News Briefs

News Briefs

June 18, 2021

The combined organization created by a merger between Tufts Health Plan and Harvard Pilgrim Health Care will now be known as Point32Health. “Inspired by the 32 points on a compass, Point32Health represents the role the organization plays in guiding and empowering its members and making a meaningful impact across the health care industry,” per a press release. The parent company of the combined organization will be headquartered in Canton, Mass.

The combined organization created by a merger between Tufts Health Plan and Harvard Pilgrim Health Care will now be known as Point32Health. “Inspired by the 32 points on a compass, Point32Health represents the role the organization plays in guiding and empowering its members and making a meaningful impact across the health care industry,” per a press release. The parent company of the combined organization will be headquartered in Canton, Mass.

More than 1.2 million people signed up for health insurance through HealthCare.gov between Feb. 15 and May 31, according to CMS. By comparison, 501,000 people signed up for coverage in 2020 in the same period of time and 359,000 did in 2019. The increased signups are possible because of a pandemic-related special en-rollment period that applies to all consumers — not just those with qualifying life events — and increased uptake is also likely due to more generous premium subsidies included in the American Rescue Plan Act.

Unlock the full version of this article by subscribing.

Log in | Learn More

News Briefs

June 18, 2021

✦ The combined organization created by a merger between Tufts Health Plan and Harvard Pilgrim Health Care will now be known as Point32Health. “Inspired by the 32 points on a compass, Point32Health represents the role the organization plays in guiding and empowering its members and making a meaningful impact across the health care industry,” per a press release. The parent company of the combined organization will be headquartered in Canton, Mass.

To access this post, you must purchase a subscription plan. Click Here to purchase.

Already a member? Click Here to login.

News Briefs

June 17, 2021

Centene Corp. on June 14 said it reached no-fault agreements with the attorneys general of Ohio and Mississippi to resolve claims made by the states related to services provided by Envolve Pharmacy Solutions, Inc. The Ohio Dept. of Medicaid and the state in March accused Centene of violating its Medicaid contract by using a “web of subcontractors” to hide pharmacy information from ODM. Those subcontractors included Envolve, one of its pharmacy benefit manager subsidiaries, which will no longer serve as a PBM on behalf of Centene’s local health plans, according to the company. As a result of the settlement, Centene will pay $88 million to Ohio and $55 million to Mississippi; it did admit any liability for the pharmacy practices alleged by both states.

Centene Corp. on June 14 said it reached no-fault agreements with the attorneys general of Ohio and Mississippi to resolve claims made by the states related to services provided by Envolve Pharmacy Solutions, Inc. The Ohio Dept. of Medicaid and the state in March accused Centene of violating its Medicaid contract by using a “web of subcontractors” to hide pharmacy information from ODM. Those subcontractors included Envolve, one of its pharmacy benefit manager subsidiaries, which will no longer serve as a PBM on behalf of Centene’s local health plans, according to the company. As a result of the settlement, Centene will pay $88 million to Ohio and $55 million to Mississippi; it did admit any liability for the pharmacy practices alleged by both states.

Three Medicare Advantage insurers that challenged a temporary star ratings policy implemented by CMS last April lost their legal battle. In AvMed, Inc. et al v. Azar et al (No. 20-3385), filed Nov. 20, 2020, in the U.S. District Court for the District of Columbia, Florida-based AvMed and Nevada-based Prominence HealthFirst argued that CMS unlawfully changed the ratings in a way that unfairly penalized organizations when it issued an interim final rule suspending the collection of certain data. In an opinion issued June 1, U.S. District Court Judge John D. Bates sided with CMS, arguing that the agency’s “analytical path was clear” and that there’s no way to confirm that the plaintiffs’ ratings would have improved if not for the suspended data collection.

Unlock the full version of this article by subscribing.

