Payer Roundup—Cigna, Express Scripts schedule merger vote; physician groups back risk adjustment payments

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Cigna shareholders will vote a proposed acquisition of Express Scripts at the end of August. (Getty/toeytoey2530)

Cigna and Express Scripts announce August merger vote

Shareholders for Cigna and pharmacy benefits manager Express Scripts will meet next month to vote on the companies’ planned merger worth $67 billion. 

In a letter to shareholders, the CEOs and chairmen of each company said the merger will create “a blueprint for integrated and personalized health care." The shareholder vote is scheduled for Aug. 24 in West Hartford, Connecticut, near Cigna’s headquarters in Bloomfield.

Current Cigna stockholders will hold about 64% of shares, and Express Scripts shareholders will hold about 36% if the merger is approved. The deal is being closely reviewed by federal regulators at the Justice Department. (SEC filing)

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Physician associations denounce suspension of risk adjustment payments

The suspension of risk adjustment payments will make health insurance unaffordable for many families, six physician associations said in a joint statement on Wednesday, urging the Centers for Medicare & Medicaid Services (CMS) to reverse its decision.

“As physicians who provide the majority of Americans’ most essential medical care, we can attest to the importance of ensuring that the people who need care the most are able to secure affordable health care coverage,” the statement read.

The groups included the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the American College of Physicians, the American Osteopathic Association and the American Psychiatric Association. (Letter [PDF])

Colorado premiums expected to rise less this year, and some will even decrease

Premiums on Colorado’s individual and small group markets could see their “smallest [price] increase in years,” the state’s Division of Insurance announced Friday.

On the individual market, the average price increase request across all companies and metal levels so far is 5.94%. Bronze, silver, and gold plans have requested an average increase of 0.9%, 12.3%, and 6.85%, respectively.

The Division noted that two plans, both under the Anthem-Blue Cross Blue Shield umbrella, requested rate decreases: -0.44% for HMO Colorado and -2.64% for Rocky Mountain Hospital and Medical Service.

The state’s small group market plans have requested an average price increase of 7.15%. (Release)

Four more insurers join AHIP

The lobbying and trade organization America’s Health Insurance Plans (AHIP) welcomed four new members on Monday: CalOptima, Health Plan of San Joaquin, CareOregon, and Priority Health.

The two California-based plans, CalOptima and Health Plan of San Joaquin, offer public coverage to low-income residents of Orange County and the Central Valley, respectively. Similarly, CareOregon provides coverage to low-income households in Oregon.

Michigan’s Priority Health offers plans on the large group, small group, and individual markets in addition to serving the state’s Medicare and Medicaid populations.

The four organizations serve more than 2 million consumers total. (Release

Physicians don't feel responsible for their patients' costs, but it's not because they don't care

A majority of physicians do not feel accountable for the costs their patients incur, according to a survey released in NEJM Catalyst last week.

Of the survey’s 571 respondents, 99% said the cost of care is “important,” “very important,” or “extremely important” to patients. But when asked whether physicians should be held accountable for the cost of care to patients, only 28% agreed, and nearly one-fifth “strongly” disagreed.

Additionally, only 36% of respondents said their organizations factor national health care costs into their clinical decisions.

So who do physicians believe drive health care costs? Some 87% of respondents said pharmaceutical companies and 81% pointed to insurers.

The report said physicians should understand how their clinical decisions impact costs for patients, but it also acknowledged that physicians are not entirely to blame, as they do not determine pricing for insurance, drugs, or devices. Further, many respondents felt they lacked the training, tools and time to discuss the cost of care with their patients.

Clinical leaders quoted in the report said physicians deserve a greater voice in discussions about costs, as well as easy-to-use resources that can keep them up-to-date on prices and coverage. Care teams that include social workers and others could help navigate costs with patients without impeding physicians’ productivity. (Report)

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