Health Plan Weekly

✦ Molina Healthcare Inc. said on July 17 that it entered a definitive agreement to buy certain assets of Passport Health Plan. The move comes after Kentucky awarded Molina a Medicaid managed care contract award, but not nonprofit Passport, which was almost entirely dependent on Medicaid business in that state. As part of the proposed transaction, Molina will acquire “certain assets related to the Medicaid and DSNP lines” of Passport’s business for $20 million, “plus contingent consideration that is payable in 2021 based on Molina’s Kentucky Health Plan’s open enrollment results in 2020.” Molina will also acquire the Passport name, as it is a well-known brand in Kentucky. The acquisition is expected to close before the end of the year. Visit https://bit.ly/3h4BN7u.

✦ Priority Health President and CEO Joan Budden will retire from leading the Grand Rapids, Mich.-based payer effective Jan. 1, 2021. During her tenure, Budden oversaw the acquisition of Total Health Care Inc. and negotiated a countrywide network reciprocity agreement with Cigna Corp. Spectrum Health Systems Inc., an integrated system that owns Priority Health, said it will engage the Furst Group for an internal and external national search for the new president of Priority Health. Budden will remain active in her role “to ensure a smooth transition through the end of the year,” the insurer said. Read more at https://bwnews.pr/30gRphJ.

In a July 10 letter, America’s Health Insurance Plans (AHIP) criticized a Trump administration proposal that would effectively require hospitals to reveal median rates they negotiate with Medicare Advantage insurers. In the letter, AHIP CEO Matthew Eyles said that the group supports price transparency in general, but the proposed rule would in fact impede that goal.

“We have several serious concerns with the proposal and believe it would fail to advance the Administration’s stated goals for increased consumer transparency and market-based FFS [fee for service] rates on multiple fronts,” Eyles wrote. “As a result, AHIP and its member plans cannot support CMS’ proposed data collection and publication of median payer-specific negotiated rates.”

With COVID-19 cases and deaths surging in some U.S. states, it has become clear that the nation won’t be back to normal anytime soon. Still, the country’s largest health insurer is betting that health care utilization, and the costs associated with it, will return to something close to typical levels in the second half of the year.

At its lowest point in April, inpatient care volume — including care for COVID-19 patients — was about three quarters less than normal, UnitedHealth Group Chief Financial Officer John Rex pointed out during a July 15 conference call to discuss the company’s second-quarter earnings. At that same low point, utilization of outpatient and physician services fell to roughly 60% of normal levels. But in June, UnitedHealth saw inpatient volume recover to nearly 95% of baseline, and as June turned to July, outpatient and physician services were “tracking above 90%,” Rex said. “These national trends have continued thus far in July, even as certain states are seeing short-term deferral of services where there are elevated levels of infection and hospitalization.”

In June, when the Supreme Court ruled in Bostock v. Clayton County, Georgia that transgender people are protected by the Civil Rights Act of 1964 in matters of employment, it was just the latest of a decade-long wave of legal and political victories for the LGBTQ+ movement.

Those changes in the law have only begun to play out in the health care industry, which has a fraught history with LGBTQ+ patients. Experts say health plans must address a legacy of discrimination in collaboration with LGBTQ+ community groups in order to better serve this population.