Health Plan Weekly

The climate for payer mergers and acquisitions (M&A) has cooled substantially at a national level ever since the collapse of the proposed deals between Anthem, Inc. and Cigna Corp. and between Aetna Inc. and Humana Inc., and experts say transactions of that scale and type are unlikely to return. However, consolidation in the provider sector has increased since the start of the COVID-19 pandemic as such firms grapple with the rapid collapse of fee-for-service revenue — and experts say that cash-rich payers may start to expand their businesses into areas including care delivery, technology and retail.

Unlike Aetna and Humana, which amicably ended their deal after losing an antitrust challenge brought by the Dept. of Justice, the breakdown of Anthem’s bid to acquire Cigna got ugly — resulting in a public spat and dueling lawsuits over Cigna’s attempt to exit their agreement before exhausting the firms’ option to appeal a federal ruling against the transaction.

✦ CVS Health Corp.’s Aetna Inc. subsidiary expanded its partnership with WellBe Senior Medical to provide in-home primary care for the insurer’s senior members in the Chicago area. The partnership launched in the Atlanta market in July. In a company press release, WellBe CEO Jeffrey Kang, M.D., said the deal is part of Aetna’s pandemic response: “I’ve never understood why we would insist on a sick patient seeing us in the office, when it’s easier, more comfortable, and more effective for the patient to have medical care go to them. We can practically do everything that is done in a doctor’s office at the patient’s home. Bringing care to the patient is particularly important during the COVID-19 pandemic to keep patients safe in the comfort of their own home.” Aetna is also working with Landmark Health to bring in-home services to chronically ill Medicare Advantage members in the New York City boroughs and Long Island, Albany, Rochester and Buffalo. Read more at https://prn.to/3hY3RKG and https://yhoo.it/2F1V6AW.

✦ A new survey by the Harris Poll indicates that Americans trust their clinicians most for advice about whether to receive a potential COVID-19 vaccine, with 88% of respondents saying they found doctors and nurses very or somewhat trustworthy. Respondents perceived nationally known health systems like the Mayo Clinic and Cleveland Clinic to be nearly as trustworthy, with 84% of respondents finding those providers very or somewhat trustworthy — more than federal institutions like the CDC (72%) and FDA (72%). Health plans and employers were far behind providers, with 61% of respondents finding them trustworthy. Read more at https://bit.ly/3jH6ktx.

An Aug. 20 study published in the journal Health Affairs found that costs for individual exchange plan members who enroll during special enrollment periods (SEPs) are higher than costs for members who enroll during open enrollment.

However, one expert says that the unique circumstances of the COVID-19 pandemic mean that adverse selection in SEPs meant to address the crisis is not as risky as in a normal SEP.

Health care industry insiders say that Amazon.com Inc.’s Aug. 27 deal to provide Halo fitness trackers to Sharp HealthCare indicates the retail and tech giant will make big bets on clinical and actuarial data analytics.

Sharp Chief Information and Innovation Officer Michael Reagin tells AIS Health that Amazon will provide the San Diego-based integrated plan and provider with about 500 of the wearable fitness trackers. According to Reagin, Amazon approached Sharp through Cerner Corp., the software vendor that Sharp uses for its electronic health record (EHR) platform.