From Medicare Advantage News - While Medicare Advantage products generally have performed strongly recently, that has not been the case in at least some aspects for two of the industry’s former stalwarts, Humana Inc. and Universal American Corp. In both cases the culprit may be related to aggressiveness that has led to high medical loss ratios (MLRs) in some markets, and the setbacks come despite relatively strong star-ratings performance. Read more
From Medicare Advantage News - If there was one factor that enabled Essence Healthcare to become a five-star-rated Medicare Advantage plan for the first time in 2016, it probably was the insurer’s model of physician engagement, Essence’s chief medical officer told an AIS star-ratings virtual conference session Feb. 4. Deborah Zimmerman, M.D., traced how the structure and incentives used in working closely with 12 physician groups have translated into having just a 2.9% medical cost… Read more
From Medicare Advantage News - Aetna Inc.’s planned acquisition of Humana Inc. took a big step forward this month when the Florida Office of Insurance Regulation (FOIR) approved the deal without requiring any divestitures. Florida is perhaps Humana’s key Medicare Advantage market, where it operates under both its own name and as CarePlus and where it had more than $1 billion in MA premiums in 2014. Humana led the state MA market with a 40%… Read more
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