Log in | Learn More

News Briefs

June 17, 2021

✦ Centene Corp. on June 14 said it reached no-fault agreements with the attorneys general of Ohio and Mississippi to resolve claims made by the states related to services provided by Envolve Pharmacy Solutions, Inc. The Ohio Dept. of Medicaid and the state in March accused Centene of violating its Medicaid contract by using a “web of subcontractors” to hide pharmacy information from ODM. Those subcontractors included Envolve, one of its pharmacy benefit manager subsidiaries, which will no longer serve as a PBM on behalf of Centene’s local health plans, according to the company. As a result of the settlement, Centene will pay $88 million to Ohio and $55 million to Mississippi; it did admit any liability for the pharmacy practices alleged by both states.

To access this post, you must purchase a subscription plan. Click Here to purchase.

Already a member? Click Here to login.

News Briefs

June 11, 2021

HHS Secretary Xavier Becerra on June 9 sent a letter to health insurers and providers warning them that COVID-19 vaccines and tests must be provided free of charge to patients. “In light of recent reports of consumer cost concerns,” he wrote — citing a recent New York Times article that indicated concern over unexpected medical bills was a reason cited by people who indicated they are hesitant to get the coronavirus vaccine — “I am reminding health care providers of their signed agreements to cover the administration of COVID-19 vaccines free-of-charge to patients, and group health plans and health insurers of their legal requirement to provide coverage of COVID-19 vaccinations and diagnostic testing without patients shouldering any cost.” Health plans that fail to comply with those legal requirements may be reported to appropriate state insurance departments or CMS “for possible enforcement action,” Becerra said.

HHS Secretary Xavier Becerra on June 9 sent a letter to health insurers and providers warning them that COVID-19 vaccines and tests must be provided free of charge to patients. “In light of recent reports of consumer cost concerns,” he wrote — citing a recent New York Times article that indicated concern over unexpected medical bills was a reason cited by people who indicated they are hesitant to get the coronavirus vaccine — “I am reminding health care providers of their signed agreements to cover the administration of COVID-19 vaccines free-of-charge to patients, and group health plans and health insurers of their legal requirement to provide coverage of COVID-19 vaccinations and diagnostic testing without patients shouldering any cost.” Health plans that fail to comply with those legal requirements may be reported to appropriate state insurance departments or CMS “for possible enforcement action,” Becerra said.

Clover Health Investments, Corp. on June 9 unveiled plans to expand its in-home primary care program, Clover Home Care, through CMS’s Direct Contracting model. The Medicare Advantage-focused startup insurer has bet big on that new model, which aims to lower costs and improve care quality for fee-for-service Medicare beneficiaries, but it also revealed during its first-quarter 2021 earnings report that it will likely have far fewer people covered by that program than it originally anticipated. In its most recent announcement, Clover said that “the goal of Direct Contracting is to make the Medicare program more financially sustainable for taxpayers while improving health outcomes for beneficiaries, which aligns with the work of Clover Home Care.” The company said its first two partners in the new effort, Spiras Health and Upward Health, “were chosen because of their record of exceptional care delivery in the home via a multidisciplinary model, which is core to Clover’s strategy for complex care management.”

Unlock the full version of this article by subscribing.

Log in | Learn More

News Briefs

June 11, 2021

✦ HHS Secretary Xavier Becerra on June 9 sent a letter to health insurers and providers warning them that COVID-19 vaccines and tests must be provided free of charge to patients. “In light of recent reports of consumer cost concerns,” he wrote — citing a recent New York Times article that indicated concern over unexpected medical bills was a reason cited by people who indicated they are hesitant to get the coronavirus vaccine — “I am reminding health care providers of their signed agreements to cover the administration of COVID-19 vaccines free-of-charge to patients, and group health plans and health insurers of their legal requirement to provide coverage of COVID-19 vaccinations and diagnostic testing without patients shouldering any cost.” Health plans that fail to comply with those legal requirements may be reported to appropriate state insurance departments or CMS “for possible enforcement action,” Becerra said.

To access this post, you must purchase a subscription plan. Click Here to purchase.

Already a member? Click Here to login.