Category: M&A&Investment

Posted on by

Behavioral Health Group Enters Rhode Island with Acquisition of Addiction Treatment Center in Pawtucket

Clip source: Behavioral Health Group Enters Rhode Island with Acquisition of Addiction Treatment Center in Pawtucket

 
 

 
 

News provided by

Behavioral Health Group 

Oct 02, 2020, 19:13 ET

Share this article

DALLAS, Oct. 2, 2020 /PRNewswire/ — Responding to the continued public health crisis of opioid addiction in the US, Behavioral Health Group (BHG), the largest network of Joint Commission-accredited outpatient opioid treatment and recovery centers in the US, today announced their expansion into Rhode Island with the acquisition of the Center for Treatment & Recovery (CTR), LLC in Pawtucket, RI. The business, currently employing 23 clinicians, mental health professionals, and staff, will become known as BHG Pawtucket Treatment Center.

“Opioid addiction continues to ravage communities across the United States, exacerbated by the current coronavirus pandemic,” said Jay Higham, Chief Executive Officer of BHG. “Our Company’s mission is to expand access to evidence-based treatment in underserved markets across the United States. The joining of BHG Pawtucket Treatment Center into the BHG family is a significant value-add to our company and to the Pawtucket community.” With this new location, BHG now operates 71 locations in 15 states.

The Company’s approach to treatment is individualized under physician supervision in an outpatient setting. Through evidence-based programs such as Medication Assisted Treatment (MAT), successful recovery is possible. MAT, the gold standard of care for opioid addiction, utilizes the combination of FDA approved medications with a full modality of behavioral health counseling and other support services for a comprehensive treatment approach to addiction.  These programs demonstrate excellent results as measured by almost all objective criteria – abstinence from drug use, improvements in employment, family dynamics, and general well-being.

“We knew that there was strong clinical alignment philosophically,” said Wendy Looker, co-founder of CTR. “We were impressed with BHG’s patient-centered, comprehensive approach to opioid treatment. BHG has proven to be a leader in this treatment approach, and I know the team looks forward to working with their peers at BHG to improve access to life-saving and life-changing treatment here in Rhode Island.”

BHG Pawtucket Treatment Center is an Opioid Treatment Program located at 82 Pond Street, Pawtucket, RI, 02860.

About BHG

Behavioral Health Group (BHG) is the largest network of Joint Commission-accredited outpatient opioid treatment and recovery centers in the U.S., delivering comprehensive, personalized evidence-based medical and behavioral therapies for individuals with opioid use disorder. With 71 locations in 15 states, BHG has more than 1,200 employees who serve more than 22,000 patients. To learn more, visit bhgrecovery.com.

For Business Development Information:

Dwight Mussleman

Dw**************@*********ry.com

214-365-6114

Media Contact:

Nancy Buttyan

Na***********@*********ry.com

214-365-6146

SOURCE Behavioral Health Group

Related Links

https://bhgrecovery.com

 
 

From <https://www.prnewswire.com/news-releases/behavioral-health-group-enters-rhode-island-with-acquisition-of-addiction-treatment-center-in-pawtucket-301145113.html>

Posted on by

DXC Spin-off To Be Renamed Gainwell Technologies

Clip source: DXC Spin-off To Be Renamed Gainwell Technologies

 
 

 
 

 
 

Veritas Capital, which plans to close its $5 billion acquisition of Technology’s state and local health and human services business on Oct. 1, unveiled the new name for the business and named DXC’s current chief financial officer as its new CEO.

By                     Joseph F. Kovar September 16, 2020, 01:50 PM EDT

The planned government and human resources spin-off from DXC Technology will be named Gainwell Technologies.

Veritas Capital, the private equity company which in March said it will acquire DXC Technology’s state and local health and human services business for $5 billion in cash, on Wednesday said the business will be named Gainwell Technology when the acquisition closes on Oct. 1.

New York-based Veritas Capital also said Paul Saleh (pictured), DXC Technology’s executive vice president and chief financial officer, will take the reins at Gainwell Technology as its CEO after the acquisition closes.

 
 

 

The move to spin off DXC Technology’s state and local health and human services businesses stems from a decision late last year by DXC Technology to divest itself of three of its businesses as a way to bolster its finances with a focus on its core services business.

DXC was formed in April 2017 from a merger of CSC and Hewlett Packard Enterprise’s enterprise services business.

 
 

The Veritas Capital purchase is not the only deal announced by DXC to divest its businesses. DXC in July said it plans to sell its healthcare provider software business to Italy-based Dedalus Group in a $525 million cash deal.

According to Veritas Capital, the name “Gainwell” stems from a commitment to improving the health outcomes in the U.S. via innovative technology solutions and support.

