Revenue Cycle and Payer News 1-10-2018

In the News…

The health insurance stock boom of 2017
Axios (@axios) reports that even though the failed attempts to repeal and replace the Affordable Care Act created uncertainty and distractions, the health insurance industry still reaped record profits as it benefited from people using less expensive health care settings.

How your health care will be reshaped in 2018
2018 is going to be a long year, and probably a hard one to keep up with in the ever-evolving world of health care. Axios invites readers to take a step back from the minute-by-minute onslaught and take stock more broadly of the big, overarching trends that will animate this year in health policy.

Credit rater predicts stable year for ObamaCare markets
According to The Hill, analysts have predicted the ObamaCare insurance markets will be relatively stable through 2018. Insurers have adapted to the uncertainty surrounding the Trump administration’s handling of the law, A.M. Best, a global credit rating organization, wrote in a briefing released Wednesday. It said insurers should have a stable 2018.

U.S. Department of Labor Announces Proposal to Expand Access to Healthcare through Small Business Health Plans
The U.S. Department of Labor announced a Notice of Proposed Rulemaking to expand the opportunity to offer employment-based health insurance to small businesses through Small Business Health Plans, also known as Association Health Plans. Up to 11 million Americans working for small businesses/sole proprietors and their families lack employer-sponsored insurance. These 11 million Americans could find coverage under this proposal. Many small employers struggle to offer insurance because it is currently too expensive and cumbersome. These employees – and their families – would have an additional alternative through Small Business Health Plans (Association Health Plans). These plans would close the gap of uninsured without eliminating options available in the healthcare marketplace.

Congress Responds to Proposed Health Care Mergers with Calls for Hearings and New Merger-Related Legislation
December saw the announcement of several significant proposed mergers in the health care industry, each of which has the potential to reshape the industry. These transactions include both vertical mergers between health care providers and national health insurers and horizontal mergers among large multi-state hospital systems. Before any of these transactions can be completed, federal and state antitrust regulators will need to be heard from concerning the permissibility of these transactions.

New health insurance rule aims to deliver on Trump promise
Striving to fulfill a campaign promise, the Trump administration proposed regulations to facilitate the interstate sale of health insurance policies that cost less but may not cover as much. The complex proposal from the Labor Department aims to deliver on President Donald Trump’s long-standing pledge to increase competition and lower costs by promoting the sale of health plans across state lines. Yet its success depends on the actions of insurers, state consumer protection regulators, plan sponsors and customers themselves. Some already have concerns.

Republicans face a fresh fight over Obamacare: Repeal it or repair it?
USA Today reports, Congressional Republicans will open their 2018 legislative agenda wrangling over a politically dicey and very familiar issue: Obamacare. Moderates want to bolster the Affordable Care Act, especially in the face of possible new hikes in premiums for insurance consumers. Conservatives want to take another shot at killing the 2010 health care law, even though the GOP’s attempts to do that consumed much of 2017 and ended in an embarrassing failure.

Aetna and CVS Were Talking to Others During Takeover Process
Bloomberg reports that CVS Health Corp. and Aetna Inc. were both talking to other potential partners during early discussions that led to their $68 billion merger, according to a regulatory filing Thursday. As late as August, Aetna was in discussions with a “Party X” about a “strategic partnership, business combination or other opportunities.” The mystery company, which isn’t named in the document, told Aetna in October that it wasn’t planning to make a takeover offer.

CVS Health Provides 2018 Outlook
This morning CVS Health (@CVSHealthissued its initial outlook for 2018, expressing confidence in the execution of its growth strategy. For full-year 2018, the company expects to deliver consolidated net revenue growth of 0.75% to 2.5% and adjusted consolidated operating profit growth of 1% to 4%. Adjusted operating profit in its Retail/LTC segment is expected to grow in the low-single digits and adjusted operating profit in its Pharmacy Services segment is expected to grow in the low- to mid-single digits. Strong growth in scripts and claims, continued purchasing efficiencies from the company’s Red Oak venture, and incremental net benefits from the company’s streamlining initiative are expected to be beneficial contributors to enterprise growth.

