Health Plan Weekly

Self-funded health plans backed by large employers are expanding the amount and quality of behavioral health benefits available to their members, but a new report prepared by Milliman Inc. shows that those plans’ members will likely have a hard time using those benefits due to provider shortages. One expert says that to overcome entrenched, structural problems in behavioral health access, plan sponsors must employ creative solutions and be willing to boost reimbursement to behavioral health providers. 

The Dec. 13 Milliman report indicates there is high demand and poor access to mental health care across the country, confirming what other research and anecdotal evidence has shown in recent years. Public health data compiled by the Centers for Disease Control and Prevention’s National Center for Health Statistics and analyzed by Milliman confirm that the most dire outcomes of untreated behavioral health conditions, deaths by suicide and overdose, respectively increased by 32% and 376% between 2001 and 2021.  

Bright Health Group, Inc. suffered another blow on Dec. 13, when the foundering startup insurer revealed that Molina Healthcare, Inc. will pay less than originally planned for Bright’s California Medicare Advantage business. Molina now plans to pay $425 million for the California business, instead of the originally announced $510 million — a development that could complicate the ongoing liquidation of several Bright subsidiaries and its Affordable Care Act risk adjustment repayment agreement with CMS. 

According to a Molina press release from Dec. 18, “the purchase price for the transaction, net of certain tax benefits, is reduced from the previously announced $510 million to approximately $425 million, and now represents 23% of expected 2023 premium revenue of $1.8 billion.” Molina expects the deal, which it predicts will close “on or about January 1, 2024,” will add $1.00 per share “to new store embedded earnings” in the coming year.  

After merger talks fizzled in September, Elevance Health, Inc.’s agreement to acquire Blue Cross and Blue Shield of Louisiana is back on, according to the New Orleans Times-Picayune. The companies had put the $2.5 billion deal on hold due to rising opposition, but the Times-Picayune reported the companies filed a new application on Dec. 14 with the Louisiana Dept. of Insurance. The structure of the deal is largely unchanged, although the companies agreed to expand the board of directors for the Accelerate Louisiana Initiative, a nonprofit foundation. The companies expect the transaction will close during the first quarter of 2024. 

More than 19 million people have signed up for coverage via Affordable Care Act exchange plans for next year, according to the most recent data from CMS. The enrollment figures are as of Dec. 15 for the 32 states that use the HealthCare.gov website and through Dec. 9 for the 18 states and Washington. D.C., that have state-based marketplaces. More than 15.3 million had signed up for plans in states using the HealthCare.gov platform, a 33% increase from last year. In addition, more than 745,000 people signed up on Dec. 15, the largest single-day record since HealthCare.gov launched on Oct. 1, 2013. 

Call it the blockbuster deal that never was. The Wall Street Journal reported on Dec. 10 that The Cigna Group abandoned merger talks with Humana Inc., ending a multiweek stir over a report from the same publication that the companies were discussing a deal that would have created a $140 billion megainsurer. With the dust now settling, analysts and industry observers are speculating about what comes next for the two firms — with some suggesting that Cigna may eventually wind up back at the negotiating table. 

Neither Cigna nor Humana ever officially confirmed their reported deal discussions. But on the same day that the WSJ reported Cigna was abandoning its pursuit of Humana, Cigna said its board of directors had approved an additional $10 billion in share repurchases. Cigna CEO David Cordani also issued a telling statement hinting at what might have derailed the merger talks — per the WSJ, the firms couldn’t agree on financial terms — and addressing the company’s merger and acquisition (M&A) strategy.