A DXC spokesperson replied to a CRN emailed request for further information on the Gainwell Technology news by saying the company is not providing further comment until the transaction with Veritas Technology closes.

However, Ramzi Musallam, CEO and managing partner at Veritas Capital, said in a prepared statement that Veritas look forward to supporting Gainwell Technologies as it partners with clients to navigate complex challenges, and welcomes Saleh and his team to the Veritas family.

“The choice of Gainwell reflects the true vision of the new company. Its trusted expertise and comprehensive technology capabilities will further benefit from the entrepreneurial spirit of a standalone company as it leads the way in developing, implementing and delivering innovative and vital technology for its clients and the communities they serve,” Musallam said.

 
 

From <https://www.crn.com/news/channel-programs/dxc-spin-off-to-be-renamed-gainwell-technologies?itc=refresh>

Posted on by

DEMO- Mergers, Acquisitions and Investments (Q3_2019)

  • Plans
  • Providers
  • VeNdors

Summary analysis

Q4 2019 saw significant plan M&A activity. 

  • Humana will acquire hospice pharmacy provider Enclara. Enclara currently serves 97,000 hospice patients. The deal is projectd to close early 2020. 
  • The Partners (NH) plan to acquire Exeter Health Resources was stopped by the state Attorney General over antitrust concerns. 
  • Centene, Walgreens and RxAdvance announced plans to pursue opportunites in certain “underserved” markets. Initial messaging suggests the alliance will pursue Medicaid PBM opportunities. 
  • Health Alliance Plan (HAP) is re-entering the Michigan market with the approval of its purchase of Trusted Health- Michigan. HAP buys footprint in Medicaid Region 10 with the buy. 
  • The BCBS NC merger with Cambria Health Solutions was scuttled after video of BC CEO Patrick Conway driving drunk surfaced in late Septmeber. BCBS NC reported $10B in revenue in 2018, compared to Cambia’s $6B. 
  • Molina bought NY footprint with its purchase of YourCare Health Plan. The deal comes with 46,000 Medicaid lives in Western NY. The deal cost Molina $40M. 
  • United bought a Medicare Advantage plan in VA. Piedmont Community Health Plans sold its MA enrollment of 5,000 members Oct. 1.
  • Optima (Sentarra) acquired majority owner status of one of the state’s oldest MCO- VA Premier- in late September. The combined MCO will have 800,000 Medicaid lives. 
  • MCNA Dental bought Healthplex. The new entity will provide dental services to more than 8M CHIP/Medicaid members.  
  • The long-strained deal to sell Fidelis (NY) encountered new obstabcles in October, when CMS questioned  Gov. Cuomo’s efforts to extract money from the sale of Fidelis to Centene. Cuomo argued that since Fidelis received significant Medicaid funding, the state should receive payments as part of the Centene purchase of Fidelis. 
  • Concerns over the Centene ownership of Arkansas Total Care mounted in Q4. Under the state PASSE (provider led plans) model, providers are supposed to own 51% of the entities. Centene’s arrangement with Mercy health system allows Arkansas Total Care plan to technically meet the requirement, but many are calling foul. 
  • BCBS of AZ bought Steward Health Choice AZ. Much of the purchase strategy centers on building competency serving duals. Steward currently serves 200,000 Medicaid members. 
  • The Centene-Wellcare deal progressed on multiple fronts, including: 
    • CVS Health will pick up Centene’s IL Medicaid and Medicare plans as part of divestment requirements.
    • Multiple states completed the approval of the Centene-WellCare merger.  
  • The Health Plan (WV) announced it will drop plans to merge with WVU Medicine. Early analysis did not yield reasons for the aborted deal. 

Related News Items 

[tcb_post_list query=”{‘paged’:1,’filter’:’custom’,’related’:|{||}|,’post_type’:’post’,’orderby’:’date’,’order’:’DESC’,’posts_per_page’:’9′,’offset’:’1′,’no_posts_text’:’There are no posts to display.’,’exclude_current_post’:|{|’1’|}|,’queried_object’:{‘ID’:10841,’post_author’:’1′,’post_type’:’post’},’sticky’:|{||}|,’rules’:|{|{‘taxonomy’:’category’,’terms’:|{|’100’|}|,’operator’:’IN’}|}|}” type=”grid” columns-d=”3″ columns-t=”2″ columns-m=”1″ vertical-space-d=”30″ horizontal-space-d=”15″ ct=”post_list-43436″ ct-name=”Small size 03″ tcb-elem-type=”post_list” pagination-type=”numeric” pages_near_current=”2″ element-name=”Post List” css=”tve-u-16fc8604771″ no_posts_text=”” horizontal-space-m=”0″ vertical-space-m=”15″ horizontal-space-t=”15″ article-tcb_hover_state_parent=”” total_post_count=”10″ total_sticky_count=”0″ posts_per_page=”9″ featured-content=”0″ disabled-links=”1″ class=” article-tcb_hover_state_parent=” ][tcb_post_list_dynamic_style][/tcb_post_list_dynamic_style][tcb_post_title css=’tve-u-16fc8604773′][/tcb_post_list][tcb_pagination data-list=’tve-u-16fc8604771′ data-type=’numeric’ data-ct=’pagination-123′]

Page [tcb_pagination_current_page] of [tcb_pagination_total_pages]

First

Previous

Next

Last

[/tcb_pagination]

Summary Analysis

Q4 2019 saw significant provider M&A activity.

