22 Recent Issues Between Hospitals and Payers

The following are the latest issues that occurred between hospitals, health systems and payers within the past month, starting with the most recent.

1. Aetna subsidiary Coventry Health Care and Des Moines, Iowa-based UnityPoint Health expanded their partnership to offer high-performance network health plans to more Iowa residents starting next year.

2. Health insurer Cigna and Hartford, Conn.-based Saint Francis HealthCare Partners, a joint venture between Saint Francis Hospital and Medical Center and about 900 care providers, launched a collaborative accountable care initiative, Cigna's version of an accountable care organization.

3. Florida Hospital in Orlando and Health First in Rockledge, Fla., announced a partnership to offer and expand health insurance across central Florida

4. Health Partners Plans, a nonprofit managed care company owned by six Philadelphia-area hospitals, applied with CMS to offer a Medicare Advantage plan.

5. Thousands of people stand to see higher rates at Hartford (Conn.) HealthCare hospitals if the health system and Cigna don't agree on a new contract before Sept. 30.

6. Medicare's 0.7 percent inpatient prospective payment system rate increase for 2014 isn't enough to cover expected costs and is a credit negative for nonprofit hospitals, a Moody's Investors Service report said.

7. From December 2009 through September 2012, New York's Medicaid program overpaid state hospitals as much as $31.1 million for services provided to patients who died within one day of admission.

8. Minuteman Health — a nonprofit health insurer founded by Boston-based Tufts Medical Center, Nashville, Tenn.-based Vanguard Health Systems and the New England Quality Care Alliance in Boston — received its HMO license and approval for its 2014 health insurance premiums rates from the Massachusetts Division of Insurance.

9. Cincinnati-based Catholic Health Partners said it will sell health plans on Ohio's health insurance exchange through its health plan subsidiary, HealthSpan

10. A state analysis found Boston-based Partners HealthCare received 31 percent of all the money commercial Massachusetts payers spent on acute-care hospital services last year.

11. Minneapolis-based Allina Integrated Medical Network of Allina Health and Blue Cross Blue Shield of Minnesota in Eagan, Minn., announced they will introduce a new health plan, BluePrint, starting next year.

12. The nation's five largest health insurers totaled approximately $78 billion of revenue combined in the second quarter of fiscal year 2013, pocketing about $3.7 billion of that amount in profit.

13. Two large Pennsylvania hospital systems — University of Pittsburgh Medical Center and Danville-based Geisinger Health System — said they want to sell plans in the state's federally run health insurance exchange.

14. Health insurer UnitedHealthcare and Dallas-based Tenet Healthcare Corp. agreed on a new contract.

15. Aetna signed a new contract with Good Samaritan Hospital in Los Angeles.

16. North Shore-Long Island Jewish Insurance Company in Great Neck, N.Y., part of North Shore-LIJ Health System, received approval as a health insurer from the New York State Department of Financial Services.

17. West Orange, N.J.-based Barnabas Health linked with Horizon Blue Cross Blue Shield of New Jersey, the state's largest health insurer, for an ACO.

18. Aetna announced accountable care agreements with five different healthcare organizations in Maine — Mercy Health System, InterMed, MaineHealth and Martin's Point Health Care, all in Portland, and MaineGeneral Health in Augusta.

19. Mount Carmel Health Partners, a physician hospital organization jointly owned by Columbus, Ohio-based Mount Carmel Health System and 1,500 physicians, and UnitedHealthcare formed an ACO, effective Oct. 1.

20. Coventry Health Care of Missouri and BJC HealthCare — both based in St. Louis —expanded their agreement to add BJC to Coventry's Medicare Advantage networks.

21. Blue Shield of California, Providence Health & Services, Southern California and its affiliates, Mission Hills, Calif.-based Facey Medical Foundation and Facey Medical Group, announced the formation of a three-year ACO.

22. The Maine Bureau of Insurance approved insurer Anthem Blue Cross and Blue Shield of Maine's proposed network of healthcare providers with some modifications, including instructions to contract with additional specialists. The network is part of Anthem's agreement with Portland-based MaineHealth to offer a health plan on the state's new online insurance exchange this fall.

More Articles on Hospitals and Payers:
Moody's: 132 Statistics on Nonprofit Hospital Medians
5 Experts' Observations on the Shift From Volume to Value
Health Insurers Limit Provider Choices to Lower Premium Costs

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