State to consider non-profit insurers' surplus

Dina Overland — Fri, 03 Feb 2012 13:02:37 -0500

Legislation in Washington state would allow the insurance commissioner to consider non-profit health insurers' surpluses when deciding whether their proposed premiums are reasonable, reported LifeHealthPro. "The state's three major insurers--all of whom are non-profit companies--have amassed more than $2.4 billion in surplus," Insurance Commissioner Mike Kreidler said. "Yet under current law, I cannot consider a company's surplus when reviewing rates. It's like trying to ignore the elephant in the room." The bills (H.B. 1301 and S.B. 5247) are two versions of a measure that would give Kriedler the authority to consider these surpluses. However, Kriedler's office clarified that insurers' surpluses aren't the same as reserves. "Reserves are required to ensure a company can pay future claims," officials wrote in a comment on the measure. "Surplus is what's left over after accounting for all foreseeable future claims and expenses." Article

Blues' Horizon invests $1M to train medical home care coordinators

Dina Overland — Fri, 03 Feb 2012 11:21:42 -0500

Horizon Healthcare Innovations has created a specialized nurse training program for nurses working in its parent Horizon Blue Cross Blue Shield of New Jersey's patient-centered medical home programs. Horizon is investing more than $1 million to fund the training program and provide payments to medical practices so they can afford to hire care coordinators.

In collaboration with Duke University School of Nursing and Rutgers College of Nursing, Horizon developed the 12-week course to train nurses to become population care coordinators, who act as patient coaches and advocates working to improve preventive and wellness care, NJ Spotlight reported.

"This gives us a great opportunity to formalize the education around what they are going to be doing in these practices," said Horizon President and chief operating officer Richard Popiel. "This is something nurses have not been taught in traditional nursing schools."

The training program, which includes both face-to-face and online sessions, can be completed either through continuing education credits or as part of an advanced nursing degree. It focuses on skills involving case management, database use, care coordination for patients admitted to and discharged from care facilities and patient-centered medical home operations, reported NJBiz.

"The patient-centered medical homes, the concept, will not translate into success unless you have the critical building blocks or foundational elements that set you up for success, and the population-care coordinator is one of those critical foundations," Popiel said.

Almost 40 nurses are undergoing the training, and Horizon hopes to train a total of 200 nurses over the next two years, according to the Star-Ledger.

To learn more:
- read the NJBiz article
- see the Star-Ledger article
- check out the NJ Spotlight article

Blue Cross bows out of state Medicaid privatization

Dina Overland — Fri, 03 Feb 2012 11:10:42 -0500

Blue Cross Blue Shield of Kansas has decided not to participate in the state's shift toward privatizing its Medicaid program.

The decision announced Wednesday means the state's largest health insurer won't be submitting a proposal to become a private Medicaid contractor, reported the Kansas City Star.

Under Kansas Gov. Sam Brownback's (R-Kan.) plan, all Medicaid members would shift into a private managed care program. But Blue Cross spokeswoman Mary Beth Chambers said the Medicaid contracts would require the insurer to provide services that it doesn't currently offer, such as helping families decide whether they should admit elderly members into a nursing home, according to the Associated Press. "We just felt it wasn't responsible for us to commit to changing our business model that much," Chambers said.

"In the end, although we believe the [request for proposals] may present a sizeable opportunity, it would have required us to dramatically change our business model to serve new populations in different settings in less than a year," Angie Strecker, director of institutional relations for Blue Cross, wrote in a letter to providers. "We decided that we could not responsibly commit to so great a change at this time."

Chambers clarified though that the Blue Cross decision shouldn't be interpreted as a criticism of Brownback's plan to privatize Medicaid, the AP noted. "We certainly have no intent - and would be disappointed - if people read our decision as criticizing the governor's proposals," she said.

Meanwhile, state Rep. Jim Ward (D-Kan.) introduced a bill (H.B. 2573) that, if implemented, the privatization plans would require Medicaid contractors to undergo annual audits to ensure Medicaid recipients' benefits aren't reduced, the Kansas City Star noted.

The audits would determine whether changes were made to the quality or quantity of service, the number of people receiving services or rates paid to providers. They also would survey Medicaid contractors and recipients to find out whether they're satisfied with the new program, the Wichita Eagle reported.

To learn more:
- read the Kansas City Star article
- see the Wichita Eagle article
- check out the Associated Press article

Medicare Advantage enrollment grows 10% as insurers compete

Dina Overland — Fri, 03 Feb 2012 10:49:54 -0500

Enrollment in Medicare Advantage has grown by 10 percent. Meanwhile, premiums have fallen at an average 7 percent as insurers compete for seniors' business, the Department of Health & Human Services announced Wednesday.

