Spotlight on Health Insurers
A weekly scan of actions taken by individual health plans
Spotlight on Health Insurers is a weekly review of news from the nation's leading health insurers, including coverage of exchanges, value-based health care arrangements, provider contracting and personnel changes. Subscribe now to get an issue delivered to your inbox every Thursday!

July 23, 2015

This week's topics: Health Plan BusinessPeople on the MoveProvider ContractingValue-Based Care

Health Plan Business

Molina Will ‘Stick to Knitting’ as Industry Consolidates
Nasdaq, July 22, 2015
Molina Healthcare, Inc. Chief Financial Officer John Molina said the company continues to focus on Medicaid as the rest of the big insurers merge.

Aetna Settles Kickback Case with Pa. Surgery Center
Law360, July 22, 2015
Aetna Inc. has settled claims it levied against Huntingdon Valley Surgery Center that it was operating its own patient referral scheme.

United, Blues Expanding Urgent Care
Forbes, July 21, 2015
UnitedHealth Group and a number of Blue Cross Blue Shield plans are increasing their investments in urgent care clinics.

Aetna Sued over Cap on Autism Benefits
Law360, July 21, 2015
A mother is suing Aetna over what she claims is an arbitrary cap on the amount of therapy the insurer allows for her autistic son.

BCBSND Agrees to Pay Md. $45M Over Health Exchange
Grand Forks Herald, July 21, 2015
Blue Cross Blue Shield of North Dakota subsidiary Noridian Healthcare Solutions will pay Maryland $45 million for its part in the state’s troubled health exchange.

Georgia Blues Faces Suit Over Up-Charging
Atlanta Journal-Constitution, July 21, 2015
A former state insurance commissioner filed a class-action lawsuit against Anthem, Inc.’s Blue Cross and Blue Shield of Georgia, alleging the insurer reduced payments to doctors but continued charging members the same rate.

United, Others Fined for MA Inaccuracies
Becker’s Hospital Review, July 17, 2015
UnitedHealthcare was among several Medicare Advantage providers slapped with a fine for failing to furnish accurate policy information to members.

United Beats Street in 2Q Earnings
USA Today, July 16, 2015
UnitedHealthcare beat earnings estimates in the second quarter as it got questioned about rumors it could acquire Aetna.

Aetna CEO Reassures Employees on Humana Deal
The Courier Journal, July 16, 2015
Aetna CEO Mark Bertolini sent an internal memo detailing the benefits of the company’s acquisition by Humana.

Calif. Official Accuses Aetna of ‘Price-Gouging’
Los Angeles Times, July 16, 2015
Aetna’s 21% proposed rate hike prompted the ire of California Dept. of Managed Care Director Shelley Rouillard.

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People on the Move

Idaho Blues CEO Retiring
Idaho Statesman, July 17, 2015
Blue Cross of Idaho CEO Zelda Geyer-Sylvia will step down in the spring.

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AIS's Specialty Pharmacy Trends and Strategies: 2015

Provider Contracting

Independence, Crozer-Keystone Renew Terms
Nasdaq, July 21, 2015
Independence Blue Cross and Crozer-Keystone Health System said they have renewed their contract terms.

Humana Adds SCL Health to Colorado Network
The Denver Post, July 20, 2015
Humana added SCL Health to its network, providing in-network coverage to three hospitals in Colorado.

Humana, HCA Reach Last-Minute Deal
Tampa Bay Times, July 17, 2015
Humana and Hospital Corp. of America agreed to new terms July 16, after Humana had notified its 1.5 million members of the contract’s impending termination.

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FREE webinar!
Web-Broker Entities: How WBEs Can Drive Future Exchange Enrollment

Tuesday, July 28, 2015

Learn how health plans and WBEs can work together to drive enrollment and retention — from thought leaders at Leavitt Partners and Softheon. Click here to sign up!

Spotlight on Health Insurers

Value-Based Care

Humana Expands Agreement with Iora Health
MarketWatch, July 21, 2015
Humana Inc. and Iora Health are opening seven new primary care clinics in Arizona, Colorado and Washington as they expand their accountable care agreement.

United Awards $54M in Doc Incentive Pay
Business Wire, July 20, 2015
UnitedHealth Group’s UnitedHealthcare said it has awarded $54 million in incentive payments to physicians meeting quality criteria under its PATH program.

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Medicare-Medicaid Dual Eligibles Database: Dual-Eligibles Data and a Wealth of Valuable Information at Your Fingertips



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