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

August 21, 2014

This week's topics: Accountable Care OrganizationsExchanges Health Plan BusinessPersonnel AnnouncementsProvider Contracting

Accountable Care Organizations

Humana and Health Choice Utah Preferred Network Partner to Launch Accountable Care in Four Counties
Humana Press Release, Aug. 19, 2014
Health Choice Utah Preferred Network and Humana Inc. reached a new accountable care agreement in Salt Lake, Davis, Weber and Utah counties of the Salt Lake City area.

-back to top-

Private Exchanges: The New Business Model for Insurers and Employers


Cigna’s Proprietary Retail Exchange Launches Nationally
Cigna Press Release, Aug. 14, 2014
Cigna is launching its proprietary private retail exchange in new markets and expanding in others, starting September 1.

Anthem Blue Cross Sued Again Over Narrow-Network Health Plans
L.A. Times, Aug. 19, 2014
Anthem, California’s largest for-profit health insurer, is being sued again for switching customers to narrow-network health plans with limited options. Members claim Anthem misrepresented its benefits package and the size of its physician network.

-back to top-

ACO Business News

Health Plan Business

UPMC Continues Strong Financial Performance Through Fiscal Year 2014 and Rapidly Changing Market
UPMC Press Release, Aug. 21, 2014
UPMC reported an operating revenue increase of $1.2 billion to $11.4 billion for the fiscal year; net income was $567 million.

N.D. Blues Finances Back in the Black
Jamestown Sun, Aug. 19, 2014
Blue Cross Blue Shield of North Dakota rebounded from last year’s $80.7 million loss with net income of $27 million in the most recent quarter.

Medicaid Program CoventryCares Changes Name to Aetna Better Health of Nebraska
Aetna Press Release, Aug. 18, 2014
Medicaid MCO CoventryCares of Nebraska is changing its name to Aetna Better Health of Nebraska, effective August 25, to reflect the acquisition of Coventry Health Care, Inc. by Aetna.

-back to top-

From the AIS Blogs

Some consumer advocacy groups contend that health plans’ placement of HIV/AIDS drugs on high formulary tiers is discriminatory. Could a discrimination case be made on behalf of anyone with a condition that requires him or her to take a drug that’s placed on a high cost-share tier? Join the conversation at the AIS Blogs.

Personnel Announcements

Scott to Retire From Blue Cross
The Advocate, Aug. 20, 2014
Former Blue Cross and Blue Shield of Louisiana Executive Vice President, Chief Operating Officer, Chief Financial Officer and Treasurer Peggy Scott will retire from the company in July of next year.

Two Aetna CarePass Execs Depart the Company
Mobi Health News, Aug. 20, 2014            
Former Vice President and Head of Consumer Products Martha Wofford and Head of Business Development for the Aetna CarePass platform Dan Conroy left the company this summer.

UnitedHealthcare of Pennsylvania Undergoes Leadership Change
Philadelphia Business Journal, Aug. 19, 2014
UnitedHealthCare of Pennsylvania CEO Sue Schick has been replaced by Dan Tropeano, a UHC Pennsylvania executive since 2006. His official title will be executive director of operations.

Former WellCare CEO Cunningham Lands at Midwest Health Care Company
Tampa Bay Times, Aug. 19, 2014
Former WellCare Health Plans CEO Alec Cunningham has been named president and CEO of Fidelis SeniorCare, a Chicago-based company focused on providing clinical health care services to seniors.

Health Net Names James Woys EVP, Chief Financial and Operating Officer, and Interim Treasurer
Business Wire Press Release, Aug. 19, 2014
Health Net announced that effective Sept. 2, James Woys will replace outgoing EVP, CFO and Treasurer Joseph C. Capezza.

WellCare To Appoint Andrew Asher as Senior Vice President
WellCare Press Release, Aug. 14, 2014
Effective Aug. 29, current Aetna CFO of Local and Regional Businesses Andrew Asher will join WellCare Health Plans as Senior Vice President; he may become chief financial officer as well by November.

-back to top-

Dual-Eligibles Programs: Initial Results, Successes and Remaining Challenges - Sept. 17 Virtual Conference

Provider Contracting

Aetna, Alegent Creighton Health and UniNet Create Patient-Centric Health Care Network in Omaha
Aetna Press Release, Aug. 20, 2014
Aetna, Alegent Creighton Health and its provider-led clinically integrated network, UniNet, announced a new collaboration for self-insured employers, Alegent Creighton Affiliated Network, for plans effective Jan. 1, 2015.

Cigna HealthCare, NCH Announce Alliance Focused on Delivering Quality Care Related to Cancer
News Medical, Aug. 20, 2014
New Century Health and Cigna HealthCare of Arizona have created an alliance to deliver quality care related to cancer. Cigna customers covered under Arizona Medicare Advantage plans who get care through the Cigna Medical Group are included in the new program.

Thousands of Nebraskans May Soon Have to Switch Hospitals
KLKNTV, Aug. 19, 2014
Blue Cross Blue Shield of Nebraska has been in contract talks with Catholic Health Initiatives due to a disagreement over rates for Alegent-Creighton Health in Omaha. If an agreement isn’t reached by the end of August, all Nebraska CHI hospitals will become out-of-network for Nebraska Blues plan customers.

Premera Adds Seattle Children’s Hospital to its Individual and Small Group Networks
Premera Press Release, Aug. 18 2014
Starting Sept. 1, Premera Blue Cross members on individual and small group metallic health plans will have full access to Seattle Children’s Hospital.

About 2 Million Eligible for BCBSM Settlement
WoodTV, Aug. 18, 2014
Approximately 2 million West Michigan residents are eligible for a class action settlement in which Blue Cross Blue Shield of Michigan has agreed to pay $30 million to patients, insurers and providers due to antitrust violations.

-back to top-



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

SPOTLIGHT ON HEALTH INSURERS is copyrighted and protected by federal law. The re-use of its content is restricted (see below). However, you are permitted to forward this email to as many of your friends and colleagues as you wish, or better yet have them sign up for their own copy at atlantic_subscription.cfm, where you can also sign up for AIS's Health Business Daily and AIS's Goverment News of the Week.

Copyright © 2014 Atlantic Information Services, Inc. (AIS). All rights reserved. It is not permissible to include all or any portion of this content on any website, intranet or electronic network or in any print publication, without AIS's written permission in advance. Permission requests should be directed to


Free White Papers, Studies and Surveys

Upcoming Webinars
Save $50!

Stark Law DOs and DON’Ts: Best Practices for Your Physician Contracts
Thurs., Sept. 18, 2014
Click here for details

Bundled Payment Success Stories: Case Study Results from Geisinger and BCBSNC
Wed., Sept. 24, 2014
Click here for details

Missed a Live Event?
Listen at your convenience to recent webinars with On-Demand or CD options!
The AIS Report on Blue Cross and Blue Shield Plans
Specialty Pharmacy Trends and Strategies: 2014