Payer Roundup—Anthem might exit more exchanges; OIG says continued CO-OP oversight needed

anthem
Anthem CEO Swedish said the insurer is continuing its strategy of “surgical extraction” from individual marketplaces when it deems it necessary. (Matthew Hurst/CC BY-SA 2.0)

Speaking at the Morgan Stanley Global Healthcare Conference this week, Anthem CEO Joseph Swedish indicated that the insurer might be poised to exit more Affordable Care Act exchanges.

“There’s still some remaining states that we are in negotiation with—both the regulators as well as the legislative arena—to position ourselves appropriately” for 2018, he said. Insurers have until Sept. 27 to finalize the ACA exchange participation plans.

Swedish said the insurer is continuing its strategy of “surgical extraction” from individual marketplaces when it deems it necessary. Anthem has already announced that it will exit the exchanges in Virginia, Nevada, Wisconsin, Indiana and Ohio next year, and it will reduce its presence in Kentucky, Missouri, California and Georgia.

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As is the case for other insurers, one of the biggest problems for Anthem’s individual market business is the uncertainty over funding for cost-sharing reduction payments, Swedish said, noting that 70% of its members receive those subsidies. “If that is not available, that translates to really significant deterioration of the marketplace,” he added. (Webcast replay)

OIG to CMS: Continue oversight of CO-OPs

Though only six consumer-operated and oriented plans out of the original 23 remained operational by the end of the 2016 plan year, federal regulators must continue to closely oversee them, according to the Department of Health and Human Services Office of Inspector General.

The six CO-OPs still standing when the agency conducted its review did not appear to be financially viable and sustainable based on their reported net income and available capital and surplus, the agency said. Thus, it recommended that the Centers for Medicare & Medicaid Services keep working with them to improve their financial condition, continue using corrective action and enhanced oversight plans, and keep working with states to ensure CO-OP plan members receive continuous coverage and access to plan providers and services. (Report) (PDF)

UnitedHealth might buy Chilean healthcare company

South American company Banmedica SA recently informed regulators that it entered a nonbinding agreement to sell all its shares to UnitedHealth.

The company provides health insurance and other services and operates clinics. It said the price per share would be $3.47 if the takeover bid materializes, though its statement did not mention the estimated total value of the proposed deal. (Reuters)

Baylor Scott & White teams up with Cigna

Cigna has joined forces with the Baylor Scott & White Quality Alliance on a population health initiative. The initiative, which aims to improve care quality and affordability as well as patient experience, will target 40,000 individuals who are covered by Cigna and get care from BSWQA physicians.

Cigna will compensate physicians involved in the initiative for the medical and care coordination services they provide, and may award them additional reimbursement if they meet certain targets for improving quality and lowering medical costs. (Release)

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