Dive Brief: Shareholders for both CVS Health and Aetna voted Tuesday in New York City to approve the $69 billion merger between the pharmacy chain and the insurer. The deal, which was scrutinized by Congress in late February, is emblematic of a quickly consolidating healthcare sector. Just last week, Cigna announced it would be attempting to acquire pharmacy benefit manager Express Scripts in a $67 billion deal. The combined company, if approved by antitrust regulators, would create a firm with annual revenues of about $245 billion. In early February, the U.S. Department of Justice asked CVS for more information on its bid to merge with Aetna. Dive Insight: More than 98% of CVS Health shares voted in favor of the merger at the special meeting of shareholders, while about 97% of Aetna shareholders voted to approve the plan. Both CVS and Aetna stated that they still expect the merger to be completed by the end of 2018. In testimony to the House Judiciary Committee, Thomas … [Read more...] about CVS Health, Aetna shareholders vote to approve merger
Aetna whole health plan
Health insurance is a type of insurance coverage that covers the cost of an insured individual's medical and surgical expenses. Depending on the type of health insurance coverage, either the insured pays costs out-of-pocket and is then reimbursed, or the insurer makes payments directly to the provider. In health insurance terminology, the "provider" is a clinic, hospital, doctor, laboratory, health care practitioner, or pharmacy. The "insured" is the owner of the health insurance policy; the person with the health insurance coverage. In countries without universal health care coverage, such as the USA, health insurance is commonly included in employer benefit packages and seen as an employment perk. Everybody at some time in their life, and often on many occasions, will need some kind of medical attention and treatment. When medical care is required, ideally the patient should be able to concentrate on getting better, rather than wondering whether he/she has got the resources to pay … [Read more...] about What Is Health Insurance?
Although there are two pending mental health reform bills (S.1945, H.R. 2646) that have kicked up the national dialogue swirling around what many call “controversial” measures, there is a major shortage of psychiatrists and other mental health professionals nationwide. In fact, there are an estimated 4,000 areas designated in the U.S. as having such a shortage where there is only one psychiatrist per 30,000 people. That is not a typo. It’s hard to imagine but explains in part why only 10% of individuals with mental health issues seek care. This leaves 90% of that population with unmet behavioral health needs, Lisa A. Marsch, PhD, director of the Center for Technology and Behavioral Health (CTBH) at Dartmouth College told Healthcare Dive. “There is a huge opportunity and unmet need to think about how we’re going to reach that 90%.” This is where technology fits into the new behavioral health paradigm. Telehealth is being adapted very quickly not … [Read more...] about Can technology shape the future of behavioral health?
Payers and providers have for decades stayed in their silos, leading to a more fractured and adversarial healthcare system. That relationship, however, is starting to soften for many in the industry. Payer-provider partnerships put the two groups on the same team in hopes of reducing costs and improving care and outcomes through sharing data and better communication. A major driver of these partnerships is the move away from fee-for-service payments and toward valued-based payments and population health management. “We’ve been tracking these partnerships for many years now and of the approximately 200 that have launched in the last five years, 92% are emphasizing value-based compensation in some shape,” Thomas Robinson, partner at Oliver Wyman, told Healthcare Dive. The payer-provider partnerships popping up across healthcare vary in type, size, location and model. There are 50/50 joint ventures with … [Read more...] about Health reform driving payer-provider partnerships
Dive Brief: Aetna, which left the Colorado small-group market in 2010 and then left the state's individual market in 2011, has since remained only in the large-group market--until now. Aetna vice president of sales and service for Colorado, Marc Nealy, told the Denver Business Journal the company has found a small-group product with which it can be competitive. While the company is also “evaluating the individual market,” it is not currently planning to re-enter that market in Colorado. Dive Insight: Aetna is counting on attracting a healthy population and on appealing to business leaders with a cost-cutting product that aims to improve on the 9% premium increases small businesses have been faced with in recent years, the Journal reports. To reach its goal, Aetna Whole Health utilizes a network of primary-care physicians to work with enrollees to reduce healthcare spending, and then shares some of that savings … [Read more...] about Aetna to rejoin Colorado small-group market
