Health Plan Weekly

Anthem, Inc. continued to struggle with a higher-than-anticipated medical loss ratio (MLR) during the last quarter of 2019, and its earnings per share (EPS) guidance for 2020 fell short of what equities analysts were anticipating as the insurer reported fourth quarter and full-year 2019 results.

“Overall, the fourth quarter medical loss ratio was 89%, representing an increase of 220 basis points over the prior year, which, as expected was primarily driven by the one-year waiver of the health insurer fee,” Anthem Chief Financial Officer John Gallina said Jan. 29 during the company’s earnings conference call.

On Jan. 31, CMS released the 2021 Notice of Benefit and Payment Parameters (NBPP), which is the annual omnibus regulation that outlines the rules of the game for Affordable Care Act (ACA) exchange plans. But that was only after a trade group for safety-net health plans sent a strongly worded letter warning the Trump administration that the clock is ticking for issuers to finalize their 2021 premiums and benefit designs.

In its Jan. 27 letter, the Association for Community Affiliated Plans (ACAP) complained to CMS that the proposed 2021 NBPP “appears to be stalled at the Office of Management and Budget.” (The OMB completed its review of the regulation on Jan. 29.) Insurers need to submit qualified health plan (QHP) applications starting in early May, ACAP pointed out. “Building in a minimum 30-day comment period in addition to 30 days for the Department to review, revise, and release the final [rule] would allow just one month for issuers to operationalize and implement necessary updates,” the group wrote. “This timeframe will not allow issuers sufficient time to prepare products and operations for Benefit Year 2021.”

Despite Colorado’s robust insurance market, relative newcomer Friday Health Plans has managed to gain traction in its first few years. The company recently inked a $50 million funding agreement that may help it expand into new territories and provide the necessary tools to increase enrollment.

Launched by Sal Gentile, CEO, and David Pinkert, president, both health care industry veterans, Friday Health got its start as the two realized that the market was changing with individuals making more decisions, Gentile tells AIS Health. “The inspiration came from watching the development of the market, believing what ultimately would become a consumer-based market…and that plans, operations and tools were going to be necessary to be focused on the health care consumer.”

An earlier version of this article incorrectly stated that Jeff Myers is the former CEO of WellCare Health Plans, Inc. Myers was never WellCare’s CEO, but worked closely with WellCare’s leaders when Myers was CEO of Medicaid Health Plans of America (MHPA). WellCare is a member of MHPA. This version has been corrected.

On Jan. 21, Paula Tregre, Louisiana’s head of procurement, canceled the state’s newest Medicaid contract awards — but not for the reasons you might think. Meanwhile, Kentucky is working through its own bidding controversy after the state’s new governor called off Medicaid pacts awarded in December.

✦ Having now satisfied all necessary regulatory requirements, Centene Corp. and WellCare Health Plans, Inc. closed their $17 billion deal on Jan. 23. Centene is the country’s largest managed Medicaid insurer and the biggest player on the Affordable Care Act exchanges, and the acquisition of WellCare will increase its footprint in the Medicare Advantage market. Centene now serves more than 24 million members across all 50 states, according to a press release. With the completion of the transaction, the divestitures of Centene’s Illinois Medicaid and Medicare Advantage plans, WellCare’s Missouri Medicaid and Medicare Advantage plans and WellCare’s Nebraska Medicaid plan have also closed, the companies noted. Visit https://bit.ly/2uoxotk.

✦ Horizon Blue Cross Blue Shield of New Jersey and 17 other Blues plans unveiled a partnership with Civica Rx — the not-for-profit generic drugmaker founded by health systems and national charities — which will “create a new subsidiary dedicated to lowering the cost of selected generic drugs.” The Blues subsidiary will acquire and develop Abbreviated New Drug Applications for generic drugs that have a high price tag due to limited competition, and it will collaborate with Civica and manufacturing partners to bring more affordable generic drugs to market, with the first drugs expected by 2022. Visit https://prn.to/37ohhKC.