Health Plans

Datapoint: Health Net, Canopy Launch New Bay Area Plan

September 22, 2020

Health Net last week said it will launch a new insurance product, targeting large employer groups in the San Francisco Bay Area, in January 2021. The plan, CanopyCare, is a partnership with Canopy Health, an accountable care network of more than 5,000 Bay Area physicians that focuses on high-touch member care and cost transparency. Health Net is a California-based division of Centene Corp., acquired in 2015. Centene is currently the fourth-largest insurer in California, with 3,132,104 members.

Health Net last week said it will launch a new insurance product, targeting large employer groups in the San Francisco Bay Area, in January 2021. The plan, CanopyCare, is a partnership with Canopy Health, an accountable care network of more than 5,000 Bay Area physicians that focuses on high-touch member care and cost transparency. Health Net is a California-based division of Centene Corp., acquired in 2015. Centene is currently the fourth-largest insurer in California, with 3,132,104 members.

Source: AIS’s Directory of Health Plans

Surgeon General, Humana CEO Say Pandemic Highlights Health Care Priorities

September 21, 2020

If there’s any upside to the COVID-19 pandemic, it’s that it has laid bare what both the country and health care organizations need to prioritize moving forward, suggested two keynote speakers during the America’s Health Insurance Plans (AHIP) National Conference on Medicare, Medicaid & Dual Eligibles, which was held online from Sept. 14-17.

“I really do hope that we don’t just look at this as a fire to be put out, but we look at it as a real opportunity to address some underlying kindling that was there,” VADM Jerome Adams, M.D., the U.S. Surgeon General, said during a Sept. 14 panel. A major part of that “kindling,” he said, are the stark disparities in social and economic conditions experienced by different racial and ethnic groups across the country.

By Leslie Small

If there’s any upside to the COVID-19 pandemic, it’s that it has laid bare what both the country and health care organizations need to prioritize moving forward, suggested two keynote speakers during the America’s Health Insurance Plans (AHIP) National Conference on Medicare, Medicaid & Dual Eligibles, which was held online from Sept. 14-17.

“I really do hope that we don’t just look at this as a fire to be put out, but we look at it as a real opportunity to address some underlying kindling that was there,” VADM Jerome Adams, M.D., the U.S. Surgeon General, said during a Sept. 14 panel. A major part of that “kindling,” he said, are the stark disparities in social and economic conditions experienced by different racial and ethnic groups across the country.

The factors contributing to those disparities are numerous, Adams suggested, but they all relate to the social determinants of health. For instance, Adams pointed out “only one in five African Americans and one in six Hispanic Americans has a job that allows them to work from home” to reduce their exposure to the novel coronavirus.

The health insurance industry, like the country at large, now has an opportunity to fix some of the problems that caused the pandemic to do so much damage, Adams argued. “As insurers, have the courage to crack some eggs and to think about how we restructure these systems, and use COVID-19 as the wind in your sails to do that,” he advised the AHIP conference’s virtual audience.

Humana President and CEO Bruce Broussard, meanwhile, said during a Sept. 14 question-and-answer panel that the pandemic has sharpened his focus on the core principles that guide his company.

“It reinforces the deep need for purpose and values inside your organization, because when you’re in a situation like COVID, if you don’t have that, then you run your business by policies and procedures, and so on, and you can’t rewrite policies and procedures in a time of change,” Broussard said.

Having a concentration in Medicare Advantage also helped shape Humana’s response to the crisis, since such plans are already reimbursed in a way that rewards taking a whole-person approach to health care, according to Broussard.

As Payer M&A Slows Down, What’s Next?

September 17, 2020

The climate for payer mergers and acquisitions (M&A) has cooled substantially at a national level ever since the collapse of the proposed deals between Anthem, Inc. and Cigna Corp. and between Aetna Inc. and Humana Inc. However, consolidation in the provider sector has increased since the start of the COVID-19 pandemic as such firms grapple with the rapid collapse of fee-for-service revenue.

The breakdown of Anthem’s bid to acquire Cigna resulted in a public spat and dueling lawsuits over Cigna’s attempt to exit their agreement before exhausting the firms’ option to appeal a federal ruling against the transaction. On Aug. 31, the Delaware Court of Chancery ruled that neither firm had to pay damages to the other over the failed deal.

By Peter Johnson

The climate for payer mergers and acquisitions (M&A) has cooled substantially at a national level ever since the collapse of the proposed deals between Anthem, Inc. and Cigna Corp. and between Aetna Inc. and Humana Inc. However, consolidation in the provider sector has increased since the start of the COVID-19 pandemic as such firms grapple with the rapid collapse of fee-for-service revenue.

The breakdown of Anthem’s bid to acquire Cigna resulted in a public spat and dueling lawsuits over Cigna’s attempt to exit their agreement before exhausting the firms’ option to appeal a federal ruling against the transaction. On Aug. 31, the Delaware Court of Chancery ruled that neither firm had to pay damages to the other over the failed deal.

This failed deal was a catalyst for the slowing pace of health insurance consolidation at the national scale, according to antitrust lawyer and former Federal Trade Commission official David Balto.

Ashraf Shehata, KPMG national sector leader for health care and life sciences, says that Cigna’s acquisition of Express Scripts, a transaction that the firm pursued partly because of the failed Anthem merger, set a precedent of its own.

