Health Plan Weekly

If the recent activity of Humana Inc.’s private jet is any indication, The Cigna Group may have to compete with Walmart Inc. in its reported bid to combine with the Medicare Advantage-focused insurer. 

That bit of corporate intrigue comes courtesy of Gordon Haskett Research Advisors, an investment brokerage that offers a service tracing the movements of major companies’ aircraft to “track possible signposts of M&A, strategic partnerships, activism, etc.”  

Don Bilson, head of event-driven research at Gordon Haskett, wrote in a Dec. 1 post on X (formerly Twitter) that “Humana flew to Arkansas yesterday” — the same day the Wall Street Journal published a report, citing anonymous sources, that Cigna and Humana were discussing a deal to combine. “Could be harmless, but these two did talk in 2018,” Bilson said, referring to a WSJ report in March of that year indicating that Walmart was in “early-stage acquisition talks” with Humana. Walmart is based in Bentonville, Arkansas.  

Hosting its first analyst-focused event in two years, CVS Health Corp. made a splash on Dec. 5 by introducing a pair of new drug reimbursement models, detailing its long-term margin improvement goals, and rebranding its health services segment.  

Although the new pharmacy models captured the most headlines, Wall Street analysts also appeared cautiously impressed with the overall picture that CVS painted — depicting a company with ambitious goals to best its rivals in the health benefits, retail pharmacy, care delivery and health services sectors by getting its many moving parts to work together. 

State Medicaid programs have sent substantial amounts of capitation payments to managed care organizations for covering members who have died, a new report from the HHS Office of Inspector General (OIG) found. The problem has bedeviled Medicaid agencies and plans for a long time, Medicaid insiders say, and is indicative of outdated and underfunded data systems.  

States paid $249 million in improper capitation payments for deceased Medicaid enrollees between 2009 and 2019, OIG found. In addition, the report said, three states have not recouped a combined outstanding balance of $41 million in such payments: Health plans owe the states of Michigan $27.5 million, New York $3.6 million and Kansas $9.7 million.  

The saga of Bright Health Group, Inc. became even more complex on Nov. 29, when the troubled health insurer's plan to remit unpaid risk adjustment fees to CMS was partially blocked by a Texas state judge at the prompting of the Texas Dept. of Insurance (TDI). The Texas court’s action will compel Bright to complete the receivership process for its Texas subsidiary and pay off creditors with claims in Texas before sending any capital to the federal government or other out-of-state creditors, experts say — that is, if there is any money to send somewhere in the first place. 

"I know that there’s some talk now that Texas will be at the back of the line for purposes of CMS or any of the Texas plans that would have gotten the risk adjustment money, in terms of being able to collect on that,” Leah Stewart, an attorney at Reed Claymon PLLC, tells AIS Health, a division of MMIT. “I think politically they [Texas officials] probably don’t care that it impacts CMS’s deal with Bright Health. But I don’t know that they were actually angling for that, as opposed to just deciding that Bright Health of Texas doesn’t have enough money and taking it down the standard liquidation path.” 

A megamerger reportedly brewing between The Cigna Group and Humana Inc. could create a health insurance giant with 31 million members that’s capable of rivaling UnitedHealth Group and CVS Health Corp — if the deal could weather antitrust challenges.

Cigna’s health insurance products cover more than 17 million people nationwide, and almost 80% of its members are enrolled in administrative services only (ASO) employer-based health plans, according to the latest data from AIS’s Directory of Health Plans (DHP). Humana, meanwhile, enrolls over 13.7 million people, with nearly 42% in Medicare Advantage plans, including those serving people who are dually eligible for Medicare and Medicaid. It also has a large contract with TRICARE, the health insurance program serving military service members, retirees and their families.