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Open in new tab 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
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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.”
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.”
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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.
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)
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.
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-Feds reviewing Cuomo’s Fidelis deal : Empire Center for Public Policy
Feds reviewing Cuomo’s Fidelis deal (Highlighted)
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.
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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.
Cision
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Insurer’s stake in firm stirs concern in Arkansas
Insurer’s stake in firm stirs concern in Arkansas (highlighted)
To participate in Arkansas’ Medicaid managed care initiative, national health insurance giant Centene teamed up with Mercy health system in 2017 to form a new company known as Arkansas Total Care.
That company is one of three that now receive millions of dollars from the state Medicaid program each month to pay for the care of about 45,000 Arkansans who have significant mental illness or developmental disabilities.
Under the state law authorizing the initiative, such companies — known as Provider-led Arkansas Share Savings Entities, or PASSEs — are required to be at least 51% owned by participating health care providers, such as doctors, hospitals or organizations offering services for the developmentally disabled.
Filings with the state Insurance Department indicate that Mercy, which owns hospitals in Arkansas and three other states, owned no more than 26% of Arkansas Total Care as of June 30. Centene owned the remaining 74%.
Despite the insurer’s large stake, the state Insurance Department considers Arkansas Total Care to meet the provider ownership requirement because Centene owns part of its share through a subsidiary, LifeShare Management Group.
The Arkansas Department of Human Services issued LifeShare a temporary certificate as a provider of services for the developmentally disabled in 2017, just over a month before Arkansas Total Care was approved to participate in the managed care program.
“The law doesn’t provide for us to look at parent companies,” Insurance Department spokesman Ryan James said. “If it’s a provider, we count it on the provider list.”
Rep. Aaron Pilkington, who sponsored the legislation, said Centene’s ownership stake is “concerning” and doesn’t follow his “intent that it would be 51% owned by providers.”
“That’s why we called it provider-led organized care,” Pilkington, R-Clarksville, said. “Literally the first word is provider.”
Sen. Missy Irvin, R-Mountain View, who is chairman of the Senate Committee on Public Health, Welfare and Labor, had a similar reaction when she recently learned about Arkansas Total Care’s ownership.
“This to me seems like an end-run around that legislation and that legislative intent, and that’s not what I believe that the Legislature endorsed,” said Irvin, who works at her husband’s family medicine practice.
She and many health care providers would have opposed Pilkington’s bill, which became Act 775, if the requirement of provider ownership had not been included, she said.
John Ryan, chief executive of Arkansas Total Care, said in a statement that his company “meets the requirements of a certified PASSE as established by Arkansas DHS and regulated by the Arkansas Insurance Department.”
“As a certified Arkansas Medicaid Provider, with an active Arkansas Medicaid Provider number, LifeShare has been serving members of the PASSE program since the program’s inception,” he said.
Under the Provider-led Arkansas Share Savings Entities initiative’s first phase, Arkansas Total Care and three other companies last year began coordinating Medicaid recipients’ care in exchange for monthly payments of $173.33 per recipient.
On March 1, three of the companies became responsible for paying for all the recipients’ care in exchange for larger monthly payments, ranging from $998.86 to $12,672.62 per recipient.
One of the companies, Forevercare, dropped out before the larger payments started.
From March through June 30, payments to the three remaining companies totaled $540 million, including $123 million that went to Arkansas Total Care.
The initiative was designed to reduce costs by better coordinating care while generating money for the state through its 2.5% tax on insurance premiums.
It emerged in 2016 as a compromise with providers who feared that managed care would lead to cuts in benefits and reimbursement rates.
“We wanted to create a new type of organization that combined the strengths of providers rooted here in the state with partners that have expertise in operating business systems that could immediately comply with insurance laws and regulations as well as federal Medicaid requirements,” Human Services Department spokeswoman Amy Webb said in an email.
“The model minimizes the incentive to deny or decrease service to our members because 51% of the ownership is by the same providers paid to provide the direct service. This forces the model to look for a better way to maintain efficiency by targeted, coordinated, care coordination to improve the overall health and care of the member, and in turn, will save money by avoiding high cost services like hospitalizations/institutions.”
The proposal won the support of providers, sailing through the Legislature with little opposition.
The federal government provides 70% of the funding for the payments that go to the managed care companies. Arkansas then recoups 2.5% of the payments — including the share funded by the federal government — through a tax on insurance premiums.