Dive Brief: A recent $4.5 million fine against Aetna in Missouri includes penalization for covering nine abortions, contrary to state law. Governor Jay Nixon's announcement of the fine earlier this month did not mention the issue of abortion coverage, but focused exclusively on Aetna's faulire to cover required autism benefits. According to Missouri law, insurers should only pay for an abortion if the patient purchases separate coverage. Missouri's state insurance regulator, Chris Cline, said the fine covered Aetna's infractions as a whole and that there was no specific portion levied for the abortion coverage alone. Dive Insight: As noted by Chris Koller, a former Rhode Island health insurance regulator, it's very unusual to see a health insurer fined for providing too much coverage—although in this instance, perhaps it's not surprising given the highly-politicized nature of abortion coverage. "I have never heard of … [Read more...] about Aetna’s $4.5M fine included penalty for covering abortions
Dive Brief: On Feb. 1, Aetna CEO Mark Bertolini received a call from HHS Secretary Sylvia Burwell, who asked him 'what happened?' soon after he expressed concerns about the ACA exchanges during an earnings call, Kaiser Health News reports. Bertolini questioned the stability of the exchanges. Yet shortly thereafter, Bertolini told Burwell he supports them but suggested changes be made. Aetna also reportedly lost money in individual coverage last year, according to their earnings report. Bertolini said he might consider joining the California insurance exchange if the insurer could agree with HHS on premiums. Dive Insight: “The secretary called me that evening at home to say, ‘What happened?’” Bertolini told Kaiser Health News. “Well, I told her you need to read the whole (earnings transcript), which she did and she calmed down," Bertolini said. "We like the program and we think … [Read more...] about Aetna CEO backs exchanges despite losses
Dive Brief: In anticipation of Humana’s final purchase by Aetna, Humana CEO Bruce Broussard is touting the benefits of Medicare Advantage. If the merger is completed, Medicare and Medicaid will comprise about 56% of the combined company’s roughly $115 billion in operating revenue, Louisville Business First notes. Meanwhile, the number of beneficiaries signing up for Medicare Advantage hit 16.9 million this year, triple the 5.6 million enrolled in 2005. Dive Insight: In an op-ed in Forbes, Broussard and Cleveland Clinic CEO Toby Cosgrove write that Medicare Advantage puts health plans and providers — historically, rivals — on a single mission to improve people’s health and well-being. New partnerships with hospitals and physicians will usher in a “new era” of healthcare delivery, the authors say. “We’re doing this by using a sophisticated, data-driven, integrated care delivery model to make a positive difference in the health … [Read more...] about Humana CEO’s op-ed outlines optimism for Medicare Advantage
Dive Brief: Aetna and Banner Health Network announced Wednesday that their Phoenix-based accountable care organization in 2013 created approximately $5 million in shared savings on Aetna Whole Health fully-insured commercial membership plans. The collaboration also created a 5% drop in average medical cost for members. BHN, a subsidiary of nonprofit giant Banner Heath, cares for 300,000 lives and is comprised of 3,000 providers. The ACO simultaneously improved outcomes as well as lowering costs, improving cancer screening rates and blood sugar management for diabetic patients and reducing avoidable admissions. "The success of this collaboration demonstrates that insurance carriers and providers can work together in a unified approach to provide quality, coordinated care while reducing healthcare costs," Aetna's local market president for Arizona Tom Dameron said. Dive Insight: The collaboration between Aetna and BHN began in 2011. The partnership … [Read more...] about Aetna, Banner Health ACO saves $5M
New analysis of CMS for 2015 by healthcare analyst firm Avalere Health concludes that the number of Part D stand-alone prescription drug plans should fall by about 14%, from 1,169 this year to 1,001 next year. This reduction in plans, which is being caused primarily by consolidation among top plan sponsors like Aetna, CIGNA and UnitedHealth, should shift many beneficiaries into lower-cost plans, Avalere predicts. Average premiums should fall by 2% from $39.88 this year to $38.95 next year. Though premiums may decline for consumers, they may end up on the hook for higher costs. Avalere's analysis concludes that Part D plan sponsors may shift more cost-sharing requirements to enrollees. As prescription drug plans work to shift more costs to beneficiaries, new plans could leave some of these beneficiaries without needed drugs that are too costly to pay for out-of-pocket. Given that the population Medicare serves is already sicker then the population as a whole, it's critical … [Read more...] about Number of Part D drug plans to shrink significantly in 2015