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!
 

June 23, 2016

This week's topics: Health Plan BusinessLegal/Regulatory IssuesProvider ContractingValue-Based Care

Health Plan Business

Report: Anthem-Cigna Deal Could Raise Health Costs
Reuters, June 23, 2016
A study done for Reuters suggests that Anthem, Inc.’s pending acquisition of Cigna Corp. could have an adverse effect on consumer health care costs.

Highmark Shops Vision Unit to Potential Buyers
Pittsburgh Tribune-Review, June 22, 2016
Highmark Health is reportedly seeking to sell its vision business, HVHC, which could bring in around $2 billion for the insurer.

Oscar Seeks Doctor to Lead New Provider Arm
Bloomberg, June 17, 2016
Oscar Health is looking for a physician to lead a new primary care clinic in New York as it seeks to expand beyond health insurance.

Indiana Awards Medicaid Contracts
Dayton Business Journal, June 16, 2016
Indiana selected Anthem, Inc., CareSource, MDWise Inc., and Managed Health Services of Indiana to administer its managed Medicaid benefits.

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Specialty Pharmacy Trends and Strategies: 2016-2017 Edition

Legal/Regulatory Issues

Insurer Mega-Deals See Different Obstacles
The CT Mirror, June 22, 2016
Although Aetna, Inc.’s proposed acquisition of Humana Inc. and Anthem’s pending purchase of Cigna were unveiled within weeks of each other, they are following different paths to completion.

Senate Dems Lobby Against Insurer Deals
Business Insurance, June 22, 2016
A group of Senate Democrats penned a letter to the Dept. of Justice, asking the agency to block the proposed mega-merger deals between four of the nation’s largest insurers.

Amendment Aims to Block Federal Funds for Risk Corridor Lawsuits
POLITICO, June 22, 2016
Rep. Ron DeSantis (R-Fla.) filed an amendment to a financial services appropriations bill that would prevent the Obama administration from using federal funds to settle lawsuits over risk corridor payments.

Florida Blue Agrees to Cover Harvoni to Settle Class Action
Bloomberg BNA, June 22, 2016
Blue Cross and Blue Shield of Florida Inc. settled a proposed class-action lawsuit by agreeing to cover the pricey hepatitis C drug Harvoni.

Horizon Settles Chiropractor Lawsuit for $33M
Law360, June 21, 2016
Horizon Blue Cross Blue Shield of New Jersey agreed to pay $33 million to a group of chiropractors who alleged the insurer improperly denied claims under ERISA.

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Provider Contracting

United Splits With UNM for Medicaid Members
Albuquerque Journal, June 21, 2016
UnitedHealth Group ended its Medicaid contract with UNM Hospitals for its Centennial Care Medicaid members, affecting around 2,000 patients.

Highmark Partners With Penn Highlands in Two Contracts
Pittsburgh Business Times, June 20, 2016
Highmark Health signed two five-year agreements with Penn Highlands Healthcare for members in Jefferson and Clearfield counties.

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From the AIS Blogs

The same day that a Maryland federal judge dismissed a putative class action against CareFirst for the 1.1 million record data breach the insurer revealed last May, a California federal judge approved another one against Anthem for the massive breach it revealed last February exposing the records of approximately 80 million people. With as many as one in four Americans affected by data breaches, the courtroom debate will keep evolving, but will more judges dismiss or approve claims? Join the conversation at the AIS Blogs.


Value-Based Care

Humana Inks MA Deal With Mount Sinai
Humana press release, June 16, 2016
Humana struck a value-based agreement with Mount Sinai Health Partners for its Medicare Advantage members in New York.

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

 

 

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

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12 PBM Contracting Pitfalls … and Ways to Avoid Them
Thurs., June 30, 2016
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