Category: Market Intel

Posted on by

Acorn Health Acquires Behavior Therapy Specialists in O’Fallon, IL | Business Wire

MM 1 Sentence Summary- Behavior Therapy Specialists joins Acorn Health which will expand ABA services in Illinois and gives them operations in Michigan, Florida, Virginia, and Illinois. 

Acorn Health Acquires Behavior Therapy Specialists in O’Fallon, IL

December 09, 2019 05:28 PM Eastern Standard Time
MIAMI–(BUSINESS WIRE)–Acorn Health is pleased to announce that Behavior Therapy Specialists (BTS) in O’Fallon, IL has now joined the Acorn Health family. Behavior Therapy Specialists will serve as a regional platform for providing high quality home- and center-based Applied Behavior Analysis (“ABA”) services to children and adults diagnosed with autism in Southern Illinois and Northern Missouri. With this acquisition, Acorn Health now has operations in Michigan, Florida, Virginia and Illinois, and continues to look for partnerships with high-quality provider groups in existing and adjacent new markets.
Acorn Health is pleased to announce that Behavior Therapy Specialists in O’Fallon, IL has now joined the Acorn Health family.
“We are excited to have Behavior Therapy Specialists join the Acorn Health family, led by their founders, Jenna Kokoski M.Ed., BCBAn and Jessica Dow, M.Ed., BCBA,” said Vicki Kroviak, CEO of Acorn Health. “As our partners, Jenna and Jessica, and their clinical team will help us grow our ability to deliver top quality ABA services to families in need in the Southern Illinois area.”
Autism has been recognized as the fastest growing developmental disability, and identifying at-risk children by two years of age leads to the highest likelihood of early intervention. Research suggests that early intervention programs are beneficial for children with autism spectrum disorder, often improving developmental functioning and decreasing maladaptive behaviors and the severity of symptoms. ABA is one of the most researched and widely accepted forms of behavior therapy for children with autism, and at Acorn Health, clinicians work closely with each family to help their children find their strengths and develop independent, meaningful lives.
“We are thrilled to be expanding our ABA services via our partnership with BTS,” said Krista Boe, a Board-Certified Behavior Analyst (BCBA) and Acorn Health’s Chief Clinical Officer. “Behavior Therapy Specialists’ clinical team has been serving clients in the area for years and Acorn Health looks forward to working with them to provide additional support and treatment options for local Illinois families.”
Behavior Therapy Specialists is now a wholly-owned subsidiary of Acorn Health – a national provider of Applied behavior analysis therapy, with locations in Michigan, Virginia, Florida, and now, Illinois. To learn more about Behavior Therapy Specialists: www.behaviortherapyspecialists.com. To inquire about services at Behavior Therapy Specialists, please call 618-206-8816.
Acorn Health
Celebrate Difference, Realize potential.
833-226-7633, in**@*********th.com
To learn more about Acorn Health: www.acornhealth.com

Contacts

Media Contact Information:
Behavior Therapy Specialists
Jenna Kokoski

Acorn Health

Release Summary

Acorn Health is pleased to announce that Behavior Therapy Specialists in O’Fallon, IL has joined the Acorn Health family.

Measure
Measure
Posted on by

InSight Telepsychiatry and Regroup Announce Merger to Become Largest Telepsychiatry Provider in US | Business Wire


InSight Telepsychiatry and Regroup Announce Merger to Become Largest Telepsychiatry Provider in US (highlighted)