“I would say what that has spawned instead of the health plan integration, it’s spawned…the PBM integration. Rather than health plan to health plan, it was health plan plus PBM. And we saw that across the board with all the commercial entities,” he says.

Shehata says he sees three likely types of payer transactions and reorganizations going forward. The first is the PBM-payer integration. Second, Shehata says that horizontal coordination between regional payers, if not outright mergers, is likely to accelerate. Finally, he’s tracking the emerging model of “health plan plus retail plus PBM.”

Michael Abrams, co-founder and managing partner of consultancy Numerof & Associates, says that large regional hospital systems with healthy balance sheets are likely to speed up their vertical acquisition of independent hospitals or horizontal consolidation with local peers.

Abrams also points out that this wave of consolidation will compound or accelerate the rising cost of health care. He adds this continual rise in prices will eventually drain the generous margins that payers have enjoyed over the course of the pandemic.

Datapoint: Centene Plots Major 2021 Exchange Expansion

September 16, 2020

Centene Corp. last week said it will expand its Affordable Care Act exchange products to two new states (Michigan and New Mexico) and 400 new counties in its existing markets for the 2021 plan year. Centene is currently the largest exchange insurer in the U.S., with 2,187,894 members across 13 states. Nationally, Centene enrolls 19.1% of all exchange lives.

Centene Corp. last week said it will expand its Affordable Care Act exchange products to two new states (Michigan and New Mexico) and 400 new counties in its existing markets for the 2021 plan year. Centene is currently the largest exchange insurer in the U.S., with 2,187,894 members across 13 states. Nationally, Centene enrolls 19.1% of all exchange lives.

Source: AIS’s Directory of Health Plans

Datapoint: Anthem, Ascension to Launch Wisconsin Exchange Plans

September 15, 2020

Anthem, Inc. last week said it will launch co-branded health plans with Ascension Wisconsin on the Affordable Care Act exchanges for the 2021 plan year. Members will have in-network access to Ascension Wisconsin’s “24 hospital campuses, 110 care locations, and more than 1,300 physicians,” according to a press release. The plans will be offered in six southeast Wisconsin counties. Anthem does not have an ACA market presence in Wisconsin, where 179,731 are currently enrolled in exchange plans.

Anthem, Inc. last week said it will launch co-branded health plans with Ascension Wisconsin on the Affordable Care Act exchanges for the 2021 plan year. Members will have in-network access to Ascension Wisconsin’s “24 hospital campuses, 110 care locations, and more than 1,300 physicians,” according to a press release. The plans will be offered in six southeast Wisconsin counties. Anthem does not have an ACA market presence in Wisconsin, where 179,731 are currently enrolled in exchange plans.

Source: AIS’s Directory of Health Plans

CMS Might Punt on Approving Georgia’s Revised Waiver Request

September 15, 2020

Georgia recently reaffirmed its proposal to make dramatic changes in its individual market, saying it plans to abandon the Affordable Care Act (ACA) marketplace in favor of a new state program despite the widespread disruptions in health care and health insurance brought by the coronavirus pandemic.

In its revised Section 1332 waiver request to CMS, Georgia said it wanted to push back the start date for part of its plan, meaning the proposal’s two parts wouldn’t take effect until 2022.

By Jane Anderson

Georgia recently reaffirmed its proposal to make dramatic changes in its individual market, saying it plans to abandon the Affordable Care Act (ACA) marketplace in favor of a new state program despite the widespread disruptions in health care and health insurance brought by the coronavirus pandemic.

In its revised Section 1332 waiver request to CMS, Georgia said it wanted to push back the start date for part of its plan, meaning the proposal’s two parts wouldn’t take effect until 2022.

The first part of the proposal, a reinsurance program, would help insurers pay high-cost claims with the goal of lowering premiums. According to Georgia’s calculations, the reinsurance program would reduce premiums for the individual market statewide by 10.2% and as a result would increase enrollment by 0.4% in 2022.

More controversially, the “Georgia Access Model” would make more drastic changes to the individual market, including directing consumers to buy coverage through private broker or insurer websites, rather than via HealthCare.gov.

Tara Straw, senior policy analyst at the left-leaning Center on Budget and Policy Priorities, warned in a Sept. 1 report that “evidence from past, far simpler transitions between federal and state marketplaces suggests that tens of thousands of Georgians might lose coverage simply because of the disruption from the state’s transition away from HealthCare.gov.”

The proposal also would “give insurers and brokers new opportunities to steer healthier consumers toward substandard plans that expose them to catastrophic costs if they get sick,” Straw wrote. “The resulting adverse selection could make comprehensive coverage more expensive for those who need it, reducing their enrollment as well.”

However, Joseph Antos, the Wilson H. Taylor Scholar in Health Care and Retirement Policy at the right-leaning American Enterprise Institute, says that it’s not clear whether CMS will move to approve Georgia’s revised proposal, or will wait to consider it until after the election. He thinks a long wait is more likely.

“It raises a political question in my mind: ‘Do you have CMS approve this thing?’ And then get into another court battle with the headline being, ‘Trump administration approves taking away good coverage for low-income people in Georgia,’” Antos says. “This doesn’t have the feel of a sure approval.”