Health Plan Weekly

✦ CVS Health Corp. said on Feb. 3 that former Aetna Inc. CEO Mark Bertolini, who led the health insurer when it was acquired by the pharmacy chain, will leave the CVS board once integration is complete. But in an interview with the Wall Street Journal, Bertolini claimed he was forced out, and implied that he lost a power struggle with CVS CEO Larry Merlo. “There’s always going to be a natural tension between the current CEO and the former CEO in any discussions regarding how you move the strategy forward,” Bertolini told the publication. Read more at https://on.wsj.com/2GTNAFV and https://bit.ly/2SpwYuT.

✦ Humana Inc. continues to expand in the health care provider space, announcing that its Partners in Primary Care brand will partner with Welsh, Carson, Anderson & Stowe (WCAS) to expand operations. “This joint venture will further allow Partners in Primary Care to scale its core operations to facilitate the continued expansion of its care model,” said a Humana press release. The venture will target seniors in “underserved areas throughout the nation,” and WCAS will invest about $600 million in the venture, the release said. WCAS owns a majority stake in MMIT, AIS Health’s parent company. Visit https://huma.na/380IX8J.

by Jinghong Chen

The cost of the lowest-priced silver plan in the Affordable Care Act exchanges fell by an average of 3.5% from 2019 to 2020, according to a new analysis from the Robert Wood Johnson Foundation. The report also examined premiums in major urban and rural areas in select states, finding that rural premiums were higher than urban premiums in Arizona, California, North Carolina, Ohio and Oregon. However, Alabama, Georgia and Indiana showed a different picture.

Nevada — which is the proverbial guinea pig among a host of states aiming to shift from the federal Affordable Care Act (ACA) exchange platform to their own state-run exchange — now has completed its first full open enrollment period independent from HealthCare.gov.

Heather Korbulic, the executive director of the Silver State Health Insurance Exchange, told AIS Health before open enrollment kicked off that to her, a successful transition would look like “we landed the plane — we got all of our consumers successfully migrated, we were able to work with enrollment professionals and the technology worked, and we could at least retain the enrollment that we had from previous years” (HPW 9/30/19, p. 1).

The 2021 Proposed Notice of Benefit and Payment Parameters (NBPP) — which CMS released on Jan. 31 after insurers grew increasingly impatient to see the annual Affordable Care Act exchange regulations (HPW 2/3/20, p. 4) — suggests a change to the automatic reenrollment process that some experts worry will be a big problem for certain near-poor enrollees.

Under the ACA, exchange plan enrollees are typically automatically reenrolled in their current plan (or a similar plan if it’s no longer available) during each open enrollment period if they fail to notify the exchange of any eligibility change — like a higher income — or don’t actively select or disenroll from a plan.

Health insurers continued to struggle with their medical loss ratios in the fourth quarter of 2019, with Humana Inc. and Centene Corp. each posting MLRs that missed analysts’ expectations and indicated higher medical expenses in specific segments.

Centene joined Anthem, Inc., in blaming costs from an early flu season in part for its elevated MLR, while Humana tagged shifts in its Medicare business for its own raised MLR. Anthem reported its earnings on Jan. 29 (HPW 2/3/20, p. 6).