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!

May 5, 2016

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

Health Plan Business

Humana Tops Q1 Estimates, Reaffirms Guidance
Zack’s, May 4, 2016
Humana Inc. reported earnings of $1.86 per share, beating investor projections and maintaining its full-year guidance.

Calif. Hits Anthem With $415k Fine
California Healthline, May 3, 2016
The California Dept. of Managed Health Care slapped Anthem Blue Cross in California with a six-figure fine over what it said was poor handling of customer appeals and grievances.

Highmark Offers $5.5M for Unconfirmed Diagnostic Codes
Highmark press release, May 3, 2016
Highmark Health is offering Pennsylvania physicians a total of $5.5 million for addressing the issue of unconfirmed diagnosis codes in patients.

HCSC Stops Accepting ACA Member Credit Cards
The Chicago Tribune, May 2, 2016
Health Care Service Corp. will no longer accept credit cards from its individual exchange members, saying the fees were a “significant expense” for everyone.

MHPA ‘Disappointed’ With Medicaid MLR Provision
MHPA statement, April 29, 2016
While Medicaid Health Plans of America was largely satisfied by the Medicaid managed care rule CMS issued last week, it says the medical loss ratio provision is a “missed opportunity” for state flexibility.

Aetna CEO Calls for Separate Risk Pools in Exchanges
Forbes, April 29, 2016
Aetna Inc. CEO Mark Bertolini said product flexibility, rating flexibility and separate risk pools are need changes in the ACA marketplace.

Molina Misses on Earnings Report
Zacks, April 29, 2016
Molina Healthcare, Inc. missed Wall Street expectations on first quarter earnings by a hefty margin, reporting earnings of 51 cents per share.

United Fights ERISA Class Action on Mental Health
Law360, April 29, 2016
UnitedHealth Group told a California federal court that certifying a class action against the insurer regarding behavioral health would be inefficient.

Beam Dental Launches Insurance Plan in Calif.
MobiHealthNews, April 28, 2016
Beam Dental, the maker of the smart toothbrush, rolled out its new dental coverage plan, SmartPremiums, in California.

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Specialty Pharmacy Trends and Strategies: 2016-2017 Edition

People on the Move

Anthem CFO Retires
Anthem press release, May 4, 2016
Anthem Chief Financial Officer Wayne DeVeydt is handing the reins over to long-time Anthem executive John Gallina.

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Save up to $200 When You Reserve AIS’s Directory of Health Plans: 2016

Provider Contracting

Anthem, Sequenom Ink Deal for Prenatal Tests
Sequenom press release, May 3, 2016
Sequenom, Inc. will administer lab tests for high-risk and average-risk pregnancies to Anthem’s expecting mothers in a number of states.

Court Partially Reverses Dismissal of Cigna ERISA Suit
Law360, May 2, 2016
The Third Circuit Court of Appeals partially reversed a lower court’s dismissal of an ERISA lawsuit a group of out-of-network doctors brought against Cigna Corp. over alleged underpayments.

Judge Orders Horizon to Turn Over OMNIA Pricing Documents
Law360, May 2, 2016
A New Jersey state judge ruled that there is no reason pricing documents Horizon used in allocating providers to Tier 2 of its OMNIA network should be kept out of court.

Hoboken Mulls Options as Horizon Breaks Ties With CarePoint
Hoboken Patch, April 29, 2016

The city of Hoboken is weighing its options after Horizon Blue Cross Blue Shield of New Jersey announced that it is parting ways with CarePoint Health.

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From the AIS Blogs

While they may not fall under the HIPAA umbrella (yet), the privacy of biometric and other health data captured by the influx of new apps and wearable gadgets is a source of concern among consumers and regulators alike. The question is what will lawmakers and regulators deem "protected" data, and will the shift to consumerism prompt them to do away with arcane technicalities like covered entities and business associates? Join the conversation at the AIS Blogs.

Value-Based Care

Anthem Docs Save Nearly $15M in Value-Based Deals
Anthem press release, April 28, 2016
Participating physicians in Anthem, Inc.’s accountable care deals saved a total of $14.8 million between 2013 and 2014.

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