should be quick and automated, like credit card checks. UnitedHealthcare, Aetna, Cigna, and Humana were among dozens of medical insurance companies that agreed to several measures on Monday, including making fewer medical procedures subject to prior authorization. If the companies follow through, patients would have to jump through fewer bureaucratic hoops, receive faster treatment approvals, and have enhanced continuity of care. Speaking to reporters Monday, Oz said that the pledge is 'not a mandate,' adding: 'This is an opportunity for the industry to show itself.' The CMS head also said he wants insurers to eliminate preapprovals for knee arthroscopy, a common, uncomplicated procedure to diagnose and treat knee issues. On Wednesday, Oz explained that he and Health and Human Services Secretary Robert F. Kennedy Jr. went to the insurance industry directly to tell them their old model was 'inefficient.' ''Secretary Kennedy feels this is wrong, the president feels this is wrong, we have to make a deal,'' he told Ingraham of his apparent dressing down of executives. ''So either you do it or we're gonna do it for you, and it's a lot less painful if you guys get together and figure this out and actually make a pledge.''
The Independent
2 days ago
- Business
- The Independent
Multi-millionaire Trump official Dr. Oz appears not to know how credit cards work
Centers for Medicare and Medicaid Administrator Dr. Mehmet Oz appeared to let slip that he doesn't quite grasp how credit cards work. The former revered heart surgeon-turned-television host appeared on Fox News' Ingraham Angle to discuss America's largest health insurance companies pledging to streamline prior authorization. After giving a confusing analogy that compared approving procedures to credit card transactions, Oz made an unintentional admission: he doesn't know how one works. 'We've insisted on a dashboard. They have to be public about what they're doing,' he told Laura Ingraham on Wednesday. 'We want to know, for example, by the end of this year, can you do these examinations instantaneously?' 'Like a credit card,' Oz, who boasts an estimated $200 million net worth, continued. 'When you put it into the machine to buy something, they don't prior authorize you. You either have money in the bank or you don't.' Credit card companies do prior authorization on every transaction to determine whether money can be spent, which includes checking if the card is valid, that there's enough credit available, and if there are any signs of fraud. Individuals also borrow and spend money on their payment cards that they do not physically have in the bank. Oz was seemingly trying to illustrate that medical approvals should be quick and automated, like credit card checks. UnitedHealthcare, Aetna, Cigna, and Humana were among dozens of medical insurance companies that agreed to several measures on Monday, including making fewer medical procedures subject to prior authorization. If the companies follow through, patients would have to jump through fewer bureaucratic hoops, receive faster treatment approvals, and have enhanced continuity of care. Speaking to reporters Monday, Oz said that the pledge is 'not a mandate,' adding: 'This is an opportunity for the industry to show itself.' The CMS head also said he wants insurers to eliminate preapprovals for knee arthroscopy, a common, uncomplicated procedure to diagnose and treat knee issues. On Wednesday, Oz explained that he and Health and Human Services Secretary Robert F. Kennedy Jr. went to the insurance industry directly to tell them their old model was 'inefficient.' ''Secretary Kennedy feels this is wrong, the president feels this is wrong, we have to make a deal,'' he told Ingraham of his apparent dressing down of executives. ''So either you do it or we're gonna do it for you, and it's a lot less painful if you guys get together and figure this out and actually make a pledge.''
CBS News
2 days ago
- Business
- CBS News
Northwestern University performing cost-cutting measures taking effect next year
Northwestern University is changing its tuition benefits program and health insurance for its staff and faculty beginning next year. According to the university, the changes are due to rising costs and other factors straining the school's finances. In an email earlier this month, the university informed staff and faculty that on Jan. 1, 2026, it will change from Blue Cross Blue Shield to UnitedHealthcare and new dental and prescription insurance providers. The move is forcing staff to petition the board of trustees to allow them to keep the Blue Cross. The university said that without the changes, employees would pay more, and the school would be forced to make additional cuts in other areas beyond what they've already announced. Changes to the tuition benefits program, which allows staff to take courses at a discount, will also be made for new and returning hires. Current faculty and staff will not be affected by the changes. Now, the school will cap the program at $12,000 per year.