December 10, 2019 01:10 PM Eastern Standard Time
PHILADELPHIA & CHICAGO–(BUSINESS WIRE)–InSight Telepsychiatry and Regroup Telehealth have merged to become the largest and most comprehensive telepsychiatry service provider in the US.
“Geoffrey and the leadership team are highly regarded by both the mental health provider community and their partners. This next phase of growth will continue to improve access to mental health care for underserved individuals, facilities and communities”
The merger between InSight and Regroup brings together a robust network of providers and an impressive group of clinical and executive leaders with extensive experience and expertise across different care settings and patient populations for underserved individuals and communities. This joint effort will allow for increased delivery of mental health services across the country in response to a nationwide shortage of specialists coupled with a rising need for behavioral health services.
“InSight is excited about the merger with Regroup and the opportunities it represents. Our organizations are remarkably similar in terms of culture, values and vision for the future. By combining our passion, drive and efforts, we will continue to set the standard for telepsychiatry delivery, leading the way to unprecedented access to care to those who need it most,” said Geoffrey Boyce, CEO of InSight and the new combined organization. “This merger allows us to align our shared goals, operational efficiencies and established models to offer scalable solutions across the continuum of care.”
InSight Telepsychiatry, based in Mt Laurel, NJ, has more than twenty years of telepsychiatry experience and serves hundreds of organizations in various settings with its on-demand, scheduled and direct-to-consumer (Inpathy) divisions. Since its inception, InSight has maintained its reputation as a trusted and experienced industry thought leader by upholding a high standard of clinical care and actively advocating for increased adoption of telebehavioral health.
Regroup, founded in 2011 and based in Chicago, brings customized telepsychiatry solutions, technology and comprehensive support teams that contribute to the seamless integration of behavioral health clinicians at partner care sites. With backing from a group of funders including the Hyde Park Angels and Frist Cressey Ventures, Regroup grew quickly. Their clinicians collaborate with onsite care teams on patient care plans and workflows, yielding better behavioral care, shorter wait times and reduced barriers in settings such as primary care clinics, community health centers, hospitals and correctional facilities.
“Regroup is excited to complement our proven approach to integrated telepsychiatry with InSight’s breadth of services, including on-demand services for partners and direct-to-consumer solutions for patients seeking care at home or other care settings of their choice,” said David Cohn, Founder and CEO of Regroup. Cohn will serve as Chief Growth Officer and maintain a seat on the board of directors for the newly combined organization.
Investors in the combined company include Harbour Point Capital, HLM Venture Partners, OCA Ventures, OSF Ventures, and Impact Engine. Ziegler, a specialty investment bank, represented Regroup in the merger process.
“Geoffrey and the leadership team are highly regarded by both the mental health provider community and their partners. This next phase of growth will continue to improve access to mental health care for underserved individuals, facilities and communities,” said David Crane, Chairman of the new organization’s board and a Partner at Harbour Point Capital.
“HLM has been a firm supporter of Regroup and is proud to see the impact they have made on how behavioral health services are provided virtually across the US. This merger marks a new chapter where the combined entity will be uniquely positioned to shape the future of the telebehavioral market even further,” said Vin Fabiani of HLM Venture Partners. Fabiani will continue to serve on the new organization’s board of directors.
About InSight Telepsychiatry
Founded by child and adolescent psychiatrist, Jim Varrell, MD, InSight is the leading national telepsychiatry service provider with a mission to transform access to quality behavioral health care through innovative applications of technology. InSight has more than two decades of telepsychiatry experience and serves hundreds of organizations across the country with its on-demand, scheduled services and Inpathy divisions. InSight has led the growth of the telepsychiatry industry and remains an industry thought leader and advocate. To learn more, visit www.InSightTelepsychiatry.com.
About Regroup Telehealth
In partnership with providers at more than 175 care locations across America, Regroup brings individualized mental health services to deliver hundreds of thousands of patient sessions per year. Regroup’s clinician-focused culture attracts highly qualified clinicians that are supported by a dedicated team of recruiting, licensing and credentialing, account management, clinician relations and technical implementation teams. For more information, visit www.regrouptelehealth.com.
The two organizations will continue to utilize their respective names and brands throughout the integration process.

