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, ACOs, health business news, provider contracting and personnel changes. Subscribe now to get an issue delivered to your inbox every Thursday!

March 26, 2015

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

Accountable Care Organizations

Humana Renames ACO Service Subsidiaries
Business Wire, March 24, 2015
Humana Inc. renamed its population health resource subsidiary Humana Management Services Organization as Transcend, and combined Certify Data Systems, Anvita Health and nliven systems into Transcend Insights.

BCNEPA, Gutrie Launch PCMH
The Times Leader, March 24, 2015
Blue Cross of Northeastern Pennsylvania and Guthrie Medical Group are collaborating in a new patient-centered medical home.

Minn. Blues, Entira Team Up in ACO
Globe Newswire, March 24, 2015
Blue Cross and Blue Shield of Minnesota partnered with Entira Family Clinics in a new accountable care organization.

Anthem Forms ACO with Kettering
Dayton Business Journal, March 23, 2015
Anthem Blue Cross and Blue Shield in Ohio, a unit of Anthem, Inc., teamed up with Kettering Health Network in a collaborative care agreement.

United, Integrated Health Expand ACO Deal
The Street, March 19, 2015
UnitedHealth Group’s UnitedHealthcare and Integrated Health Network of Wisconsin expanded their accountable care program to include an additional 30,000 people in the state.

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Health Plan Business

Blue Shield of Calif. Offers $1.2B for Care1st
Sacramento Business Journal, March 26, 2015
Blue Shield of California revealed it paid $1.2 billion to acquire Care1st Health Plan in a deal awaiting approval by state regulators.

Cigna Partners with SCAN in MA Collaboration
Yahoo! Finance, March 24, 2015
Cigna Corp. and SCAN Health Plan, a unit of SCAN Group, are joining forces to provide better Medicare Advantage services to beneficiaries and ensure seamless transition for new retirees.

Alaska, Ore., Wash. Investigating Premera Breach
KTVA Alaska, March 24, 2015
The insurance commissioners of the three states announced a joint investigation into how Premera Blue Cross handled the data breach the insurer discovered on Jan. 29.

DOJ Widens Humana Probe
Reuters, March 24, 2015
The Dept. of Justice is expanding its investigation into Humana risk adjustment practices to include providers like DaVita Healthcare Partners Inc.

Premera Asks Judge to Dismiss Tribal Health Group Motion
Law360, March 23, 2015
Premera asked a federal judge to dismiss a motion from Alaska Native Tribal Health Consortium for summary judgment on the grounds they improperly used an expert witness.

Premera Warned of Security Issues Before Breach
SC Magazine, March 19, 2015
A routine audit by the Office of Personnel Management found security gaps in Premera’s security system a few weeks prior to its data breach last year.

Calif. Insurance Commissioner Accuses Blue Shield of ‘Tax Dodge’
California Healthline, March 19, 2015
California Insurance Commissioner Dave Jones accused Blue Shield of California of dodging taxes for years.

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Inside Health Insurance Exchanges

People on the Move

Tufts Appoints New Senior VP
Tufts press release, March 24, 2015
Tufts Health Plan, a unit of Tufts Associated Health Plans, Inc., named Marc Backon senior vice president.

WellCare Chair Announces Plans to Resign
WellCare press release, March 23, 2015
WellCare Health Plans, Inc. Chairman of the Board David Gallitano said he will not be running for reelection for the upcoming term.

Kaiser Anoints New Exec
Kaiser press release, March 19, 2015
Kaiser Permanente appointed Bill Marsh, M.D., associate executive director of government relations and care delivery information technology for The Permanente Foundation.

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From the AIS Blogs

With the approval of the first U.S. biosimilar through the Biologics Price Competition and Innovation Act and others to follow, it’s an exciting time in pharmacy benefit management. But biosimilars — like several other marketplace dynamics — are rife with unknowns. What can payers do to address or mitigate the impact of potential marketplace issues? Join the conversation at the AIS Blogs.

Provider Contracting

Highmark Delays Claims to UPMC
Pittsburgh Tribune-Review, March 25, 2015
Highmark Health stalled payments to University of Pittsburgh Medical Center physicians, asking the state to clarify whether the claims fall in line with a consent decree signed last year.

United Sues HCA Over Confidential Info
Law360, March 23, 2015
UnitedHealth Group’s UnitedHealthcare Insurance Co. sued HCA Holdings Inc. for allegedly threatening the insurer with publicizing its provider payment rates.

Humana Sells Concentra
Reuters, March 23, 2015
Humana is selling Concentra Operating Corp., five years after the insurer purchased it, to a private equity firm in a deal valued at $1 billion.

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Dual-Eligibles Initiatives: What's Working? What's Not? What's New?



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