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The AIS Report on Blue Cross and Blue Shield Plans
Today’s issue is brought to you by The AIS Report on Blue Cross and Blue Shield Plans, a hard-hitting independent monthly newsletter on new products, market share, management strategies, profitability, strategic alliances and executive compensation of BC/BS plans. (Not affiliated with the Blue Cross and Blue Shield Association or its member companies.) Sign up for a $72 two-month trial subscription today.

Note: Health Business Daily will not be published July 4 because of the Independence Day holiday. The next issue will be sent on Tuesday, July 5.

July 1, 2016

Today's Featured Story

How Did Horizon Succeed on the Exchanges as Others Staggered?
Reprinted from The AIS Report on Blue Cross and Blue Shield Plans*

While many Blues plans have suffered substantial financial losses on the public insurance exchanges, Horizon Blue Cross Blue Shield of New Jersey is touting record enrollment in the individual market. Between 2013 and 2016 membership in that segment ballooned from 120,000 enrollees to more than 220,000.... Read Full Story

* Not affiliated with the Blue Cross and Blue Shield Association or its member companies


Quote of the Day

“At this point, it is not dangerous at all [to see health insurers increase their borrowing by 94% over the last five years]. When we saw this trend, we decided to put this briefing together. The point is less to stress the danger of borrowing and more to show the impact the ACA is having on the financial flows for the health insurers. Companies are taking more and more government products in general [like Medicare Advantage], as well as ACA exchange products where 80% of enrollees are on government subsidies, which have been delayed at times in being paid back to insurers. And then you have the 3Rs, which is a retroactive [payment] by nature so what health insurers are faced with is a different type of cash flow than from commercial products.”

— Doniella Pliss, a senior financial analyst at A.M. Best Co., which issued a recent report on health plan debt, told AIS’s Health Plan Week.

Click here to read the HEALTH PLAN WEEK article in which this quote appeared — "Health Plans Borrow More to Ease Cash Flow Fluctuations Caused by ACA Programs" (Free for HPW subscribers; $17 for non-subscribers.)


Today's Datapoint

23% ... of respondents for the 12th edition of the EMD Serono Specialty Digest, which contains specialty drug data from 58 commercial plans in the U.S., used episode-of-care or bundled payments in 2015, up from 11% the prior year, but 65% said they have no plans to implement such a reimbursement model.

Click here to read the DRUG BENEFIT NEWS article in which this datapoint appeared — "Digest: Prior-Authorization Change Was Top Specialty Tactic in 2015" (Free for DBN subscribers; $17 for non-subscribers.)


Today from Washington

People on the Move

The American Association of Colleges of Osteopathic Medicine (AACOM) promoted Vice President of Government Relations Pamela Murphy to senior vice president of government relations....Johnson & Johnson named pharmaceuticals unit Vice President of Group Finance Joseph Wolk vice president of investor relations, succeeding Louise Mehrotra, who is retiring....Mirati Therapeutics, Inc. Executive Vice President and Chief Operations Officer Mark Gergen is stepping down to pursue other opportunities. Board Chairman Rodney Lappe, Ph.D., will assume the role of executive chairman....Continuum Health Alliance appointed Don McDaniel president and CEO. He previously was CEO of Sage Growth Partners.


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