Health Plan Weekly

✦ CVS Health Corp. promoted Daniel Finke to executive vice president of its Health Care Benefits (HCB) Segment effective February 2021, succeeding Karen Lynch, who will become president and CEO of CVS at the same time. HCB includes Aetna and, according to a press release announcing the promotion, covers 34 million lives. According to the release, Finke has worked for Aetna since 2014, most recently leading the payer’s Commercial Business and Markets division, and previously “spent more than a decade at Anthem in various national executive roles.” Read more at https://bit.ly/2Izcij7.

✦ A Connecticut primary care practice has sued Cigna Corp. in federal court, alleging that the insurer wrongfully denied over $4.6 million in COVID-19 testing costs for over 4,400 patients. While the figures involved are relatively small for a national carrier, the suit could have substantial implications for the managed care industry if successful. According to Bloomberg Law, “the lawsuit is an early instance of the Employee Retirement Income Security Act being used in coronavirus coverage litigation,” and it cites new COVID-19 relief laws including the Families First Coronavirus Response Act and the Coronavirus Aid, Relief, and Economic Security (CARES) Act. Read the Bloomberg article at https://bit.ly/32FPCVo and the filing at https://bit.ly/38ExPBQ.

The Trump administration has finalized its long-awaited rewrite of an Obama-era Medicaid rule, delivering wins on network adequacy and rate adjustments to managed care organizations (MCOs) operating in state Medicaid programs.

The final rule, released Nov. 9, was four years in the making and is intended to reduce administrative and regulatory burdens on Medicaid/CHIP managed care agencies and plans while offering states additional flexibility, according to CMS.

Centene Corp. on Nov. 9 said it will acquire health care analytics company Apixio Inc., a move that industry insiders say will help the insurer leverage electronic health record (EHR) and population health data. That strategy, they suggest, is especially important with the industrywide implementation of EHR interoperability regulations, which will release a flood of patient data.

In a Nov. 9 investor note, Citi analyst Ralph Giacobbe cited the increasing importance of analytics in managed care.

Although a constitutional challenge to the Affordable Care Act (ACA) has been winding its way through the court system for more than two years — fueling ongoing concerns about the law’s future — the Supreme Court during a Nov. 10 hearing appeared highly skeptical that the case has much merit. That’s welcome news for the health insurance industry, as analysts have long pointed out that the sector is eager to move past the uncertainty that the lawsuit has created.

The suit in question, now known as California v. Texas, was first brought by a Texas-led coalition of conservative states in 2018. It argues that the ACA’s individual mandate — which compels people to purchase health insurance — is unconstitutional because Congress removed the mandate’s tax penalty via a budget bill in 2017. The states’ argument relies upon a 2012 Supreme Court decision in the case National Federal of Independent Businesses (NFIB) v. Sebelius, when the justices ruled that the mandate was constitutional because it fell under Congress’ taxing authority. So if the mandate is only permissible as a tax, and the tax is now zero, the conservative states argue that the mandate itself is now unconstitutional — and with it, the rest of the law.