Roughly 12.8 million seniors now are enrolled in a Medicare Advantage health plan, up from 11.7 million in 2011. Average monthly premiums fell from $33.97 in 2011 to $31.54 this year. In total, Medicare Advantage premiums have dropped by 16 percent, and enrollment has increased by 17 percent since health reform law passed in 2010, reported The Hill's Healthwatch.

"We're seeing a very competitive landscape," Jonathan Blum, deputy administrator of the Centers for Medicare & Medicaid Services, told USA Today. "The plans seem to want to compete hard for their beneficiaries."

In fact, the CEOs of several large insurers offering Medicare Advantage plans, including WellPoint, Humana and UnitedHealth, have predicted their Medicare business will continue to grow, the USA Today reported.

HHS also said seniors are getting better coverage as they increasingly enroll in four- and five-star private Medicare plans. "The Affordable Care Act has strengthened Medicare Advantage by motivating plans to improve the quality of their coverage," said CMS Acting Administrator Marilyn Tavenner.

However, Robert Zirkelbach, spokesman for America's Health Insurance Plans, warned that the reform law's biggest cuts to Medicare Advantage don't come until 2015 so insurers shouldn't start celebrating just yet, reported Kaiser Health News.

"When you take $200 billion out of the program, it's going to have a real impact on seniors," Zirkelbach told KHN. "These cuts will result in higher out-of-pocket costs and reduced benefits for seniors in Medicare Advantage."

To learn more:
- read the USA Today article
- see the Kaiser Health News article
- check out The Hill's Healthwatch article
- see the HHS press release

Aetna's Q4 profits soar 73%, Cigna's earnings drop

Dina Overland — Fri, 03 Feb 2012 10:43:25 -0500

Aetna's fourth-quarter profit rose sharply as a result of its members using few healthcare services, while Cigna's profits dropped.

Aetna said Wednesday its earnings increased by 73 percent and its net income rose to $372.6 million compared to $215.6 million last year. The insurer's fourth-quarter operating income also rose 39 percent to $354.3 million from $255 million a year before, reported the Hartford Courant.

"During 2011, we made strategic investments in acquisitions and technologies that created a unique set of capabilities to both extend aetna's core health business and poise us to capitalize on exciting new consumer and provider opportunities emerging in the marketplace," said aetna CEO Mark Bertolini.

Cigna, however, didn't fare as well when it posted its fourth quarter results Thursday. The insurer's quarterly earnings dropped 37 percent as its net income fell to $290 million from $461 million a year earlier, reported the Associated Press.

The good news was that earnings from Cigna's healthcare division rose 4 percent to $216 million, and its membership grew by about 900,000 members to a total of 11.48 million members, Reuters reported.

Revenue from Cigna's international business increased 31 percent last year as the insurer began selling health plans in Asia. Although Cigna expects to increase its earnings outside of the United States by as much as 30 percent, it doesn't plan to continue expanding internationally. "From a prioritization of new countries to enter, we did Turkey and India, so we are where we want to be," Cigna CEO David Cordani told Bloomberg. "There are not additional countries on the horizon to enter."

To learn more:
- see the Hartford Courant article
- read the Reuters article
- see the Bloomberg article
- read the Associated Press article

Michigan Blues wants aetna antitrust lawsuit dismissed

Dina Overland — Thu, 02 Feb 2012 09:44:35 -0500

Blue Cross Blue Shield of Michigan on Monday asked a federal court to dismiss aetna's lawsuit that claims its hospital contracts are anti-competitive and therefore cause aetna members' healthcare costs to increase.

Aetna filed the lawsuit, alleging Blue Cross uses its market dominance in Michigan to implement most-favored nation clauses with hospitals that forces them to charge aetna more than the Blue Cross rate. Aetna also claims the Blues contracts have prevented aetna from successfully expanding in the Michigan insurance market, including causing the insurer to stop selling health plans to small businesses in the state, reported the Detroit News.

In its motion, Blue Cross responded to aetna's claims, saying the Hartford-based insurer isn't prohibited from contracting with hospitals in Michigan just because it successfully negotiates with hospitals to achieve discounts, Crain's Detroit Business reported.

"Rather than investing in the state like Blue Cross does, aetna is resorting to litigation as a business strategy to tear down a competitor that is invested here," said Andrew Hetzel, Blue Cross vice president for corporate communications. "In contrast, Blue Cross is succeeding in Michigan by providing more health care value for customers' dollars. Our discounts - fairly negotiated with hospitals - are part of that value."

Aetna, however, stood its ground. Spokesman Scot Roskelley said the company sued because "there is strong evidence" that Blue Cross is "in violation of antitrust laws," according to the Detroit Free Press.

To learn more:
- read the Detroit News article
- see the Crain's Detroit Business article
- check out the Detroit Free Press article