Act 775 of 2017 requires half of the premium tax money to go toward reducing the number of people with developmental disabilities on a waiting list for home-based services, such as help with dressing and bathing.
As of August, about 4,500 people were receiving the services and 3,300 were on the waiting list.
THE OTHER COMPANIES
Anthem, an Indianapolis-based health insurer, owns 49% of one of the managed care companies, Summit Community Care.
The remaining 51% of Summit is owned by the Arkansas Provider Coalition. According to materials presented by the Human Services Department to state legislators in April, the coalition includes the Little Rock-based Baptist Health system, all but one of the state’s 12 community mental health centers and dozens of other providers of mental-health care and services for the developmentally disabled.
Through its pending acquisition of Boston-based Beacon Health Options, Anthem is also set to own a sixth of the other managed care company, Empower Healthcare Solutions.
The rest of Empower’s ownership is evenly split among five other entities: Arkansas Community Health Network, the Arkansas Healthcare Alliance, Independent Case Management, Woodruff Health Group and Statera.
Arkansas Community Health Network consists of Baxter Regional Health System, North Arkansas Medical System, Unity Health and White River Health System.
The Arkansas Healthcare Alliance is made up of 22 providers of mental health and substance abuse treatment services and services for the developmentally disabled, according to the Human Services Department.
Independent Case Management, based in Little Rock, serves the developmentally disabled.
Woodruff Health Group “was created to hold the interest of ARcare,” a federally funded, Augusta-based community health center with more than 40 clinics in Arkansas, Mississippi and Kentucky, according to a June 15, 2017, letter to the Insurance Department announcing Empower’s intention to participate in the managed care initiative.
Statera is “an entity comprised of leaders and innovators committed to serving the long-term support services needs of Arkansans,” according to Empower’s website.
Representatives of Summit Community Care and Empower didn’t return calls seeking comment.
INFORMATION REMOVED
As of June 30, Centene owned 49% of Arkansas Total Care through a health plan subsidiary, Arkansas Health and Wellness, and an additional 25% through LifeShare, according to Insurance Department filings.
LifeShare’s temporary Arkansas certification allowed it to provide case management and supportive living services to the developmentally disabled.
The certification was upgraded to a regular license on Feb. 1 of this year.
According to since-removed pages from its website, LifeShare was founded in New Hampshire in 1995 and acquired by Centene in 2015.
At a conference with investors that year in New York City, Centene executive Holly Benson said LifeShare had helped address the needs of the disabled by developing a “pathways model for coordinating in partnership with managed care” as well as a “rapid crisis response” program to reduce unnecessary emergency room visits, according to a transcript of the conference.
As recently as April 6, LifeShare said on its website that it “develops and delivers person-centered solutions for people with [intellectual and developmental disabilities] and others with complex needs through managed care organizations,” according to version of a page from the site captured by the San Francisco-based Internet Archive.
LifeShare’s website also said then that it is a “direct services IDD and child welfare provider in multiple states.”
Centene’s site, as recently as July 19, said LifeShare “develops and delivers person-centered solutions for people with intellectual or developmental disabilities (IDD) and others with complex needs through managed care and state and health organizations,” according to an archived page.
That information had disappeared from the version of that page on Centene’s website as of Friday.
LifeShare’s site appeared to contain little more than a link to Arkansas Total Care’s website and a staff member’s phone number and email address. The staff member didn’t return a call seeking comment.
In a response to written questions from the Arkansas Democrat-Gazette, including why the website was changed, Arkansas Total Care provided only Ryan’s statement.
‘PERSON-CENTERED APPROACH’
The 2017 state law defines a “participating provider” as one that “delivers healthcare services” to Medicaid recipients served or eligible to be served by one of the managed care companies.
Webb, the Human Services Department spokeswoman, said LifeShare has never filed a claim with the state Medicaid program.
As of last month, she said it also didn’t appear that LifeShare had billed Arkansas Total Care or the other two managed care entities for any services.
She added that “providers would not have to bill immediately, and it’s my understanding that PASSEs have not submitted all encounters yet, so I can’t say for certain there won’t be any encounters for this timeframe.”
Tom Masseau, executive director of Disability Rights Arkansas, a federally funded nonprofit, said the size of Centene’s stake in Arkansas Total Care “kind of defeats the whole entire purpose” of the provider-led managed care legislation.
