Category: MegaMixTape

MM Curator summary

The health insurance giant continues its payer and provider services build out with the $13B purchase of Change.

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

(Bloomberg) — UnitedHealth Group Inc. agreed to purchase Change Healthcare Inc. in a deal that values the health technology company at about $8 billion.

UnitedHealth will pay $25.75 per share in cash, the companies said Wednesday, a 41% premium over Change Healthcare’s closing price Tuesday of $18.24. Including more than $5 billion in debt owed by Change Healthcare, the deal amounts to $13 billion.

The deal will combine Change Healthcare with UnitedHealth’s OptumInsight unit to offer software, data analytics, technology and other services to the health-care industry.

The acquisition is one of UnitedHealth’s largest and is another step in expanding the company’s health services business under its Optum division. The companies said the combination would help simplify services around medical care to improve health outcomes and lower costs.

Both businesses inhabit the complex behind-the-scenes space of U.S. health care, where companies determine what medical care is appropriate and provide services to move information on claims and payments between insurers, medical providers, and patients.

“Together we will help streamline and inform the vital clinical, administrative and payment processes on which health care providers and payers depend to serve patients,” Andrew Witty, president of UnitedHealth Group and chief executive officer of Optum, said in a news release.

Change Healthcare rose 39% in premarket trading at 6:56 a.m. in New York. They had gained 16% in the past 12 months through Monday. UnitedHealth fell 2.3% in premarket trading.

Broadening Reach

In recent years, UnitedHealth has broadened its reach well beyond health insurance. Through its Optum division, the company increasingly delivers medical care directly to patients and sells consulting, technology, and data to other health-care entities.

Change Healthcare’s CEO, Neil de Crescenzo, will lead the combined business unit as the CEO of OptumInsight, the companies said. Nashville, Tennessee-based Change Healthcare has about 15,000 employees, according to data compiled by Bloomberg.

OptumInsight is the smallest business unit in the Optum family by revenue, yet it has the highest operating margins of the company’s reported segments, exceeding 20% in each of the last three full years.

The OptumInsight business accounted for about $2.8 billion in revenue in the three months ending Sept. 30, according to filings, or about 4% of the company’s total. That includes revenue from outside clients as well as “affiliated customers” within UnitedHealth Group. Change Healthcare reported revenue of $756 million in the same period.

The deal is expected to close in the second half of 2021. Private equity funds affiliated with Blackstone Group Inc. that own about 20% of Change Healthcare’s common stock have agreed to vote in favor of it, the companies said. It’s expected to boost UnitedHealth’s adjusted earnings per share by $0.50 in 2022, the companies said.

The acquisition is the second major health-care deal in the first week of 2021. On Monday Centene Corp. agreed to buy Magellan Health Inc. for $2.2 billion.

Clipped from: https://finance.yahoo.com/news/unitedhealth-purchase-change-healthcare-13-113122374.html

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Analysts speculate that the move is simply CVS excluding a top competitor.

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

The removal of one pharmacy chain from the network has not created or contributed to network access issues, Aetna says.

As of December 1, Aetna dropped CVS competitor Walgreens from its Illinois Medicaid plan. 

Aetna’s decision to exclude the Walgreens chain from its Aetna Better Health of Illinois pharmacy network affects about 400,000 residents in the state, according to the Chicago Tribune. Many in this population are poor, unemployed and disproportionately suffering from COVID-19.

Nearly 2,000 pharmacies participate in Aetna’s Better Health of Illinois network, Aetna Medicaid said by statement, including other national pharmacy chains such as Walmart, regional chains such as Osco and many independent pharmacies. 

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In Chicago, there are 271 in-network pharmacies with an average distance to these locations of half a mile, Aetna said.

“The removal of one pharmacy chain from the network earlier this month has not created or contributed to network access issues, and we meet or exceed all of the state’s access requirements for managed care organizations,” Aetna said. “In fact, the Illinois Department of Healthcare and Family Services has reviewed our updated network and determined it promotes equity.”

Aetna said it has worked with its pharmacy partners to offer and expand coverage of 90-day prescriptions through mail order, offer free delivery to members across the state and empower pharmacists to allow early medication refills where situationally appropriate.

WHY THIS MATTERS

In November 2018, the $69 billion merger for CVS Health to acquire Aetna closed.

Aetna has given no reason for its decision to exclude Walgreens, leaving critics to fill in the blank that eliminating a large competitor from its network would be the motivating factor.

In 2019, CVS Health topped a Becker’s Hospital Review list of the nation’s largest pharmacies, which were ranked by total prescription revenue. CVS was followed by Walgreens, Cigna\Express Scripts, UnitedHealth Group’s OptumRx and Walmart. 

THE LARGER TREND

In 2018, the Tribune reported that pharmacy access was a growing concern in Chicago. Some public health experts said that more than a dozen low-income neighborhoods, mostly on the South and West sides of Chicago, were becoming pharmacy deserts.

Providers have increasingly been addressing the social determinants of health for patients as it has become clear that SDOH issues such as food and housing insecurity, transportation and isolation have as much influence on health as clinical concerns. 

RWJBarnabas Health recently launched a social determinants of health program called Health Beyond the Hospital in collaboration with NowPow and ConsejoSano, in order to refer and connect patients to community-based services.  

Clipped from: https://www.healthcarefinancenews.com/news/aetna-drops-walgreens-its-illinois-medicaid-plan

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Humana is arguing that Passport did not have the right to sell future enrollment to Molina, as that enrollment is part of plans win when they bid successfully.

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

Humana filed a lawsuit against the state over the Medicaid program.