UnitedHealth To Acquire Chilean Health Insurer For $2.8 Billion
A purchase agreement has been signed by UnitedHealth Group (@UnitedHealthGrp) with a view to launching an acquisition bid for Empresas Banmedica, a healthcare provider and health insurer based in Chile. UnitedHealth is expected to pay close to $2.8 billion for the Chilean firm as it looks to enhance its footprint in Latin America. Subject to the fulfilment of certain terms and conditions the deal is expected to close in 2018’s first quarter.

Cigna Corporation’s Fourth Quarter 2017 Earnings Release Details
Cigna Corporation (@Cigna) will release its Fourth Quarter 2017 financial results on Thursday, February 1, 2018 and will host a conference call on the same day.

Humana Inc. to Present at the 36th Annual J.P. Morgan Healthcare Conference
Humana Inc. (@Humana) announced today that Bruce D. Broussard, President and Chief Executive Officer, will make a presentation to investors at the J.P. Morgan Healthcare Conference on Tuesday, January 9, 2018, at 1:30 p.m. pacific time.

Anthem drawing hard line on what emergency room visits it will cover
According to WKYT, one of the leading insurance companies in Kentucky is now refusing coverage on certain emergency room visits. An Anthem Blue Cross Blue Shield policy allows the insurance carrier to decide, after they see a final diagnosis from an emergency room visit, if they are going to cover the claim.

Lieff Cabraser Files Class Action Fraud Lawsuit Against HCC Medical Insurance Services
Lieff Cabraser Heimann & Bernstein, LLP partners Rachel Geman and Elizabeth J. Cabraser, with co-counsel, have filed a multi-state class action lawsuit in Indiana federal court alleging that HCC Medical Insurance Services, LLC, HCC Life Insurance Company, and Health Insurance Innovations, Inc. (“Defendants”) have cheated the plaintiffs—consumers of short-term insurance plans who have incurred sometimes catastrophic medical expenses—by routinely and systematically refusing to pay promised insurance benefits, including through the common vehicle of post-claims underwriting.

Repeal of fine for not having health insurance set for 2019
The Mountaineer reports that U.S. law still mandates that people have health insurance in 2018, but in 2019 the fine on those who don’t have insurance goes away. An insurance broker has said it will be good when the dust settles and the effects of the change become clearer. HealthMarkets Insurance Agency Individual Insurance Agent Dave Ferguson said there won’t be much of a change in insurance offerings once the mandate is essentially lifted in 2019, but he said premiums outside of government insurance exchanges could go up 10 percent every year.

In State News:

Oregon Sets New Obamacare Record, Despite Shorter Enrollment Period
According to the Lund Report, Oregon exceeded expectations in its open enrollment period for 2018 individual health plans sold on — cresting above 156,000 plans, a slight increase over a year ago and higher than all previous years since Obamacare took effect in 2014.

Four health insurance tasks for Oregonians in new year
Oregonians who signed up for individual health insurance during open enrollment have four important tasks to consider as 2018 kicks off, according to Channel 21

20 percent decline in West Virginia insurance exchange enrollment may grow
Metro News reports that West Virginia could see a total decline of as much as 30 percent in insurance enrollments on the exchange created in the Affordable Care Act by the time the numbers are finalized later this year, according to a state insurance official.

Repeal and Replace takes its Toll: NJ ACA Enrollment Dips in 2018
Reports show 20,000 fewer New Jersey residents signed up for health insurance coverage for 2018 through the federal Affordable Care Act marketplace, something advocates warned might happen given the Trump administration’s lack of support for the program.

Upcoming AHIP Conferences:

National Health Policy Conference
When: March 7 – 8, 2018
Register for this event.
Twitter: @AHIPCoverage

Where will we be in 2018? What health policy issues will be in the spotlight? On what priorities should your organization focus? AHIP’s National Health Policy Conference will deliver expert insights, top-level dialogue, and innovative solutions as we work together to advance a health care system focused on quality and sustainability.

National Conference on the Individual and Small-Group Markets
When: March 8 – 9, 2018
Register for this event.
Twitter: @AHIPCoverage

What will be the key policy and operational issues for those serving the Individual and Small-Group markets? Join us in March as thought leaders from throughout the health care industry share where we are and what’s needed next to succeed in these important markets. You’ll leave with innovative ideas from states, what’s next for small groups, how to best tackle affordability and access, and more. Located immediately following AHIP’s National Health Policy Conference (March 7-8), combine both conferences with one trip.