Spotlight on Health Insurers
A weekly scan of actions taken by individual health plans
 

October 23, 2014

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

Accountable Care Organizations

Cigna, Regional HealthPlus Partner in ACO
Cigna press release, Oct. 16, 2014
Cigna Corp. and Regional HealthPlus formed a collaborative care arrangement in South Carolina.

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Health Plan Facts,Trends and Data 2014-2015

Exchanges

Sam’s Club Launching Exchange with Aetna
The Washington Post, Oct. 22, 2014
Sam’s Club announced an insurance exchange for its members, in conjunction with Aetna, Inc.

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The AIS Report on Blue Cross and Blue Shield Plans

Health Plan Business

NY Blues Plans to Stay in Medicaid and Child Health Programs
The Buffalo News, Oct. 22, 2014
BlueCross BlueShield of Western New York will stay in the Medicaid and Child Health Plus programs, reversing its initial decision to exit.

Humana Considers Selling Concentra
Reuters, Oct. 22, 2014
Humana Inc. is exploring selling its urgent care unit Concentra, less than four years after acquiring the company.

Insurers Donate Big to Defeat Calif. Reform Bill
Los Angeles Times, Oct. 20, 2014
Blue Shield of California, WellPoint, Inc., Kaiser Permanente and Health Net donated millions to defeat a California bill that would allow the state insurance commissioner to reject “excessive” proposed rate increases.

CoOportunity Health Pulling Out of Iowa Medicaid Plan
The Des Moines Register, Oct. 17, 2014
CoOportunity Health will not be returning to the Iowa Medicaid exchange next year, leaving Coventry Health Care the sole private provider.

Colo. Insurers Cancel 22,000 Plans Last Month
Politico, Oct. 17, 2014
State insurance authorities notified 22,000 Colorado residents their health plans would be canceled at the end of the year.

WellCare, Florida Agree to Medicaid Reimbursement Rate for Sovaldi Treatment
iMarketreports.com, Oct. 17, 2014
WellCare Health Plans Inc. and Florida’s Agency for Health Care Administration amended their Medicaid agreement regarding Sovaldi payments.

Patients Sue United for $2.5B in Hep C Lawsuit
Law360, Oct. 17, 2014
Patients are seeking $2.5 billion from UnitedHealth Group’s subsidiaries Health Plan of Nevada and parent company Sierra Health Services Inc. after the insurers referred them to a clinic contaminated with hepatitis C.

Cigna Sues Health Diagnostic Laboratory for $84M in Overbilling Claim
Hartford Courant, Oct. 20, 2014
Cigna is suing a Virginia clinical lab for $84 million, saying the lab attracted patients by promising no co-pays, then billing the insurer for “phantom” services.

PreferredOne to Increase Premiums by 63%
Star Tribune, Oct. 16, 2014
Minnesota’s top-selling insurer, who had some of the lowest premiums in the country, said 2015 premiums will increase by an average of 68%.

Kaiser HMO Scores Top Marks in Calif.
Los Angeles Times, Oct. 15, 2014
California officials gave Kaiser Permanente the only top health plan score in the state.

Del. Reaches Medicaid Agreement with United, Highmark
Delaware Health and Social Services, Oct. 15, 2014
Delaware announced Highmark Inc. will join its Medicaid program, and that it has reached an agreement with UnitedHealth Group to continue their partnership.

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From the AIS Blogs

Some in the device industry contend that new payment models are going to squelch reimbursement for new technology, like medical devices used in heart surgery procedures, but others in the health care space disagree. What do you think? Are payment models that put value or shift the risk in part to providers a possible roadblock to new technology? Join the conversation at the AIS Blogs.


People on the Move

CareSource Names New Leadership
CareSource press release, Oct. 21, 2014
Kim Roherty joined CareSource as vice president of quality and performance outcomes. She was previously in charge of health plan best practices, outcome management and business intelligence for Hewlett Packard.

BCBSNJ Names Senior VP
BCBSNJ press release, Oct. 20, 2014
Horizon Blue Cross Blue Shield of New Jersey appointed Minal Patel, M.D., senior vice president and chief strategy officer. Patel was most recently executive vice president of iHealth Technologies.

San Francisco Health Plan Names New CMO
PRNewswire, Oct. 21, 2014
San Francisco Health Plan named James Glauber, M.D., M.P.H., chief medical officer. He joined the company from Neighborhood Health Plan in Boston.

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Provider Contracting

Sutter North Docs Added to Anthem Network
Appeal-Democrat, Oct. 21, 2014
Sutter North Medical Group added 65 physicians to Anthem Blue Cross, a division of Anthem Insurance Companies, Inc.

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Have breaking news or an editorial question? Email Erin Trompeter, editor of SPOTLIGHT ON HEALTH INSURERS, at etrompeter@aishealth.com. If you are interested in sponsoring SPOTLIGHT ON HEALTH INSURERS please contact Bailey Sterrett at bsterrett@aishealth.com.

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