Measure
Measure
Posted on by

UnitedHealth buys Virginia Medicare Advantage plan


UnitedHealth buys Virginia Medicare Advantage plan (highlighted)

Morgan Haefner – Monday, October 7th, 2019 
A UnitedHealth Group subsidiary bought a Medicare Advantage plan in Virginia for an undisclosed amount, according to The News and Advance. 
Under the deal, effective Oct. 1, UnitedHealthcare Insurance Company of the River Valley absorbed 5,000 Medicare Advantage members from Piedmont Community Health Plans. Piedmont Select Medicare Advantage members will likely see no change from the sale.
CMS approved the spinoff of Piedmont Select Medicare Advantage on Aug. 29. Under a transition agreement, Piedmont will continue to administer the plans through the end of the year, after which UnitedHealthcare will take over management of the plan.
Lynchburg, Va.-based Centra Health became the owner of Piedmont Community Health Plans in 2015. The health plan still has about 25,000 members in other products.
Measure
Measure
Posted on by

Molina Healthcare to Expand New York Presence Through Acquisition of Certain Assets of YourCare Health Plan | Business Wire


Molina Healthcare to Expand New York Presence Through Acquisition of Certain Assets of YourCare Health Plan (highlighted)

October 16, 2019 06:00 AM Eastern Daylight Time
LONG BEACH, Calif.–(BUSINESS WIRE)–Molina Healthcare, Inc. (NYSE: MOH) today announced that it has entered into a definitive agreement to acquire certain assets of YourCare Health Plan, Inc., a not-for-profit subsidiary of Monroe Plan for Medical Care. As a part of the transaction, Molina will assume the right to serve approximately 46,000 Medicaid members in seven counties in the Western New York and Finger Lakes regions. Monroe and its affiliate MP CareSolutions will continue to provide certain management and administrative services related to member care and provider relations.
Molina Healthcare to Expand New York Presence Through Acquisition of Certain Assets of YourCare Health Plan
The purchase price of approximately $40 million will be funded through Molina’s available cash. Subject to the receipt of regulatory approvals and the satisfaction of other customary conditions, the closing of the transaction is expected to occur in early 2020. YourCare’s estimated premium revenue for the full year 2019 is approximately $285 million.
“We look forward to providing high-quality care to YourCare members in close partnership with the New York Department of Health and the provider community in the Western New York and Finger Lakes regions,” said Colleen Schmidt, president of Molina Healthcare of New York. “Molina is excited to partner with Monroe and MP CareSolutions on select services to facilitate access to quality health care and ensure a seamless transition for members and providers. This agreement represents an exciting opportunity to build upon our existing operations in New York and expand into new service areas.”
About Molina Healthcare
Molina Healthcare, Inc., a FORTUNE 500 company, provides managed health care services under the Medicaid and Medicare programs and through the state insurance marketplaces. Through its locally operated health plans, Molina Healthcare served approximately 3.4 million members as of June 30, 2019. For more information about Molina Healthcare, please visit molinahealthcare.com.
Safe Harbor Statement under the Private Securities Litigation Reform Act of 1995
This press release contains “forward-looking statements” regarding the proposed acquisition by Molina of certain assets of YourCare. All forward-looking statements are based on current expectations that are subject to numerous risk factors that could cause actual results to differ materially. Such risk factors include, without limitation, risks related to: the possibility that the transaction will not be completed on a timely basis or at all; the risk that regulatory or other approvals required for the transaction may be delayed or not obtained, or are obtained subject to conditions that are not anticipated that could require the exertion of management’s time and resources or otherwise have an adverse effect on Molina; the possible attrition in YourCare membership pending the completion of and following the closing of the transaction; the difficulty of maintaining new provider relations and managing potential medical cost increases resulting from potentially unfavorable changes in contracting or re-contracting with providers; the risk that, following the transaction, estimated premium revenue of YourCare or expected synergies and value creation from the transaction may not be realized, or will not be realized within the expected time period; the risk that Molina is unable to accurately estimate incurred but not reported medical costs with respect to this new population; and the risk that unexpected costs will be incurred in connection with the assumption of the YourCare membership or that the expansion to new regions will be more difficult or time consuming than expected. Additional information regarding the risk factors to which the Company is subject to, is provided in greater detail in its periodic reports and filings with the Securities and Exchange Commission, including its most recent Annual Report on Form 10-K. These reports can be accessed under the investor relations tab of the Company’s website or on the SEC’s website at sec.gov. Given these risks and uncertainties, the Company can give no assurances that its forward-looking statements will prove to be accurate, or that any other results or events projected or contemplated by its forward-looking statements will in fact occur, and the Company cautions investors not to place undue reliance on these statements. All forward-looking statements in this release represent the Company’s judgment as of the date hereof, and, except as otherwise required by law, Molina disclaims any obligation to update any forward-looking statements to conform the statement to actual results or changes in its expectations.