San Francisco Chronicle
3 days ago
- Health
- San Francisco Chronicle
5 takeaways from health insurers' new pledge to improve prior authorization
Nearly seven months after the fatal shooting of an insurance CEO in New York drew widespread attention to health insurers' practice of denying or delaying doctor-ordered care, the largest U.S. insurers agreed this week to streamline their often cumbersome preapproval system. Dozens of insurance companies, including Cigna, Aetna, Humana, and UnitedHealthcare, agreed Monday to several measures, which include making fewer medical procedures subject to prior authorization and speeding up the review process. Insurers also pledged to use clear language when communicating with patients and promised that medical professionals would review coverage denials. While Trump administration officials applauded the insurance industry for its willingness to change, they acknowledged limitations of the agreement. 'The pledge is not a mandate,' Mehmet Oz, administrator of the Centers for Medicare & Medicaid Services, said during a news conference. 'This is an opportunity for the industry to show itself.' Oz said he wants insurers to eliminate preapprovals for knee arthroscopy, a common, minimally invasive procedure to diagnose and treat knee problems. Chris Klomp, director of the Center for Medicare at CMS, recommended prior authorization be eliminated for vaginal deliveries, colonoscopies and cataract surgeries, among other procedures. Health insurers said the changes would benefit most Americans, including those with commercial or private coverage, Medicare Advantage and Medicaid managed care. The insurers have also agreed that patients who switch insurance plans may continue receiving treatment or other health care services for 90 days without facing immediate prior authorization requirements imposed by their new insurer. But health policy analysts say prior authorization — a system that forces some people to delay care or abandon treatment — may continue to pose serious health consequences for affected patients. That said, many people may not notice a difference, even if insurers follow through on their new commitments. 'So much of the prior authorization process is behind the black box,' said Kaye Pestaina, director of the Program on Patient and Consumer Protections at KFF, a health information nonprofit that includes KFF Health News. Often, she said, patients aren't even aware that they're subject to prior authorization requirements until they face a denial. 'I'm not sure how this changes that,' Pestaina said. The pledge from insurers follows the killing of UnitedHealthcare CEO Brian Thompson, who was shot in midtown Manhattan in early December on the way to an investor meeting, forcing the issue of prior authorization to the forefront. Oz acknowledged 'violence in the streets' prompted Monday's announcement. Klomp told KFF Health News that insurers were reacting to the shooting because the problem has 'reached a fever pitch.' Health insurance CEOs now move with security details wherever they go, Klomp said. 'There's no question that health insurers have a reputation problem,' said Robert Hartwig, an insurance expert and a clinical associate professor at the University of South Carolina. The pledge shows that insurers are hoping to stave off 'more draconian' legislation or regulation in the future, Hartwig said. But government interventions to improve prior authorization will be used 'if we're forced to use them,' Oz said during the news conference. 'The administration has made it clear we're not going to tolerate it anymore,' he said. 'So either you fix it or we're going to fix it.' Here are the key takeaways for consumers: 1. Prior authorization isn't going anywhere Health insurers will still be allowed to deny doctor-recommended care, which is arguably the biggest criticism that patients and providers level against insurance companies. And it isn't clear how the new commitments will protect the sickest patients, such as those diagnosed with cancer, who need the most expensive treatment. 2. Reform efforts aren't new Most states have already passed at least one law imposing requirements on insurers, often intended to reduce the time patients spend waiting for answers from their insurance company and to require transparency from insurers about which prescriptions and procedures require preapproval. Some states have also enacted 'gold card' programs for doctors that allow physicians with a robust record of prior authorization approvals to bypass the requirements. Nationally, rules proposed by the first Trump administration and finalized by the Biden administration are already set to take effect next year. They will require insurers to respond to requests within seven days or 72 hours, depending on their urgency, and to process prior authorization requests electronically, instead of by phone or fax, among other changes. Those rules apply only to certain categories of insurance, including Medicare Advantage and Medicaid. Beyond that, some insurance companies committed to improvement long before Monday's announcement. Earlier this year, UnitedHealthcare pledged to reduce prior authorization volume by 10%. Cigna announced its own set of improvements in February. 3. Insurance companies are already supposed to be doing some of these things For example, the Affordable Care Act already requires insurers to communicate with patients in plain language about health plan benefits and coverage. But denial letters remain confusing because companies tend to use jargon. For instance, AHIP, the health insurance industry trade group, used the term 'non-approved requests' in Monday's announcement. Insurers also pledged that medical professionals would continue to review prior authorization denials. AHIP claims this is 'a standard already in place.' But recent lawsuits allege otherwise, accusing companies of denying claims in a matter of seconds. 4. Health insurers will increasingly rely on artificial intelligence Health insurers issue millions of denials every year, though most prior authorization requests are quickly, sometimes even instantly, approved. The use of AI in making prior authorization decisions isn't new — and it will probably continue to ramp up, with insurers pledging Monday to issue 80% of prior authorization decisions 'in real-time' by 2027. 'Artificial intelligence should help this tremendously,' Rep. Gregory Murphy (R-N.C.), a physician, said during the news conference. 'But remember, artificial intelligence is only as good as what you put into it,' he added. Results from a survey published by the American Medical Association in February indicated 61% of physicians are concerned that the use of AI by insurance companies is already increasing denials. 5. Key details remain up in the air Oz said CMS will post a full list of participating insurers this summer, while other details will become public by January. He said insurers have agreed to post data about their use of prior authorization on a public dashboard, but it isn't clear when that platform will be unveiled. The same holds true for 'performance targets' that Oz spoke of during the news conference. He did not name specific targets, indicate how they will be made public, or specify how the government would enforce them. While the AMA, which represents doctors, applauded the announcement, 'patients and physicians will need specifics demonstrating that the latest insurer pledge will yield substantive actions,' the association's president, Bobby Mukkamala, said in a statement. He noted that health insurers made 'past promises' to improve prior authorization in 2018. Meanwhile, it also remains unclear what services insurers will ultimately agree to release from prior authorization requirements. Patient advocates are in the process of identifying 'low-value codes,' Oz said, that should not require preapproval, but it is unknown when those codes will be made public or when insurers will agree to release them from prior authorization rules.
