Datapoint: Molina Scores Kentucky Medicaid Contract

December 9, 2019

Following a period of contract losses and service area reductions, Molina Healthcare last week scored a new managed Medicaid contract in Kentucky. The insurer will operate one of five plans selected to serve Kentucky’s 1.26 million Medicaid lives. Molina currently enrolls 2,783,150 Medicaid and CHIP members in 10 states and Puerto Rico.

Following a period of contract losses and service area reductions, Molina Healthcare last week scored a new managed Medicaid contract in Kentucky. The insurer will operate one of five plans selected to serve Kentucky’s 1.26 million Medicaid lives. Molina currently enrolls 2,783,150 Medicaid and CHIP members in 10 states and Puerto Rico.

Source: AIS’s Directory of Health Plans

Highmark’s New Hemophilia Initiative Aims to Improve Care, Reduce Costs

December 9, 2019

With an eye on reducing spending and improving care among members with hemophilia, Highmark Inc. will launch a comprehensive program focused on the condition on Jan. 1. The health plan will partner exclusively with three companies — Option Care Health, Inc., Soleo Health and the Hemophilia Center of Western Pennsylvania — on the initiative, which has the potential to improve member care, reduce costs and cut down on fraud, waste and abuse.

By Angela Maas

With an eye on reducing spending and improving care among members with hemophilia, Highmark Inc. will launch a comprehensive program focused on the condition on Jan. 1. The health plan will partner exclusively with three companies — Option Care Health, Inc., Soleo Health and the Hemophilia Center of Western Pennsylvania — on the initiative, which has the potential to improve member care, reduce costs and cut down on fraud, waste and abuse.

Highmark chose hemophilia to focus on for a few reasons, says Sean Burke, manager of specialty pharmacy services at the plan. “We have a pretty comparatively high population” of people with hemophilia, and “clients were coming to us” for effective management strategies. New therapies — as well as a crowded pipeline — mean there is “a big opportunity to potentially save money.”

Of Highmark’s 4.5 million members, approximately 190 have a hemophilia diagnosis, and the health plan says it spends about $80 million annually on their care, with pharmacy costs making up about 90% of that.
The partners will be able to obtain the therapies at competitive rates, in large part because they “have more volume,” says Ned Finn, director of specialty pharmacy services at the insurer.

Highmark and the providers have performance guarantees and oversight protocols in place. Plan members not only will receive better care, but members and health plan clients will see potential cost savings of “15% or so,” says Burke.

“There are a number of guarantees,” Drew Walk, Soleo’s CEO, says, that are “focused on reducing waste and overall cost of care,” as well as “improving patient outcomes.…There are clinical and financial outcomes measurements.” Hemophilia is a “unique” condition which requires “monitoring individual patient response,” he notes. The key, he maintains, is to “not be too obtrusive” in management but to “intervene when necessary and provide a good patient experience. It’s more than just dispensing the product.”

If a product experiences a shortage or goes off the market temporarily, “we have direct lines of communication with the providers” to handle the situation, says Burke. “These pharmacies are very experienced with knowing how to handle this.”

People on the Move

December 6, 2019

National Health Spending Reaches $3.88 Trillion in September

December 6, 2019

National health spending rose 4.9% between September 2018 and September 2019, according to a report by the nonprofit research and consulting organization Altarum. Spending on hospital care represented 33% of total health expenditures in September 2019, followed by spending on physician and clinical services. All major health spending categories saw increases year over year, with expenditures on prescription drugs growing the fastest, at 8.0%. Growth in home health care spending was only 1.9% over the same period of time.

by Jinghong Chen

National health spending rose 4.9% between September 2018 and September 2019, according to a report by the nonprofit research and consulting organization Altarum. Spending on hospital care represented 33% of total health expenditures in September 2019, followed by spending on physician and clinical services. All major health spending categories saw increases year over year, with expenditures on prescription drugs growing the fastest, at 8.0%. Growth in home health care spending was only 1.9% over the same period of time.

SOURCE: “Insights from Monthly National Health Spending Data through September 2019,” Altarum Center for Value in Health Care.

Datapoint: Centene to Sell Illinois Medicaid Plan to CVS

December 5, 2019

In light of the Medicaid behemoth’s planned merger with WellCare Health Plans, Inc., Centene Corp. this week said it has agreed to sell its Illinois managed Medicaid business, IlliniCare, to CVS Health, the parent company of Aetna. IlliniCare currently operates the third-largest managed Medicaid plan in Illinois, with 345,994 members.

In light of the Medicaid behemoth’s planned merger with WellCare Health Plans, Inc., Centene Corp. this week said it has agreed to sell its Illinois managed Medicaid business, IlliniCare, to CVS Health, the parent company of Aetna. IlliniCare currently operates the third-largest managed Medicaid plan in Illinois, with 345,994 members.

Source: AIS’s Directory of Health Plans