Contacts

Investor Contact: Julie Trudell, Ju***********@**************re.com, 562-912-6720
Media Contact: Laura Murray, La**********@**************re.com, 562-506-9208
Measure
Measure
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

-Centene, Walgreens and RxAdvance Announce Partnership to Provide Innovative Pharmacy Management Model


Centene, Walgreens and RxAdvance Announce Partnership to Provide Innovative Pharmacy Management Model (highlighted)

News provided by
Oct 17, 2019, 07:00 ET
Share this article
ST. LOUIS and DEERFIELD, Ill., Oct. 17, 2019 /PRNewswire/ — Centene Corporation (NYSE: CNC), Walgreens and RxAdvance today announced a strategic partnership to introduce an innovative model for pharmacy management that aims to increase transparency, enhance customer experience and ultimately result in better health outcomes at lower costs. The partnership builds upon an existing Centene and Walgreens relationship, leveraging Walgreens trusted retail pharmacy expertise and Centene’s national leadership in providing comprehensive health care services to the underserved, while also utilizing RxAdvance’s innovative pharmacy benefit management model powered by its Collaborative PBM Cloud platform.
There is a growing need for new approaches to pharmacy benefit management, particularly to serve the Medicaid population. This partnership addresses the need for leading companies to collaborate on a better model, and one which provides higher quality care and lower pricing for drugs.
“Centene is committed to supporting a transparent pharmacy benefit management model that is sustainable with higher quality care for members at a lower cost to our customers,” said Michael F. Neidorff, chairman, president and CEO, Centene. “This new approach to pharmacy management will improve the transparency and quality of care, while reducing unnecessary medical costs for millions of people.”
Using RxAdvance’s Collaborative PBM Cloud™ transactional platform and clinical intelligence, the companies will work together to improve overall patient care across the continuum of health care and to offer such a model to other large payers.
“Collaboration between retail pharmacies and payers like Centene can further transform the way we provide care,” said Stefano Pessina, executive vice chairman and CEO, Walgreens Boots Alliance, Inc. “Using RxAdvance’s Collaborative PBM Cloud, our partnership can empower our pharmacists to make critical decisions at the point of sale to help improve adherence and also to reduce avoidable medical costs.”
The parties have identified initial markets to deploy the partnership model and are working with community leaders on new pharmacy models.
Further exemplifying this commitment, Walgreens has made a small investment in RxAdvance, and Centene has increased its stake in RxAdvance, following its initial investment announced in March 2018.
“I am excited that today we have partners across the care continuum – Centene and Walgreens – who are committed to the power of RxAdvance’s collaborative PBM model, and to completely reimagine what is possible in this industry,” said Ravi Ika, founder and CEO, RxAdvance. “By pushing the limits of innovative technology and existing transaction standards, there is a clear path forward to reduce administrative costs, avoidable medical costs, and to improve overall quality of care.”
About Centene Corporation
Centene Corporation, a Fortune 100 company, is a diversified, multi-national healthcare enterprise that provides a portfolio of services to government sponsored and commercial healthcare programs, focusing on under-insured and uninsured individuals. Many receive benefits provided under Medicaid, including the State Children’s Health Insurance Program (CHIP), as well as Aged, Blind or Disabled (ABD), Foster Care and Long-Term Services and Supports (LTSS), in addition to other state-sponsored programs, Medicare (including the Medicare prescription drug benefit commonly known as “Part D”), dual eligible programs and programs with the U.S. Department of Defense. Centene also provides healthcare services to groups and individuals delivered through commercial health plans. Centene operates local health plans and offers a range of health insurance solutions. It also contracts with other healthcare and commercial organizations to provide specialty services including behavioral health management, care management software, correctional healthcare services, dental benefits management, commercial programs, home-based primary care services, life and health management, vision benefits management, pharmacy benefits management, specialty pharmacy and telehealth services.
