The Real Eisman Playbook The Only Health Insurance Stock You Can Own with Michael Ha | The Real Eisman Playbook Episode 51
29 snips
Mar 23, 2026 
Michael Ha, a Baird healthcare analyst known for data-driven work on Medicare Advantage, Medicaid and PBM dynamics, joins to dissect turmoil across insurers. They dig into risk adjustment coding, Optum’s rising pains after acquisitions, Medicare Advantage rate changes, Molina’s Medicaid pressures, and why vertical integration and PBMs complicate drug pricing. Short, sharp, and sector-focused.
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Optum Fueled UnitedHealth Growth Through Provider Acquisitions
- UnitedHealth's growth shifted from insurance to Optum with Optum now driving over half of earnings.
- Optum expansion came via acquiring provider practices (e.g., DaVita Medical Group) that materially raised risk scores after 2019.
Acquisitions Drove A 50 Percent Jump In Risk Scores
- Optum Health aggressively increased risk-adjustment scores after acquiring large provider groups in LA County, boosting revenue by ~50% for that book.
- Michael Ha's 10-year CMS data analysis showed LA risk scores rose from ~1.0 to 1.51 post-acquisition.
Risk Model Changes Crushed Aggressive Coding Margins
- Biden-era risk model revisions tightened coding, lowering the ceiling for aggressive coders and creating negative operating leverage for Optum.
- Optum Health margins collapsed from ~6% to negative 0.8% in the reported quarter as coding headwinds hit revenue.