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!

April 30, 2015

This week's topics: Value-Based CareHealth Plan BusinessPeople on the MoveProvider Contracting

Note: Spotlight on Health Insurers will not be published next week. The next issue will be sent on May 14.

Value-Based Care

BCBSIL Launches 4 ACOs
BCBSIL press release, April 29, 2015
Blue Cross and Blue Shield of Illinois, a division of Health Care Service Corp., organized four new accountable care organizations with providers throughout the state.

Anthem Says ACOs Lowered Health Costs
The Wall Street Journal, April 28, 2015
Anthem, Inc. said the first year of its accountable care organization reduced health care costs by 3.3%.

IBC Launches Medication Adherence Pilot
GlobeNewswire, April 28, 2015
Independence Blue Cross teamed up with TowerView Health and the University of Pennsylvania to launch a program aimed at improving medication adherence for chronically ill members.

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Health Plan Business

26 Companies Challenge $30M BCBSM Settlement
Law360, April 29, 2015
Twenty-six self-insured companies are asking the Sixth Circuit to review the $30 million settlement over Blue Cross Blue Shield of Michigan’s most-favored nation practice.

Humana Earnings Miss Projections
Zacks, April 29, 2015
Humana Inc. reported lower-than-expected first quarter earnings of $2.47 per share, missing street predictions of $2.54 per share.

Medicaid Expansion Helps Anthem Beat Street
Associated Press, April 29, 2015
Higher Medicaid enrollment drove Anthem’s growth in the first quarter.

Assurant Health Goes Under
Journal Sentinel, April 28, 2015
Assurant Inc. said it will sell or shut down its health insurance arm, Assurant Health, after failing to adapt to health reform regulation.

Aetna Ups 2015 Forecast After 1Q Earnings
The New York Times, April 28, 2015
Aetna Inc. increased its 2015 forecast for the third time following positive first quarter earnings.

Consumer Watchdog Sues Cigna for HIV Discrimination
Associated Press, April 28, 2015
Consumer Watchdog filed suit against Cigna Corp., alleging a policy that requires HIV patients to order medication from its mail-order pharmacy is discriminatory.

Anthem Replaces Acres of Lawn in Calif.
Business Wire, April 27, 2015
Anthem replaced nearly 10 football fields’ worth of thirsty lawn space with drought-friendly landscaping to help combat California’s water shortage.

Judge Approves Anthem Bait-and-Switch Settlement
Law360, April 27, 2015
A California judge approved an $8.2 million dollar settlement over allegations that Anthem Blue Cross in California, a unit of Anthem, Inc., used bait-and-switch techniques on more than 130,000 members.

Blue Shield of Calif. Files Suit Against Fired Exec
Los Angeles Times, April 24, 2015
Blue Shield of California fired a countersuit against its former chief technology officer, alleging he spent company money on his girlfriend, actress Tara Reid, whom they also said acted inappropriately at company functions.

Calif. Low-Income Plan Offers Cash Option
Los Angeles Times, April 24, 2015
L.A. Care Covered began offering a way for members to pay their premiums in cash.

Ind. Supreme Court Rules for Anthem in Reinsurance Suit
Law360, April 24, 2015
The Indiana Supreme Court ruled Anthem is entitled to coverage for legal defense costs in a suit over medical reimbursement claims, nearly overturning a win for the reinsurers involved.

BCBSA Launches Retiree Exchange
Forbes, April 24, 2015
The Blue Cross Blue Shield Association launched a retiree health exchange for its Medicare Advantage members. Nearly 30 insurers, including Anthem, will participate.

Excellus Says It Has $2.5M in Unclaimed Checks
WSYR-TV, April 23, 2015
Excellus BlueCross BlueShield said it has more than $2.5 million in unclaimed checks issued to members and providers in 2011, which it will be required to turn over to the state at the end of August.

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Bundled Payment Models: Bottom-Line Strategies for Insurers

People on the Move

Centene Appoints New CMO
Centene press release, April 27, 2015
Centene Corp. named Ken Yamaguchi chief medical officer.

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From the AIS Blogs

When UnitedHealth Group recently said it would acquire Catamaran Corp. for a little under $13 billion, it set the stage for a test of which business model in the PBM space will win out, or if different strategies can survive in the same marketplace against each other. The consensus is that UnitedHealth, flush with cash, made a bold move, but was it the right one, and at the correct time? Join the conversation at the AIS Blogs.

Provider Contracting

Anthem Opens Cincinnati Clinic
Cincinnati Business Courier, April 28, 2015
Anthem opened the first of two planned chronic care clinics in an effort to reduce hospital readmissions.

Judge Dismisses Hospital’s Objections in Humana Lawsuit
Law360, April 28, 2015
A Florida judge dismissed Plaza Medical Center Corp.’s objections that a lower court’s findings in a False Claims Act suit with Humana were overly broad.

Pa. Asks Court for Help in UPMC-Highmark Spat
Pittsburgh Post-Gazette, April 27, 2015
The state of Pennsylvania is seeking a court order to force UPMC and Highmark Health into arbitration.

Miami Hospital Sues Humana for Underpayment
Law360, April 23, 2015
Baptist Hospital in Miami is suing a unit of Humana for allegedly underpaying for services.

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The AIS Report on Blue Cross and Blue Shield Plans



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