  • Highlights from health system deals included: 
    • Hackensack Meridien Health and Englewood Health (NJ) executed a merger agreement. Hackensack brought 17 hospitals and $400M in cash to the deal. Hackensack has focused recently on expanding the service array, including opening a behavioral health urgent care center. 
    • CHS will sold 3 of its VA hospitals (totalling 485 beds) to Bon Secours Mercy Health. 
    • The CA St Joseph-Adventist merger was blocked by the state Attorney General. The deal would have created a new network of 9 rural hospitals.  
    • Sanford Health (SD) and UnityPoint (IA) backed out of the planned $11B merger they announced in the summer. Early analysis suggests there may have been some issues related to kickbacks allegations at Sanford that were not uncovered in initial discovery. 
    • Quorum Health is said to be exploring investment from KKR. Quorum, formed in 2016, has 24 facilities and has posted losses the last 2 years. 
  • The investment focus on home health continued in Q4, including: 
    • Walmart and Amedisys announced their intent to take their pilot nationwide. Amedisyis provides care coordination and referrals to home health services working with 700 different home care agencies. Early efforts with Walmart are based on a kiosk in the retail space designed to assess for home health needs. 
    • Revelstoke PE invested in The Care Team (TCT). TCT provides home health / home care services in Michigan. 
    • Alpine invested in AmeriBest, a home care agency in PA. 
    • CareFinders bought At Home Quality Care (PA) and Philadelphia Home Care. 
    • CareAdvantage bought Team Nurse, Inc. CareAdvantage operates an in-hom nurse network in DE, MD, VA and D.C. 
  • Hospice activity included: 
    • Towerbrook PE and Ascension Health teamed up to buy Compassus (Nashville-based hospice provider) or $1B. Compassus has locations in 30 states.
    • Addus closed out an intense year of acqusitions with its $130M purchase of Hospice Partners of America (based in AL, with 21 locations nationwide). 
  • There was intense activity in the behavioral health space, including: 
    • 4 Arkansas provider groups formed Arisa Health, with the new organization totalling 1,275 employees.
    •  The Stepping Stones Group bought New England ABA (an applied behavioral analysis therapy provider)
    • Acorn Health acquired Behavior Therapy Specialists (an ABA provider). BTS has operations in IL and MO. 
    • Seaside Healthcare (LA) bought Strategic Interventions (NC) to expand its footprint in NC, LA, GA and TX. Both entities provide substance abuse and behavioral health services. 

Related news items

[tcb_post_list query=”{‘paged’:1,’filter’:’custom’,’related’:|{||}|,’post_type’:’post’,’orderby’:’date’,’order’:’DESC’,’posts_per_page’:’9′,’offset’:’1′,’no_posts_text’:’There are no posts to display.’,’exclude_current_post’:|{|’1’|}|,’queried_object’:{‘ID’:10841,’post_author’:’1′,’post_type’:’post’},’sticky’:|{||}|,’rules’:|{|{‘taxonomy’:’category’,’terms’:|{|’101’|}|,’operator’:’IN’}|}|}” type=”grid” columns-d=”3″ columns-t=”2″ columns-m=”1″ vertical-space-d=”30″ horizontal-space-d=”15″ ct=”post_list-43436″ ct-name=”Small size 03″ tcb-elem-type=”post_list” pagination-type=”numeric” pages_near_current=”2″ element-name=”Post List” css=”tve-u-16fc87fd6c5″ no_posts_text=”” horizontal-space-m=”0″ vertical-space-m=”15″ horizontal-space-t=”15″ article-tcb_hover_state_parent=”” total_post_count=”17″ total_sticky_count=”0″ posts_per_page=”9″ featured-content=”0″ disabled-links=”1″ class=” article-tcb_hover_state_parent=” ][tcb_post_list_dynamic_style][/tcb_post_list_dynamic_style][tcb_post_title css=’tve-u-16fc8604773′][/tcb_post_list][tcb_pagination data-list=’tve-u-16fc87fd6c5′ data-type=’numeric’ data-ct=’pagination-123′]

Page [tcb_pagination_current_page] of [tcb_pagination_total_pages]

First

Previous

Next

Last

[/tcb_pagination]

Summary Analysis

There was limited activity for investment in solution vendors related to Medicaid in Q4. 

