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

August 28, 2014

This week's topics: Accountable Care OrganizationsExchanges Health Plan BusinessPersonnel AnnouncementsProvider Contracting

Accountable Care Organizations

Noble Health Alliance Selects Independence Blue Cross for Medical Benefits Administration, Accountable Care Initiatives
Independence Blue Cross Press Release, Aug. 26, 2014
Noble Health Alliance has chosen Independence Blue Cross to be its sole administrator of medical benefits plans and its preferred health insurer for the creation of an ACO.

The Nebraska Medical Center, Methodist Health System and Humana Announce Accountable Care Agreement for 2015
Humana Press Release, Aug. 26, 2014
Starting Jan. 1, 2015, Nebraska Medical Center, Methodist Health System and Humana will begin an accountable care partnership to improve the quality of Medicare Advantage plans for members in Omaha.

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Medicare Advantage News


UnitedHealthcare and ConnectedHealth Partner to Distribute Benefit Plan Options Through Smart Choices™ Marketplace
ConnectedHealth Press Release, Aug. 27, 2014
ConnectedHealth has partnered with UnitedHealthcare to offer group benefits to small- and medium-sized employers. The Columbus Bar Association is working with both companies to help roll out a joint version of ConnectedHealth’s Smart Choices Marketplace.

UnitedHealth to Expand Obamacare Reach From 4 to 24 States for 2015
MarketWatch, Aug. 22, 2014
Florida, Louisiana, Michigan, North Carolina, Ohio, Pennsylvania and Texas are among the 20 new states that will have access to UnitedHealthcare next year.

Assurant, UnitedHealth May Sell Through Illinois Exchange
LifeHealth Pro, Aug. 22, 2014
Assurant and UnitedHealthcare are likely to start selling coverage through the Illinois public health insurance exchange for the first time in 2015.

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The AIS Guide to Blue Cross and Blue Shield Plans: 2014

Health Plan Business

Compass Healthcare CFO Pleads Guilty to Fraud
WXIA, Aug. 27, 2014
Daniel Lane, Vice President and CFO of the St. Louis-based Compass Healthcare, has admitted to scamming Medicare and Blue Cross Blue Shield. 

Highmark Denies Allegations of Anti-Competitive Pricing
Bidness Etc, Aug. 27, 2014
A Highmark executive is denying the claim that the company raised prices in West Virginia due to a lack of competition. President Fred Earley cited the company’s limited network plan and West Virginians’ overall unhealthiness for the price hikes.

California Reverses Position on Health Insurance Abortion Coverage
San Jose Mercury News, Aug. 22, 2014
The California Department of Managed Health Care wrote a letter to seven insurers mandating that all group plans in the state include coverage for elective abortions. This follows two California universities changing their employer health insurance policies to not cover abortions unless they are medically necessary.

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From the AIS Blogs

Consultants say that nearly all PBMs now include a narrow network option when responding to requests for proposals. So maybe it’s no longer news that clients are “curious” about implementing a narrow network; perhaps it’s just a reality. Do you think narrow pharmacy networks are here to stay? Join the conversation at the AIS Blogs.

Personnel Announcements

Magellan Health Names Dr. Karen Amstutz as Chief Medical Officer
Magellan Health Press Release, Aug. 26, 2014
Starting September 15, Karen Amstutz will begin as Magellan’s chief medical officer and will be responsible for the company’s clinical strategy and policy vision.

HHS and CMS Announce New Members of the Management Team Ahead of 2015 Open Enrollment
HHS Press Release, Aug. 26, 2014
Access Health CT CEO Kevin Counihan is leaving Connecticut’s exchange to become CEO of

WellCare Promotes Miller to COO in Florida
Tampa Bay Business Journal, Aug. 26, 2014
WellCare has promoted Liz Miller to the chief operating officer position at WellCare of Florida, effective August 25.

Blue Cross and Blue Shield of Kansas City Announces Retirement of President and CEO David Gentile
Blue Cross Blue Shield Kansas City Press Release, Aug. 25, 2014
Blue Cross Blue Shield of Kansas City CEO David Gentile has retired. Danette Wilson will serve as interim President and CEO while the company searches for a new CEO.

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Specialty Pharmacy Trends and Strategies: 2014

Provider Contracting

MBS Sticks With Highmark for 2015
Pittsburgh Business Times, Aug. 26, 2014
Pittsburgh-based Municipal Benefits Services (MBS) will continue its contract with Highmark Blue Cross Blue Shield next year.

RMC Reportedly Extends Contract With Blue Cross
InsuranceNewsNet, Aug. 25, 2014
Regional Medical Center has extended its contract with Blue Cross Blue Shield of Alabama. Details concerning the length of the contract have not been disclosed.

Aetna to Recoup $8.4M for Inflated ER Billing
Healthcare Payer News, Aug. 25, 2014
Aetna is recouping $8.4 million after a federal judge in Texas ruled that three clinics had used a non-existent affiliation with a Cleveland Imaging & Surgical Hospital to charge higher fees over a two-year period.

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

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