Centene uses its investor relations website to publish important information about the Company, including information that may be deemed material to investors. Financial and other information about Centene is routinely posted and is accessible on Centene’s investor relations website, http://www.centene.com/investors.
About Walgreens
Walgreens (walgreens.com), one of the nation’s largest drugstore chains, is included in the Retail Pharmacy USA Division of Walgreens Boots Alliance, Inc. (NASDAQ: WBA), the first global pharmacy-led, health and wellbeing enterprise. Approximately 8 million customers interact with Walgreens in stores and online each day, using the most convenient, multichannel access to consumer goods and services and trusted, cost-effective pharmacy, health and wellness services and advice. As of Aug. 31, 2018, Walgreens operates 9,560 drugstores with a presence in all 50 states, the District of Columbia, Puerto Rico and the U.S. Virgin Islands, along with its omni-channel business, Walgreens.com. Approximately 400 Walgreens stores offer Healthcare Clinic or other provider retail clinic services.
About RxAdvance
RxAdvance is an innovative national full-service pharmacy benefit manager (PBM) that leverages their Collaborative PBM Cloud™ platform to deliver integrated services that reduce overall pharmacy costs and avoidable drug-impacted medical costs while optimizing specialty spend. In addition, standing shoulder-to-shoulder with plan sponsors, RxAdvance offers a global pharmacy risk partnership model. Our tailored, world-class services are for all plan sponsors — health plans, accountable care organizations (ACOs), exchanges, state Medicaid programs, and employer groups. We provide contractually guaranteed savings in administrative costs, ingredient unit costs, and rebate revenues. For more information, visit www.rxadvance.com.
Forward-Looking Statements
All statements in this release that are not historical are forward-looking statements made pursuant to the safe harbor provisions of the Private Securities Litigation Reform Act of 1995. Without limiting the foregoing, forward-looking statements often use words such as “believe,” “anticipate,” “plan,” “expect,” “estimate,” “intend,” “seek,” “target,” “goal,” “may,” “will,” “would,” “could,” “should,” “can,” “continue” and other similar words or expressions (and the negative thereof). In particular, these statements include, without limitation, statements about our future operating or financial performance, market opportunity, growth strategy, competition and investments. These forward-looking statements reflect current views with respect to future events and are based on numerous assumptions and assessments made in light of current experience and perception of historical trends, current conditions, business strategies, operating environments, future developments and other factors believed to be appropriate. These forward-looking statements are not guarantees of future performance and involve risks, assumptions and uncertainties, including those described in: “Risk Factors” appearing in the registration statement on Form S-4 filed by Centene Corporation with the Securities Exchange Commission on May 23, 2019; Item 1A (Risk Factors) of the Walgreens Boots Alliance, Inc. Form 10-K for the fiscal year ended August 31, 2018; and in other documents that Centene Corporation, Walgreens Boots Alliance and RxAdvance may file or furnish with the Securities and Exchange Commission. Should one or more of these risks or uncertainties materialize, or should underlying assumptions prove incorrect, actual results from this collaborative effort may vary materially. These forward-looking statements speak only as of the date they are made and are based only on information available on the date hereof. Except to the extent required by law, Centene Corporation, Walgreens Boots Alliance, Walgreens and RxAdvance do not undertake, and expressly disclaim, any duty or obligation to update publicly any forward-looking statement after the date of this release, whether as a result of new information, future events, changes in assumptions or otherwise. You should not place undue reliance on any forward-looking statements, as actual results may differ materially.
SOURCE Centene Corporation

Related Links

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