  • Insight and Regroup (both telehealth) merged to become the largest telepsychiatry provider in the nation. 
  • MEDNAX sold its data division (MedData) to Frazier Healthcare Partners. MedData has 10,000 physician clients and 3,000 facility clients and 2,000 employees.

Related News Items

[tcb_post_list query=”{‘paged’:1,’filter’:’custom’,’related’:|{||}|,’post_type’:’post’,’orderby’:’date’,’order’:’DESC’,’posts_per_page’:’9′,’offset’:’1′,’no_posts_text’:’There are no posts to display.’,’exclude_current_post’:|{|’1’|}|,’queried_object’:{‘ID’:10841,’post_author’:’1′,’post_type’:’post’},’sticky’:|{||}|,’rules’:|{|{‘taxonomy’:’category’,’terms’:|{|’102’|}|,’operator’:’IN’}|}|}” type=”grid” columns-d=”3″ columns-t=”2″ columns-m=”1″ vertical-space-d=”30″ horizontal-space-d=”15″ ct=”post_list-43436″ ct-name=”Small size 03″ tcb-elem-type=”post_list” pagination-type=”numeric” pages_near_current=”2″ element-name=”Post List” css=”tve-u-16fc8826880″ no_posts_text=”” horizontal-space-m=”0″ vertical-space-m=”15″ horizontal-space-t=”15″ article-tcb_hover_state_parent=”” total_post_count=”2″ total_sticky_count=”0″ posts_per_page=”9″ featured-content=”0″ disabled-links=”1″ class=” article-tcb_hover_state_parent=” ][tcb_post_list_dynamic_style][/tcb_post_list_dynamic_style][tcb_post_title css=’tve-u-16fc8604773′][/tcb_post_list][tcb_pagination data-list=’tve-u-16fc8826880′ data-type=’numeric’ data-ct=’pagination-123′]

Page [tcb_pagination_current_page] of [tcb_pagination_total_pages]

First

Previous

Next

Last

[/tcb_pagination]

Posted on by

Health Alliance Plan Acquisition Of Trusted HP – Michigan Approved

MM 1 Sentence Summary- Health Alliance acquires Trusted HP-Michigan 

Health Alliance Plan Acquisition Of Trusted HP – Michigan Approved (highlighted)

Transaction begins Medicaid expansion in metro Detroit for HAP and Henry Ford Health System
News provided by
Sep 19, 2019, 11:15 ET
Henry Ford Health System and Health Alliance Plan (HAP), a nonprofit health plan and operating unit of , announced today that HAP’s acquisition of Trusted HP – Michigan has received all regulatory approvals and the acquisition became effective on .
Wright Lassiter III, president and CEO, Henry Ford Health System
Dr. Michael Genord, Interim President & CEO, HAP
(PRNewsfoto/Health Alliance Plan,Henry Ford)
Henry Ford and HAP announced in June that HAP had signed a definitive agreement to acquire Trusted HP – Michigan, a Medicaid plan based in Detroit, formerly known as Harbor Health Plan, Inc.  The completion of this transaction solidifies HAP’s re-entrance into the state of Michigan’s Medicaid HMO service area known as Region 10, which includes Wayne, Oakland and Macomb counties.
“Participation in Michigan’s Region 10 Medicaid service area is a key strategic priority for Henry Ford and HAP given our geographical footprint, and this acquisition positions us for Medicaid growth in our primary service area,” said Wright Lassiter III, President and CEO, Henry Ford Health System.  “HAP and Henry Ford are dedicated to using our joint assets and unique integrated health system programs to improve the quality and access to care for this area’s Medicaid patients, which are among our most vulnerable populations.”
HAP acquired Trusted HP – Michigan from Trusted Health Plan Inc., a Washington, D.C.-based managed care organization.  Previously named Harbor Health Plan and ProCare Health Plan, the plan has been operating as a licensed HMO in Michigan since 2000.  As a result of this transaction, Trusted HP – Michigan’s nearly two dozen employees will become HAP employees.
The terms of the agreement provide for a seamless transition for Trusted HP – Michigan members, who will be able to keep their doctor and continue using their services and current ID cards.  There is no impact to current HAP members as a result of this transaction.  The Trusted brand will remain in place through the end of 2019.  Effective January 1, 2020, all Medicaid members will be under one HAP-branded Medicaid name.
“HAP and Henry Ford Health System are focused on providing Medicaid beneficiaries with a differentiated care model focused on value-based care,” said Dr. Michael Genord, interim president and CEO, HAP.  “We are investing in care coordination programs, including those aimed at social determinants of health, to improve the health and well-being of the members we serve.  And we are thrilled that this now includes Trusted’s Medicaid members, most of whom are in Wayne County.”
HAP serves 570,000 total members across Michigan.  HAP’s subsidiary, HAP Midwest Health Plan, offers Medicaid products under the HAP Empowered name. HAP Empowered is currently available in Region 6, which includes Genesee, Huron, Lapeer, Sanilac, Shiawassee, St. Clair and Tuscola counties. Covered Medicaid programs offered through HAP Empowered include health care coverage for people impacted by the Flint water crisis, MIChild, Healthy Michigan Plan and Children’s Special Health Care Services.
HAP also participates in the MI Health Link Dual Demonstration Project, serving 4,500 members who are eligible for both Medicare and Medicaid in Wayne and Macomb counties, including some of the most underserved areas of Detroit.
About Henry Ford Health System
Henry Ford Health System is a six-hospital system headquartered in Detroit, Michigan. It is one of the nation’s leading comprehensive, integrated health systems, recognized for clinical excellence and innovation. Henry Ford provides both health insurance and health care delivery, including acute, specialty, primary and preventive care services backed by excellence in research and education. Henry Ford Health System is led by President & CEO Wright Lassiter III. Visit HenryFord.com to learn more.
About Health Alliance Plan
Health Alliance Plan (HAP) is a Michigan-based, nonprofit health plan that provides health coverage to individuals and companies of all sizes. For nearly 60 years, HAP has partnered with leading doctors and hospitals, employers and community organizations to enhance the health and well-being of the lives it touches. HAP offers a product portfolio with six distinct product lines: Group Insured Commercial, Individual, Medicare, Medicaid (using the HAP Empowered name), Self-Funded and Network Leasing. HAP excels in delivering award-winning preventive services, disease management and wellness programs, as well as personalized customer service. For more information, visit www.hap.org.
SOURCE Henry Ford Health System; Health Alliance Plan

