Spotlight on Health Insurers
A weekly scan of actions taken by individual health plans

October 16, 2014

This week's topics: Accountable Care OrganizationsExchangesHealth Plan BusinessPeople on the MoveProvider Contracting

Accountable Care Organizations

MDX Hawai’i, Humana Announce ACO
Business Wire, Oct. 15, 2014
MDX Hawai’I and Humana Inc. have partnered to form an accountable care organization in the state of Hawaii.

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Health Plan Week


La. Insurers Increasing Premiums on State Exchange
The Times-Picayune, Oct. 8, 2014
BlueCross BlueShield of Louisiana, Humana and Vantage Health Plan, Inc. are among insurers in the state increasing rates between 9.9% and 19.7% for 2015.

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Private Exchanges: The New Business Model for Insurers and Employers

Health Plan Business

Aetna Ending Del. Medicaid Plan
Philadelphia Business Journal, Oct. 15, 2014
Aetna, Inc. is discontinuing its Medicaid plan with the state of Delaware after failed negotiations regarding reimbursement rates.

UnitedHealth Group Beats Q3 Profit Estimates
Bloomberg, Oct. 16, 2014
UnitedHealth Group raised its earnings per share forecasts as its third quarter profits topped estimates.

WellPoint Adds More Pharmacies to Network
WellPoint press release, Oct. 14, 2014
WellPoint, Inc. added CVS Health, Delhaize Group’s Food Lion, Giant Eagle, Inc., Hannaford Bros. Co., Harris Teeter, Inc. and Target Brands, Inc. to its pharmacy network.

CMS Issues Memorandum on Noncompliance
The New York Times, Oct. 12, 2014
In a memorandum to insurers, CMS listed common areas of noncompliance, following penalties for Capital BlueCross, Moda, Inc., BCBS plans in Arizona, Florida and North Carolina, Aetna, WellCare Health Plans, Inc., Health Alliance Plan of Michigan and CalOptima.

Md. Approves 2015 Small Business Insurance Rates
The Baltimore Sun, Oct. 10, 2014
Maryland state officials approved 2015 small business insurance rates from insurers like Aetna, UnitedHealthcare, Evergreen Health Cooperative and CareFirst BlueCross BlueShield.

AMA Study Says WellPoint Has Largest Geographical Footprint
AMA press release, Oct. 9, 2014
A study from the American Medical Association finds WellPoint to have the largest market share in 82 of the 388 metropolitan areas analyzed.

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From the AIS Blogs

Is competition affecting the price of health insurance on exchanges? Do you expect low-enrollment carriers will stick with the exchanges for 2016? Join the conversation at the AIS Blogs.

People on the Move

Kaiser Permanente Appoints Georgia President
Atlanta Business Journal, Oct. 15, 2014
Kaiser Permanente appointed Julie Miller-Phipps president of Kaiser Foundation Health Plan of Georgia. She was previously senior vice president and executive director of Kaiser Foundation Hospitals and Health Plan in Orange County, Calif.

Premera Blue Cross Adds to Executive Team
PR Newswire, Oct. 14, 2014
Premera Blue Cross promoted John Espinola, M.D., M.B.A., to executive vice president of health care services. He was previously vice president for quality, medical management and provider engagement.

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Specialty Pharmacy Trends and Strategies: 2014

Provider Contracting

BCBS of Texas, Hendrick Health System Fail to Reach Agreement
KTXS, Oct. 15, 2014
Hendrick Health System will likely remain out of network for BlueCross BlueShield of Texas members for the rest of 2014 and all of 2015 as contract negotiations fell through.

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Have breaking news or an editorial question? Email Erin Trompeter, editor of SPOTLIGHT ON HEALTH INSURERS, at If you are interested in sponsoring SPOTLIGHT ON HEALTH INSURERS please contact Bailey Sterrett at

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