Datapoint

Datapoint: Johns Hopkins Rebrands Insurance Arm

Baltimore-based health system Johns Hopkins Medicine is rebranding its health insurance unit, Johns Hopkins HealthCare, to Johns Hopkins Health Plans. "Our new name better captures our core business, which is helping our plan members access the top-tier healthcare and the celebrated clinical and research assets of Johns Hopkins," J.P. Holland, CEO of Johns Hopkins Health Plans, said in a July 12 press release. Hopkins’ insurance brands include Priority Partners, a Maryland Medicaid MCO with 361,352 members, and Johns Hopkins Advantage MD, a Medicare Advantage plan with 14,787 members. The company also serves some employer health programs and TRICARE.

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Datapoint: Specialty C-SNP Insurer to Expand to Florida

Scottsdale, Ariz.-based Gold Kidney Health Plan will expand its offerings to nine Florida counties for the 2024 plan year, pending regulatory approval from CMS. The specialty Medicare Advantage insurer offers chronic special needs plans (C-SNPs) focused on integrated, patient-centered benefits for Medicare eligibles with chronic conditions that cause kidney disease. "By coming to Florida — one of the Top 3 most populous states for U.S. residents aged 65 and older, we plan to help make a difference in the lives of more seniors…by designing plans tailored to their specific care needs," Gregg Kunemund, chief operating officer at Gold Kidney Health Plan, said in a statement. The insurer currently serves 230 members in Arizona.

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Datapoint: Cigna Adds Humira Biosimilars to Formulary

Cigna on July 10 said it will add three new Humira biosimilars — Boehringer Ingelheim’s Cyltezo and Sandoz’s Hyrimoz and Adalimumab-adaz (the unbranded equivalent of Hyrimoz) — to its national preferred, standard, performance, and legacy commercial formularies controlled by Cigna Pharmacy Management. The products will be preferred at parity with Humira. The company also said it will cover Organon’s Hadlima as a preferred drug on its value, advantage, and total savings formularies. Cigna Pharmacy Management, which handles drug benefits for Cigna Healthcare, currently manages 11.2 million pharmacy lives. Humira is a preferred product that requires utilization management, such as step therapy and/or prior authorization, for 67% of Cigna’s pharmacy lives.

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Datapoint: Ohio to Pursue Medicaid Work Requirements

Ohio’s newly passed budget requires lawmakers to ask CMS that a work requirement provision be added to the state’s Medicaid program in February 2025, according to a July 6 Cleveland.com report. The work requirement would apply to “able-bodied” beneficiaries aged 55 and younger, who must pursue at least 20 hours per week of work or education. Ohio currently enrolls 3,291,240 Medicaid beneficiaries, with 92.5% enrolled in managed care plans.

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Datapoint: South Dakota Expands Medicaid

South Dakota on July 1 implemented its voter-backed Medicaid expansion, which will bring health coverage to about 52,000 people, according to CMS. The state will also receive enhanced federal funding via the American Rescue Plan. South Dakota served 104,860 Medicaid lives as of June 2023, a significant increase from a pre-COVID total of about 88,000 lives. South Dakota is also one of a handful of states that continues to facilitate Medicaid benefits under a fee-for-service model.

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Datapoint: Molina to Acquire Remaining Bright Health Medicare Assets

Startup insurer Bright Health will sell its remaining Medicare Advantage assets to Molina Healthcare for an estimated $600 million, according to a June 30 press release. The California MA plans are Bright’s last remaining insurance assets as the struggling insurtech works to “satisfy its obligations to its bank lenders.” The company said it will put the remaining funds used toward “liabilities in its discontinued ACA insurance business.” Bright Health enrolls 124,776 MA and dual eligible members in California as of June 2023, to Molina’s 14,590.

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Datapoint: Georgia Launches Partial Medicaid Expansion, Work Requirements

Georgia on July 1 implemented its partial Medicaid expansion — which also comes with a work requirement. The program, Pathways to Coverage, allows uninsured able-bodied adults living at or below the federal poverty line to become eligible for Medicaid benefits if they participate in 80 or more hours per month of work, volunteering, school or another qualifying activity. The Trump administration approved the program in October 2020, and Georgia is now the only state in the country to tie a work requirement to Medicaid coverage. Georgia currently serves 2,887,544 Medicaid beneficiaries, with 77.0% enrolled in managed care plans. The state estimates about 100,000 additional lives would enroll in Medicaid under Pathways to Coverage, according to the Associated Press.

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Datapoint: Arizona Blues Insurer Launches Primary Care Business

Blue Cross Blue Shield of Arizona (AZ Blue) on June 29 unveiled the launch of Prosano Health Solutions, Inc., a new primary care subsidiary. The insurer said it intends for Prosano to “become an integral part of improving healthcare for Arizonans.” Prosano’s first “advanced primary care center,” which offers primary care, behavioral health and lab services, as well as a pharmacy and virtual care options to AZ Blue employees, is open in Maricopa County, with three additional locations planned to open in 2024. AZ Blue will also launch a new health plan, BlueSignature Prosano PPO, to employer groups next year. The Blues payer is currently the second-largest insurer in Arizona (behind UnitedHealthcare), with 998,051 members.

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Datapoint: Clover Health Settles Shareholder Lawsuits

Startup insurer Clover Health said it has reached an agreement to settle seven shareholder-filed lawsuits that accused the Medicare Advantage-focused insurtech of concealing material information from investors before going public. In April, the company agreed to pay $22 million to settle a similar class-action lawsuit filed by shareholders, which centered on allegations outlined in a report from the activist short-selling firm Hindenburg Research. Clover did not admit wrongdoing as part of either the April settlement or the June agreement, which will resolve the remaining shareholder-led civil cases filed against it in Delaware, New York, and Tennessee courts. Clover currently enrolls 82,661 MA members in six states.

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Datapoint: UPMC, Washington Health System to Affiliate

Pittsburgh-based UPMC (the University of Pittsburgh Medical Center) has signed a nonbinding letter of intent to affiliate Washington Health System, a two-hospital system based in Washington, Pa., into the UPMC system, according to a June 20 press release. “Our primary focus is to ensure the residents of Washington and Greene Counties have local access to high-quality health care that is sustainable into the future,” Brook Ward, President and CEO of Washington Health System, said in a statement. “After careful consideration and analysis, we believe the best path forward is to affiliate with UPMC to achieve that goal.” The UPMC system currently consists of more than 35 hospitals, with a network of more than 8,000 providers. Its insurance unit, UPMC Health Plan, is the third-largest insurer in Pennsylvania, with 1,512,846 members.

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