Related Links

Posted on by

New Hampshire regulators block Partners acquisition over antitrust concerns – Boston Business Journal

MM 1 Sentence Summary- NH attorney general blocks Massachusetts Gen Hospital from acquiring Partners saying it will violate state antitrust laws 

New Hampshire regulators block Partners acquisition over antitrust concerns

Sep 20, 2019, 1:07pm EDT
Partners HealthCare’s plan to further its expansion into New Hampshire ran into a roadblock on Friday, with the Granite State’s attorney general, Gordon MacDonald, saying the acquisition would violate state antitrust laws.
In May 2018, Partners’ flagship Massachusetts General Hospital announced that it planned to acquire Exeter Health Resources in New Hampshire. Plans called for Exeter to merge with Wentworth-Douglass Hospital, which MGH acquired in 2017, forming a new non-profit system for New Hampshire’s Seacoast region.
While the attorney general’s charitable trusts unit has been reviewing the transaction since the hospitals submitted materials in May 2019, the attorney general’s consumer protection and antitrust bureau has been conducting a private review of the transactions for over a year.
Last week, the antitrust division issued a notice of intent to halt the transaction over concerns of antitrust violations. The charitable trusts unit subsequently issued a report Friday objecting to the proposed transaction, noting that if the hospitals resolve concerns with the antitrust division, it can refile its submission to charitable trusts.
“Our most important duty is to protect the public and we will not hesitate to use the enforcement tools available to us to do so,” MacDonald said in a statement. “New Hampshire patients already pay some of the highest prices for health care in the country. Based on our investigation, we have concluded that this transaction implicates our laws protecting free and fair competition and therefore threatens even higher health care costs to be borne by New Hampshire consumers.”
In a release, hospital officials said they expect to continue conversations with the attorney general on the benefits of the transaction to ultimately resolve the concerns.
“We are optimistic that the parties can continue to have an open dialogue with the regulators or government officials about this important affiliation,” said Dr. Peter Slavin, MGH’s president. “We remain fully committed to seeing this transaction through and are confident that the Attorney General’s Office will ultimately determine that our affiliation will pass antitrust review based on the thorough review that the expert economists have completed on this proposal. We look forward to continuing to enhance quality healthcare in the Seacoast Region.”
Posted on by

Blue Cross puts merger on hold amid video showing CEO sideswiping tractor trailer on I-85

MM 1 Sentence Summary- BCBS and Cambia Health’s merge has been delayed because of CEO Conway’s legal trouble 

Blue Cross puts merger on hold amid video showing CEO sideswiping tractor trailer on I-85

September 24, 2019 12:57 PM
Video appears to show BCBS CEO driving erratically, hitting tractor-trailer on I-85
A video provided to The News & Observer appears to show an SUV driven by Patrick Conway, president and CEO of Blue Cross and Blue Shield of NC, weaving between lanes for several miles on Interstate 85 before colliding with a tractor-trailer. By Submitted Video
ASHEBORO
North Carolina’s largest health insurer on Tuesday suspended an ongoing merger, making the announcement the same day new details emerged about its CEO’s recent driving charges.
“Blue Cross NC has decided to put its proposed strategic affiliation with Cambia Health Solutions on temporary hold,” the company announced in an email to media shortly after 3 p.m. “Blue Cross NC is committed to focusing on its customers, employees and the North Carolina communities it serves.”
TOP ARTICLES
Blue Cross and Blue Shield of North Carolina and Cambia, an Oregon-based company, announced their intentions to form a partnership in March. The two companies would together cover around 6 million people and have about $16 billion in combined revenue, the News & Observer previously reported.

