Amid challenges co-ops have faced — like disproportionate numbers of new, sick policyholders and losses under the federal government’s risk adjustment program — New Mexico’s co-op is afloat and recorded a profit last month, according to Dr. Hickey. He said the co-op looks to continue bringing in profit through the year.
Dr. Hickey said the co-op continues to do well because it contracted directly with providers from its beginning, which cut costs by not working with third party rate negotiators, according to the report. The co-op also has medical managers who make sure patients are taking prescriptions and limiting hospital visits.
Despite Dr. Hickey’s outlook, New Mexico Health Connections co-op sued the federal government in August for allegedly mismanaging the ACA’s risk adjustment program, under which the insurer owes $14.6 million. Under the lawsuit, the co-op says it faces closure in the next few years if the program remains in effect.
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