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!

November 19, 2015

Note: Spotlight on Health Insurers will not be published next week. The next issue will be sent on Dec. 3.

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

Health Plan Business

United Reports $425M Loss on Exchanges
United press release, Nov. 19, 2015
UnitedHealth Group said it expects a reduction of $0.26 in earnings per share as a result of its business on the health insurance exchanges, saying it might not participate in 2017.

Molina Wins Medicaid Contract in SW Washington
Molina press release, Nov. 18, 2015
Molina Healthcare, Inc. will provide Medicaid services to the state’s southwest region of its Apple Health Fully Integrated Managed Care Program.

BCBSRI Cuts 80 Jobs in Deal With Dell
Providence Journal, Nov. 18, 2015
Blue Cross & Blue Shield of Rhode Island struck an agreement with Dell, Inc. to outsource its IT operations, affecting one-third of its workforce and eliminating 80 workers.

Anthem Named Best Place to Work for LGBTs
Anthem press release, Nov. 18, 2015
Anthem, Inc. received a 100% on the Human Rights Campaign’s Corporate Equality Index for the second year running.

Regulators, Calif. Blue Shield at Odds Over Care1st Deal
Los Angeles Times, Nov. 17, 2015
Ambiguous language in a contract between Blue Shield of California and the state is placing the two at odds over $140 million in charitable donations.

Advisory Firm Recommends Voting for Anthem Deal
Anthem press release, Nov. 16, 2015
Institutional Shareholder Services recommended Anthem shareholders vote in favor of its pending acquisition of Cigna Corp.

DOJ Antitrust Head Questions Insurer Mergers
Indianapolis Business Journal, Nov. 16, 2015
The Dept. of Justice’s head of its antitrust division, Assistant Attorney General William Baer, said that size and leverage aren’t enough to justify the major industry acquisitions.

Anthem: Doctors OK With Telehealth if Compensated
Anthem press release, Nov. 16, 2015
An Anthem study found that nine out of 10 family physicians are willing to use telehealth services with their patients provided they are compensated fairly.

Humana Seniors Lose Weight With Omada’s Digital Program
Omada press release, Nov. 13, 2015
Humana Inc. and digital behavioral health company Omada Health reported clinically meaningful results in a study on overweight seniors participating in an Omada program to shed pounds.

MA Plan Closure Ousts 10K New Yorkers
Crain’s New York Business, Nov. 12, 2015
Medicare Advantage plan Touchstone Health HMO is shutting down at the end of the year after losing 30% of its membership over the past five years.

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Health Insurance Exchange Database: 2016 Plans and Premiums - Now with online access!

People on the Move

Horizon Appoints New Government Affairs Exec
Politicker NJ, Nov. 18, 2015
Horizon Blue Cross Blue Shield of New Jersey named William Castner, Jr., senior vice president of corporate and regulatory affairs.

ACHP Names New President and CEO
ACHP press release, Nov. 17, 2015
The Alliance of Community Health Plans appointed Ceci Connolly president and CEO.

BCBSLA Promotes New Company Head
BCBSLA press release, Nov. 13, 2015
Blue Cross and Blue Shield of Louisiana promoted Executive Vice President of Health Services I. Steven Udvarhelyi, M.D., to the company’s top spot.

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Health Plan Facts, Trends and Data: 2015-2016

Provider Contracting

Highmark, UPMC Settle on Continuity of Care
Pittsburgh Tribune-Review, Nov. 12, 2015
Highmark Health and UPMC outlined provisions under disputed language regarding continuity of care in their contracts, resolving another portion of their ongoing disagreement.

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From the AIS Blogs

Condition-specific health plans have long been a staple of the indemnity world, and now, public health insurance exchanges are breathing new life into this model. Do you think insurers will adopt condition-specific health plans? Why? And what disease states are next? Join the conversation at the AIS Blogs.

Value-Based Care

BCBSTX ACO Inks Deal With Independent Docs
MySanAntonio, Nov. 18, 2015
Health Care Service Corp. unit Blue Cross Blue Shield of Texas signed an agreement through its accountable care arm, TMA PracticeEdge, with 48 independent physicians.

Humana Pays Out $77M in Physician Rewards
Business Wire, Nov. 12, 2015
Humana distributed $77 million this year to physicians who participated in its accountable care organizations.

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Innovative Plan-Provider Ventures: Case Studies From Anthem and Aetna



Have breaking news or an editorial question? Email Executive Editor Jill Brown at If you are interested in advertising in SPOTLIGHT ON HEALTH INSURERS please contact Bailey Sterrett at

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