Blue Cross is bigger than Cambia, reporting $9.9 billion in revenue last year and covering 3.7 million people. Cambia had revenue of about $6 billion on coverage of around 2.6 million people.
Blue Cross announced the merger being put on hold on the same day that new details emerged about Dr. Patrick Conway, its president and CEO. A video provided to The News & Observer Tuesday appears to show Conway weaving between lanes for several miles on Interstate 85 before sideswiping a tractor-trailer.
Conway, 45, was charged with driving while impaired and misdemeanor child abuse after the June 22 accident. His two daughters were in the car, according to police.

Video of Conway’s car

The video, shot by a motorist on I-85 and sent to police, shows an SUV that appears to match the 2017 Cadillac listed on the report from Archdale police.
An affidavit from the Archdale officer said Conway smelled of alcohol, had bloodshot eyes and slurred speech and was unsteady on his feet. He refused a blood-alcohol test and had his license revoked for 30 days, according to court records.
According to a confidential police report obtained by WRAL, Conway denied wrongdoing and later became “belligerent” at the police station.
The report quotes Conway saying: “’You had a choice. You could have let me go. You don’t know who I am. I am a doctor, a CO of a company. I’ll call Governor Cooper and get you in trouble,’“ WRAL reported.
Cooper “was not involved in this incident in any way,” spokesman Ford Porter told The N&O.
Blue Cross didn’t comment on Tuesday’s reports. Conway’s attorney, Thomas Walker, released a statement to the N&O saying the CEO is “deeply ashamed and embarrassed” about the pain he caused family and co-workers.
“He knows his conduct was unacceptable and not consistent with who he is as a person. He has never had an incident like this before,” Walker said.
“To his credit, he immediately disclosed the incident to the Blue Cross NC Board. He stepped down from his daily duties and voluntarily and successfully completed 30 days of inpatient substance use treatment. He’s committed to continuing to handle this appropriately going forward and will do so.”

Blue Cross response

Last week, state Insurance Commissioner Mike Causey asked for Conway to be replaced by an interim president while his charges are resolved, calling them “alarming.”
He also chided the Blue Cross board for appearing to hide the arrest, saying he expected the insurer’s executive team to be more “accountable, responsible and transparent.”
Conway earned $3.59 million last year, WRAL reported.
In response, board Chairman Frank Holding Jr. said Conway had undergone a professional substance abuse assessment and attended a 30-day inpatient treatment.
“Based on detailed information shared by the facility based on Dr. Conway’s assessment and treatment, the board was satisfied Dr. Conway could continue to provide strong leadership to BlueCross NC,” Holding’s letter said.
Blue Cross “refrained” from talking publicly about Conway’s incident “out of respect for the legal process underway in Randolph County, Dr. Conway’s right to due process, and medical privacy concerns and obligations,” Holding added.

Washington commissioner’s letter

On Tuesday night, Washington’s state insurance commissioner released a letter he sent to Cambia Heath Solutions’ Board of Directors earlier that day.
In the letter, Commissioner Mike Kreidler said his office is reviewing the proposed merger of Cambia with Blue Cross. Cambia was formerly known as The Regence Group, according to its website.
Krieidler said he learned only about Conway’s June arrest on Sept. 19, the day news reports were published about the allegations. He said he learned about the arrest after Cambia CEO Mark Ganz asked for his personal cell phone number “to communicate an urgent message that could not wait until normal business hours.”
Kreidler said Blue Cross should have notified him immediately and had a “legal obligation” to inform him within two business days of “any material changes” to Conway’s biographical affidavit.
“The fact that Dr. Conway was arrested and faces serious allegations and charges is without question a material change,” Kreidler wrote.
“I am deeply troubled by your failure to communicate responsibly and transparently,” he said in the letter to the board of directors. “Both the board and CEO share the responsibility to deal with my office in a straightforward and honest fashion. Secrets are not permissible.
“Your behavior in this matter must, and will, be taken into account as my office considers the Cambia/Regence’s request for a merger,” the letter concluded.
Staff writers Zachery Eanes and Mark Schultz contributed to this story
Paul “Andy” Specht reports on North Carolina leaders and state politics for The News & Observer and PolitiFact. Specht previously covered Raleigh City Hall and town governments around the Triangle. He’s a Raleigh native who graduated from Campbell University in Buies Creek, N.C. Contact him at as*****@**********er.com or (919) 829-4870.

