AIS’s Directory of Health Plans

Datapoint: Keytruda Scores Major Kidney Cancer Nod

Keytruda’s latest FDA nod could give Merck a blockbuster edge in kidney cancer, as the PD-1 inhibitor on Nov. 18 became the first immunotherapy approved to treat early renal cell carcinoma at intermediate-high or high risk of recurrence. Renal cell carcinoma is the most common form of kidney cancer. Keytruda, in combination with Pfizer’s Inlyta, was initially approved as a first-line treatment for kidney cancer in August 2019. It holds covered or better status for 83% of all insured lives under the medical benefit, compared to 71% under the pharmacy benefit.

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Datapoint: Zing Health Acquires Lasso Healthcare

Chicago-based Medicare Advantage insurer Zing Health on Nov. 9 completed its acquisition of Lasso Healthcare, an MA org in Texas. The move will significantly boost Zing’s enrollment, as the insurer currently enrolls just under 1,000 lives compared to Lasso’s 3,080. Lasso’s plans utilize a medical savings account model and target underserved rural populations. The two entities will continue to operate separately.

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Datapoint: Paramount Loses Ohio Medicaid Battle

An Ohio judge on Nov. 9 ruled against Paramount Advantage in a contract dispute with the Ohio Department of Medicaid. Earlier this year, the state declined to renew Paramount’s contract in the state’s upcoming Medicaid managed care transformation. Paramount currently serves 243,382 Medicaid lives in Ohio, but those members will be transitioned to new MCOs in July 2022. More than 90% of Ohio’s 2.9 million Medicaid lives are served by a managed care plan.

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Datapoint: Colorado Providers Protest Bright Health

Providers in Summit County, Colorado are protesting startup insurer Bright Health over unpaid and denied claims, according to a Nov. 4 article in the Summit Daily. About 7,000 of Bright Health’s 59,011 Colorado members could be impacted by the dispute, as some physicians told the Summit Daily they may stop accepting Bright Health plans.

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Datapoint: Aetna Expects 100K Additional Exchange Members in 2022

CVS Health Corp. CEO Karen Lynch at the company’s third-quarter 2021 earnings call she expects Aetna’s Affordable Care Act exchange enrollment to reach more than 100,000 members in the 2022 plan year. Aetna previously exited the exchanges in 2018, citing financial losses in excess of $200 million. ACA enrollment reached 12,949,212 members in 2021, according to the latest update to AIS’s Directory of Health Plans. Market leader Centene Corp. enrolls 15.7% of that cohort, with 2,031,174 lives.

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Datapoint: Minnesota Unveils Medicaid Contract Awards

The Minnesota Department of Human Services last week unveiled its latest Medicaid contract awards, valued at $3.87 billion. The contracts, granted to Blue Cross and Blue Shield of Minnesota, HealthPartners, Hennepin Health, Medica, UCare and new entrant UnitedHealthcare, cover about 600,000 children and qualifying parents in the Twin Cities metro area. Minnesota’s Medicaid managed care program currently serves 1,065,148 lives, with Blue Cross and Blue Shield of Minnesota as the market leader at 383,172 members.

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Datapoint: Jefferson Health Completes Health Partners Plans Deal

Philadelphia-based health system Jefferson Health completed its deal to acquire Health Partners Plans. The 18-hospital system, a unit of Thomas Jefferson University Hospitals Inc, gained a 25% stake in the Medicare and Medicaid insurer in 2016, growing its share via deals with co-owners Einstein Healthcare Network, which Jefferson Health agreed to merge with in 2019, and Temple University Health System. Health Partners Plans currently serves 286,796 members in Pennsylvania, with more than 90% enrolled in a Medicaid product.

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Datapoint: Blue Premier Saves $40 Million for UNC Health

UNC Health, the health system affiliated with the University of North Carolina, says Blue Cross and Blue Shield of North Carolina’s value-based care initiative, Blue Premier, saved one of its provider networks $40 million in 2020 alone. The provider group, UNC Health Alliance, also earned a 100% quality score from the program for the second year in a row. BCBS NC is currently the largest insurer in the state, serving 2,875,542 members, 31.2% of the insured population.

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Datapoint: HAP Expands Provider Network With Aetna Deal

Health Alliance Plan (HAP), the fifth-largest health insurer in Michigan, last week unveiled a new partnership with Aetna that will greatly expand its national provider network. Beginning Jan. 1, 2022, HAP will become an Aetna Signature Administrator, granting HAP’s PPO members access to Aetna’s nationwide PPO network and services at CVS Health MinuteClinic locations. HAP currently serves 421,656 members, with 35.3% enrolled in commercial risk-based products.

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Datapoint: ACA Benchmark Plan Premiums Drop 3% for 2022

CMS last week said the average monthly premium for benchmark plans (or second lowest-cost silver plans), the most common type of coverage received on the Affordable Care Act exchanges, will decrease by 3% in 2022. This is the fourth consecutive year of premium drops for benchmark plans. According to the latest update to AIS’s Directory of Health Plans, 12,949,212 people currently receive coverage through the exchanges.

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