Humana Health Plan Inc., a subsidiary of Humana Inc. that operates its Kentucky Medicaid program, has filed another lawsuit in the dispute over the state’s five Medicaid contracts.

In the suit filed Dec. 23, Humana alleges that the state violated the new Medicaid contracts when it allowed Long Beach, California-based Molina Healthcare Inc. to acquire Passport Health Plan Inc.’s membership in 2020 and allowed it keep Passport members going into the new 2021 contracts, which started on Jan. 1.

Molina’s deal to acquire Passport closed in September. Passport was not awarded a contract by the Beshear administration when it announced the awards in May.

At issue in the suit is how members within the Medicaid program are assigned to companies for coverage and whether or not Molina’s takeover of Passport allows it to acquire Passport’s membership for a new contract period.

Humana maintains that Passport doesn’t have the rights to sell off its membership and had no claim to its membership at all beyond its contract, which ended at the end of 2020.

“The [Medicaid] contracts did not contemplate that [Medicaid companies] who failed to win new contracts could auction off their members to the highest bidder,” the lawsuit reads. “Thus, Passport had no membership rights to ‘sell’ Molina.

“Similarly, as a ‘new [Medicaid company],’ Molina had no right under the [contract] to obtain Passport’s membership except under the reallocation formula set forth in” a specific section of the contract.

Humana maintains that allowing Molina to acquire Passport’s membership deprives Humana and the other winning Medicaid companies from enjoying the benefit of winning the contracts, which includes, in part, having the members from failing Medicaid companies reassigned to the winners.

The company maintains that Passport’s membership should be reassigned to the winning companies based on a process and formula articulated in the 2021 Medicaid contracts.

Humana appealed Molina’s takeover of Passport’s membership twice — to the Kentucky Finance and Administration Cabinet and the Kentucky Health and Family Services Cabinet. Both appeals were denied, the lawsuit states.

Issues of membership

For Molina’s part, the company’s executives told investors and analysts on a public call that it hoped that it simply would get all of Passport’s roughly 315,000 members, rather than the 140,000 members that it expected to get through the assignment process, the lawsuit states. In a transcript of the call, Molina’s CEO Joseph Zubretsky said: “If we obtained all 315,000 members, that would represent a little over $1 billion of upside… to the estimate we’ve given you.”

Clipped from: https://www.bizjournals.com/louisville/news/2021/01/04/humana-files-a-new-lawsuit.html

MM Summary

Centene adds a giant pharmacy services component with the purchase of Magellan.

M&A activity continues to pick up in the health-care space.

Centene (ticker: CNC) announced Monday that it will pay $95 per share for Magellan Health (MGLN), a 14.7% premium over Magellan’s closing price last Thursday of $82.84. Shares of Magellan were up 12.3%, to $93.00, in early trading on Monday.

Shares of Centene, meanwhile, were up 1% at the open of trading Monday, to $60.62.

The deal comes a year after Centene closed its $17.3 billion acquisition of WellCare Health Plans, another insurer focused on government-sponsored health plans. Centene is one of the largest players in that sector, with a managed care membership of 25.2 million people, with roughly half of them enrolled in Medicaid plans.

Centene said that it expects the Magellan deal to bring in 5.5 million members on government-sponsored plans, 2 million members of Magellan’s pharmacy benefit manager plans, and a behavioral health platform with 41 million members, among other businesses.

“This acquisition accelerates our diversification strategy and enhances our ability to build next generation capabilities in our specialty care business by leveraging our scale and investments in technology,” said Centene CEO Michael Neidorff in a statement.

In an interview with Barron’s on Monday morning, Neidorff said that he chiefly wanted Centene to have access to Magellan’s behavioral-health network, which contracts with states, employers, and other insurers to offer various behavioral health care services.

“Behavioral health is probably the most underserved area,” Neidorff said. “This gives us access to a very broad network… It gives them access to our technology.”

Neidorff said that Magellan will be treated as an independent company within Centene, and that outside clients will have equal access to its behavioral-health product.

“If you have a newly diagnosed diabetic, after they see their endocrinologist, they should go see a psychologist to help them deal with it,” Neidorff said. “You end up with better compliance and a healthier situation.”

Neidorff said that he expects the deal to close in the second half of the year.

On an analyst call Monday, Neidorff said that regulatory approval for the deal wouldn’t pose a major challenge. “It’s complex, but it’s something we’re very used to. We’ve had some that are far more complex,” Neidorff said. “I don’t anticipate any divestitures.”

Magellan recently sold off its Magellan Complete Care business, which offers Medicaid and Medicare plans in certain states, to Molina Healthcare (MOH) for $820 million. Molina Healthcare announced Monday that the transaction closed last Thursday.

In the interview with Barron’s, Neidorff said that the sale of that business was necessary to allow regulatory clearance of the deal.

The immediate reaction to the deal from Wall Street analysts appears to be positive. In a note out early Monday, Cantor Fitzgerald analyst Steven Halper said the transaction looked good for Centene.

“We believe [Magellan Health] is a solid acquisition with modest near term accretion,” Halper wrote. “The company’s leverage ratios will certainly increase again, but given a relatively low cost of capital, the company should be able to drive incremental returns.”

Shares of Centene were down 1.8% over the past 12 months, as of Friday’s close. The stock trades at 11.4 times expected earnings over the next 12 months, according to FactSet, below its five-year average of 14 times earnings. Of the twenty-one analysts who cover the stock tracked by FactSet, 19 rate it a Buy or Overweight, while two rate it a Hold.

Clipped from: https://www.barrons.com/articles/centene-is-climbing-on-its-plans-to-buy-magellan-health-for-2-2-billion-51609771065