Major Blue Health Insurers Drop Deal to Combine

Move comes after resignation of North Carolina insurer CEO Patrick Conway

By
Anna Wilde Mathews,
Leslie Scism and
Valerie Bauerlein
Oct. 11, 2019 8:51 pm ET
Blue Cross and Blue Shield of North Carolina and Cambia Health Solutions said they were dropping plans to combine, after the resignation of the North Carolina insurer’s chief executive.
Former Blue Cross of North Carolina CEO Patrick Conway had stepped down amid fallout over an allegedly alcohol-related traffic accident. The two insurers had said they were pausing their deal on Sept. 24, as details of the June incident emerged.
Posted on by

Optima Health to take majority stake in Virginia Premier | Virginia Business

MM 1 Sentence Summary- Optima Health Plan takes majority ownership of MCO VA Premier and together they will serve 800k members. 

Optima Health to take majority stake in Virginia Premier (Highlighted)

Published September 26, 2019 by Robert Powell, III
Virginia Beach-based Optima Health Plan will become the majority owner of Richmond-based Virginia Premier, a nonprofit managed-care organization.
Virginia Premier was founded in 1995 by VCU Health System. The Richmond-based health system will retain a 20% ownership stake in Virginia Premier. Together, Optima and Virginia Premier will serve nearly 800,000 members. Optima is a subsidiary of Norfolk-based Sentara Healthcare.
“As provider-led health plans, Optima Health and Virginia Premier share similar cultures, values and a commitment to delivering innovative services that meet the unique needs of the populations we serve,” Dennis A. Matheis, president of Optima Health and executive vice president of Sentara Healthcare, said in a statement. “Together, we will be better positioned to increase access to quality care, achieve greater efficiencies and develop new services to improve our members’ overall experience.”
Optima and Virginia Premier are two of the state’s original Medicaid managed care organizations. Company officials said Virginia Premier and Optima will continue to operate as separate entities, retaining their names and brands. Virginia Premier will maintain an operations center in Richmond and a presence in other areas in the state.
Measure
Measure
Posted on by

-Feds reviewing Cuomo’s Fidelis deal : Empire Center for Public Policy

Feds reviewing Cuomo’s Fidelis deal (Highlighted)

by Bill Hammond |  October 03, 2019 | NY Torch
Federal officials are reviewing the state’s expropriation of $2 billion from the sale of Fidelis Care health plan, potentially throwing a wrench into the Cuomo administration’s plans for using the money.
An Aug. 21 letter from the Centers for Medicare & Medicaid Services, recently posted on the state Health Department’s website, says the Fidelis transaction is being examined “pursuant to Section 1903(w) of the Social Security Act.”
That section of law is meant to discourage states from using certain tactics to raise revenue for their Medicaid programs. Depending on the outcome of the CMS review, the state could ultimately lose a share of its federal matching aid – which would add to the Medicaid program’s burgeoning budget crunch.
The feds’ review adds a new wrinkle to a deal engineered by Cuomo last year, which was the focus of a front-page expose in today’s New York Times.
Founded as a Catholic-affiliated non-profit health plan, Fidelis agreed in September 2017 to be bought out by for-profit Centene Corp. for a price of $3.75 billion. The state’s Catholic bishops intended to put the proceeds into a charitable foundation, but Governor Cuomo insisted that the money should go to state government instead – on grounds that most of Fidelis’ business had come from government-funded programs such as Medicaid, Child Health Plus and the Essential Plan.
Under pressure from Cuomo, the bishops and Centene agreed to pay the state $2 billion over four years. Cuomo and Legislature placed the money into a newly established “Health Care Transformation Fund,” which the governor could spend at his discretion on a broad range of health-related purposes.
The first use of the funds came in October 2018, which the Health Department announced Medicaid rate increases of 2 percent for hospitals and 1.5 percent for nursing homes – a major victory for influential interest groups that included one of the governor’s biggest campaign donors.
In the Aug. 21 letter, CMS gave approval for the nursing home rate increase but added a note of caution about the revenue source:
During our review of the proposed state plan changes, CMS became aware that the State of New York received considerable revenues related to [the] sale of assets between Fidelis Care (a non-profit insurer associated with Catholic Diocese of New York) and Centene Corporation (a for profit health insurer). Our review of these revenues is still ongoing pursuant section 1903(w) of the Act.
Section 1903(w) restricts the ability of states to finance Medicaid with revenue from health-care sources. The concern is that states will allocate a certain amount of money for Medicaid, use that expenditure to draw federal matching funds, then grab back all or most of their initial expenditure through taxes or “donations” paid by the health-care industry. If the quasi-voluntary payments by Fidelis and Centene are determined to violate this rule, the federal government is supposed to reduce the state’s allocation of federal Medicaid funding by the amount of the improper payments.
The outcome of CMS’s review is hard to predict. What’s clear is that an adverse decision would open a new hole in state finances.
For example: The state has projected that its share of the rate increases for hospitals and nursing homes would be $500 million over four years – but that assumed a roughly dollar-for-dollar match from Washington. If CMS rejects the use of Fidelis funds, and reduces aid accordingly, the state would need to put up another $500 million of its own.
Even without this complication, the Cuomo administration has been struggling to balance Medicaid’s finances. The program ran so far over budget that the state delayed $1.7 billion in payments from March to April, shifting the expense from fiscal year 2019 to fiscal year 2020. Budget reports since then have warned that Medicaid spending continues to exceed expectations, and that the state might have to make program cuts or delay further payments in the future.

