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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.

December 13, 2016

Today's Featured Story

Horizon, Blue Shield of Calif. to Issue MLR Rebate Checks
Reprinted from The AIS Report on Blue Cross and Blue Shield Plans*

Two large Blues plans are refunding millions of dollars to customers because they didn’t spend enough on claims under the medical loss ratio (MLR) provision of the Affordable Care Act. Horizon Blue Cross Blue Shield of New Jersey on Nov. 17 said it will pay out more than $70 million in MLR rebates for the 2015 plan year. About 155,000 members who purchased an individual policy will receive an average rebate of $423, the company said, and 31,000 small-group members will receive an average $77 rebate.... Read Full Story

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


Quote of the Day

“[Medicare Advantage star quality rating] cut points go up every year, so we wanted to stay ahead of that curve and drive adherence as high as we can. And to be able to stay a five-star, we know we have to keep working at it.”

— Kelly Verrall, manager, medication therapy management, with Independent Health told Medicare Advantage News.

Click here to read the MEDICARE ADVANTAGE NEWS article in which this quote appeared — "Independent Health Stays Ahead Of Stars Curve With Pharmacist Pact" (Free for MAN subscribers; $17 for non-subscribers.)


Today's Datapoint

3 ... Medicare Advantage Prescription Drug plan contracts serving dually eligible Medicare-Medicaid beneficiaries earned overall star ratings of 5 for the first time for the 2017 contract year, according to an AIS analysis of recently posted CMS data.

Click here to read the MEDICARE ADVANTAGE NEWS article in which this datapoint appeared — "MA Plans Serving Medicare-Medicaid Dual Eligibles With Overall Star Ratings Of 4.5 or Higher, 2017" (Free for MAN subscribers; $17 for non-subscribers.)


Today from Washington

People on the Move

Second Genome, Inc. appointed Jim Sjoerdsma executive vice president of human resources and Brian Dowd senior vice president of finance. Sjoerdsma previously served in various human resources roles at Genencor. Dowd comes from Johnson & Johnson, where he served as the vice president, controller of Alios BioPharma....Enterome SA appointed Jai Patel, Ph.D., chief medical officer. Patel most recently served as chief medical and scientific officer at NephroGenex, Inc....Simione Healthcare Consultants appointed Anna M. Alvarez senior manager in operations consulting. Alvarez was previously the Southeast regional vice president for clinical operations at Kindred at Home in Louisville, Ky.


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