“If that’s the direction the state wanted to go, they should have just done that in the first place and just had Centene or Anthem come in and operate the managed care program,” he said.
He added, however, that he hadn’t heard any complaints about Arkansas Total Care and was impressed by a presentation the company gave in May.
“They really seemed to really understand the person-centered approach,” he said. “They were looking at how the person could live successfully in the community and not just within going to their group home or day [habilitation] program.”
Stephanie Smith, chief operating officer of Easterseals Arkansas, said “all three PASSEs have figured ways to meet the spirit and intent of the provider-led requirement.” Easterseals Arkansas serves the developmentally disabled and, according to the Human Services Department, has a small stake in Summit Community Care,
Of the three Provider-led Arkansas Share Savings Entities, she said, Arkansas Total Care is “the one most willing to come to the table and meet with providers and [has] really been the lead in being proactive in getting some of the initial problems solved.”
Those problems included delayed payments and difficulties that providers encountered submitting claims during the rollout of the managed care initiative’s second phase.
“As long as they’re doing a good job making sure that the individuals with behavioral health needs and developmental disability needs are getting the services that they need, they’re getting the care coordination that they need, and they’re working well with providers to ensure that they’re timely in prior authorizing services and making sure there’s access to services — to me that’s the piece that’s most important,” she said.
A Section on 11/02/2019
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Blue Cross Blue Shield of Arizona acquires Steward Health Choice Arizona | AZ Big Media
Blue Cross Blue Shield of Arizona acquires Steward Health Choice Arizona
Above: Pam Kehaly is president and CEO of Blue Cross Blue Shield of Arizona (BCBSAZ), the state’s largest locally owned healthcare insurer.
Blue Cross Blue Shield of Arizona (BCBSAZ) plans to acquire Steward Health Choice Arizona from Steward Health Care System LLC, including the Arizona Health Care Cost Containment System (AHCCCS) Complete Care plan and the “Generations” Medicare health plan for dual-eligible special needs members. The acquisition will give BCBSAZ the capability to serve Arizonans who are eligible for Medicaid and those who are dual-eligible for both Medicare and Medicaid. It advances the organization’s strategy of expanding access to quality healthcare in Arizona, addressing members’ evolving healthcare needs, and better supporting Arizona’s vulnerable populations.
The transaction is expected to close following regulatory approval. The Health Choice plans will remain fully operational, stand-alone plans, and the local leadership team will remain the same.
“As a local, non-profit plan, our job is to help Arizonans with their healthcare needs,” said Pam Kehaly, President and CEO of BCBSAZ. “This investment brings us closer to Arizonans who need our support, and gives us more opportunity to inspire health, which is truly at the heart of what we do.”
BCBSAZ and Steward Health Choice Arizona both share long-term commitments to the state of Arizona, its residents and providers. Both companies have decades of experience serving a broad range of managed care programs, including commercial, employer based, and large government-sponsored programs in Arizona.
“Steward Health Choice Arizona shares our values, our commitment to members and Arizona, and our vision of bringing affordable, innovative healthcare solutions to the people of Arizona,” Kehaly added. “This acquisition will allow BCBSAZ to work in partnership with the state of Arizona to support a population that is heavily burdened with health challenges.”
With more than 17,000 healthcare professionals providing services to more than 200,000 AHCCCS members, Steward Health Choice Arizona has laid the groundwork for BCBSAZ to improve the quality of life for more individuals and families.
“Steward’s guiding principle and proven model as a leading Accountable Care Organization is to provide an integrated approach to health and wellness for our patients,” said Dr. Michael Callum, Executive Vice President of Steward Health Care. “By concentrating on our providers and our Accountable Care Organization, we’re enhancing our commitment to patients’ well-being.”
“BCBSAZ’s acquisition of Steward Health Choice Arizona will give Arizonans of all ages access to a wider range of comprehensive programs and solutions, and further enhance both organizations’ focus on affordable and high-quality healthcare services,” said Rubén José King-Shaw Jr., President of Steward Health Care Network.
BCBSAZ and Steward Health Choice Arizona will work diligently in partnership with AHCCCS for a smooth transition for both employees and members so that members continue to receive healthcare benefits throughout the transition period.
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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.
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