Measure
Measure
Posted on by

Healthplex Acquired by Affiliates of MCNA Dental


Healthplex Acquired by Affiliates of MCNA Dental (highlighted)

PR NewswireSeptember 17, 2019
UNIONDALE, N.Y., Sept. 17, 2019 /PRNewswire/ — Healthplex, Inc., announced today that, following the receipt of all required regulatory approvals, the company has been acquired by affiliates of MCNA Dental, the largest full-risk Medicaid and Children’s Health Insurance Program dental benefits manager in the country. These combined affiliate companies will serve over 8 million members nationwide.
“The addition of Healthplex to our family of companies allows us to take the next step in our strategy for growth, complementing our national platform and expanding our commercial dental insurance products and other offerings. Healthplex shares in our mission of promoting accessible dental care for all. Our entire organization is enthusiastic about this opportunity to further transform oral health care in our communities by delivering enhanced value for the members, providers, Managed Care Organizations, and state partners we serve,” said Glen Feingold, Chief Operating Officer for MCNA Dental.
MCNA Dental has a proven 27-year track record of facilitating high quality, cost effective oral healthcare services. MCNA serves beneficiaries in Texas, Louisiana, Florida, Iowa, Idaho, Arkansas, Nebraska, and Utah all through direct contracts with the state Medicaid agencies in each state. It was the first dental plan in the nation to receive full URAC Dental Plan Accreditation and has maintained NCQA accreditation in credentialing since 2011.
Founded in 1977 by Dr. Martin Kane and Dr. Stephen Cuchel, Healthplex is a New York-based dental insurance and management company with extensive experience in both government-funded and commercial dental programs. Healthplex has provided best-in-class dental services to government-funded programs through contracts with Managed Care Organizations (MCOs) since 1995. The company currently administers dental benefits for the programs of 33 MCO clients to include Medicaid, Child Health Plus, Medicare, MLTC, FIDA, Essential, and HARP plans. Healthplex also underwrites and administers dental plans for 225 prominent labor unions and municipalities, and 3,000 commercial businesses. The company currently serves 2.4 million members in New York State.
“The Healthplex team is looking forward to combining our regional expertise with MCNA’s national presence while implementing proven best practices, making both companies stronger. I am personally excited to have the opportunity to continue to build upon Healthplex’s 40-year story of growth with a company so closely aligned with our vision and our commitment to service in our community. Healthplex already manages the highest rated dental plans in our markets, and having the energy and enthusiasm of the Feingold family behind us will make Healthplex that much more formidable as a competitor in our existing and expansion markets,” said Christopher Schmidt, President and CEO of Healthplex.
DLA Piper LLP (US) and Windels Marx Lane & Mittendorf LLP served as legal adviser to the selling shareholders of Healthplex, Inc., throughout the acquisition process. Akerman LLP and Greenberg Traurig LLP of New York served as legal advisers to the purchasers and MCNA Dental.
Healthplex, New York’s only dental plan founded by dentists, has over 40 years of experience in  administering and insuring dental benefits, specializing in the design of cost-effective dental programs for Medicaid, Child Health Plus (CHP), Medicare, Health Exchanges, Corporations, Unions, Municipalities, Small Business, FIDA, HARP, MLTC, and Essential Plans. The company serves over 2.4 million members, and maintains the largest, most comprehensive dental provider network in New York State. Healthplex is certified by NCQA as a Credentials Verification Organization (CVO). The company is also accredited by NCQA in Utilization Management. Healthplex is committed to providing access to high quality affordable dental care and to improving the oral health of our community.
Contact: Valerie Vignola
Healthplex, Inc.
Phone: 516-542-2264
333 Earle Ovington Blvd., Suite 300
Uniondale, NY 11553
Cision
Measure
Measure