Health Plan Weekly

Here’s how major U.S. health insurers performed financially in the third quarter of 2023. Health Plan Weekly subscribers can access more health plan financial data — including year-over-year comparisons of leading health plans’ net income, premium revenue, medical loss ratios and net margins. Just email support@aishealth.com to request spreadsheets for current and past quarters.

AHIP appointed a new president and CEO: Mike Tuffin, UnitedHealth Group’s senior vice president for external affairs. Tuffin succeeds Julie Simon Miller, who has been the health insurance trade group’s interim CEO since September, when Matt Eyles stepped down. Eyles helmed AHIP for nearly five years and said in May that his move to resign was a “personal decision.” Tuffin is no stranger to AHIP, having served as the group’s executive vice president for public affairs from 2002 to 2012. Before his role at UnitedHealth, Tuffin was managing director of APCO Worldwide’s Washington, D.C. headquarters.  

If the recent activity of Humana Inc.’s private jet is any indication, The Cigna Group may have to compete with Walmart Inc. in its reported bid to combine with the Medicare Advantage-focused insurer. 

That bit of corporate intrigue comes courtesy of Gordon Haskett Research Advisors, an investment brokerage that offers a service tracing the movements of major companies’ aircraft to “track possible signposts of M&A, strategic partnerships, activism, etc.”  

Don Bilson, head of event-driven research at Gordon Haskett, wrote in a Dec. 1 post on X (formerly Twitter) that “Humana flew to Arkansas yesterday” — the same day the Wall Street Journal published a report, citing anonymous sources, that Cigna and Humana were discussing a deal to combine. “Could be harmless, but these two did talk in 2018,” Bilson said, referring to a WSJ report in March of that year indicating that Walmart was in “early-stage acquisition talks” with Humana. Walmart is based in Bentonville, Arkansas.  

Hosting its first analyst-focused event in two years, CVS Health Corp. made a splash on Dec. 5 by introducing a pair of new drug reimbursement models, detailing its long-term margin improvement goals, and rebranding its health services segment.  

Although the new pharmacy models captured the most headlines, Wall Street analysts also appeared cautiously impressed with the overall picture that CVS painted — depicting a company with ambitious goals to best its rivals in the health benefits, retail pharmacy, care delivery and health services sectors by getting its many moving parts to work together. 

State Medicaid programs have sent substantial amounts of capitation payments to managed care organizations for covering members who have died, a new report from the HHS Office of Inspector General (OIG) found. The problem has bedeviled Medicaid agencies and plans for a long time, Medicaid insiders say, and is indicative of outdated and underfunded data systems.  

States paid $249 million in improper capitation payments for deceased Medicaid enrollees between 2009 and 2019, OIG found. In addition, the report said, three states have not recouped a combined outstanding balance of $41 million in such payments: Health plans owe the states of Michigan $27.5 million, New York $3.6 million and Kansas $9.7 million.