Anthem reports flat operating revenues due to exit from Affordable Care Act market

http://www.healthcarefinancenews.com/news/anthem-reports-flat-operating-revenues-due-exit-affordable-care-act-market?mkt_tok=eyJpIjoiT1RrME5HWmxNV0kyTkRZeCIsInQiOiJzQ2N6dzlKclF2QmpZaGZraHhUYWRwZThOSit4NjFJZ003dUtnU3NKem9WSkN0QXZUdVJVcUFIRWhMRHJZQ2I3a0N6YWNiR1pLVVFTdzdcL0hvSFl3WVR5ZVpJRWFhSUM1Y3Jyd0FRZVk0YXdOYjF3bXRWUXFXMkN1VlwvMkRMTGNpIn0%3D

Net income increased 30 percent driven by premium rate increases, the return of the health insurance tax and the acquisition of MA plans.

Anthem reported a 30 percent increase in net income for the first quarter compared to the same three months of 2017, but operating revenues remained relatively flat primarily due to the insurer’s planned exits from the Affordable Care Act marketplace.

On Wednesday, Anthem reported net income for the first quarter of $1.3 billion, versus 1 billion for the first three months in 2017.

First quarter operating revenues were relatively flat at $22.3 billion year-over-year due to a decrease in its individual market business.

In 2017, Anthem announced it would cut back its ACA footprint by about 70 percent.

Revenues were helped by premium rate increases to cover overall cost trends, the return of the health insurance tax and the acquisitions of HealthSun and America’s 1st Choice.

Anthem’s acquisition of HealthSun, completed at the end of 2017, added a Medicare Advantage health plan and delivery network in Florida.

The acquisition of America’s 1st Choice was finalized in February. The privately-held, for-profit Medicare Advantage organization  offers HMO products, including chronic special needs plans and dual-eligible special needs plans under its Freedom Health and Optimum brands in Florida. The deal added 135,000 Medicare Advantage members and included a 5 star plan.

Anthem’s medical enrollment totaled approximately 39.6 million members as of March 31, a decrease of 1 million or 2.5 percent percent, from 40.6 million at March 31, 2017.

The company said it now expects medical enrollment to be between 40.1 – 40.3 million for the full year 2018.

Counteracting the individual market decline, Anthem’s government business grew 10 percent year-over-year through a focus on serving the complex social and medical requirements of the dual special needs population.

Medical enrollment declined by 616,000 during the first quarter reflecting a decrease in the individual and local group fully-insured businesses. Medicare grew by 237,000 members and Medicaid enrollment declined by 120,000 individuals.

“We are pleased with our first quarter 2018 financial performance, which reflects our commitment to strong medical cost performance by effectively leveraging community based innovative and integrated clinical and value based care models across our markets,” said CEO and President Gail Boudreaux. “Throughout 2018, we are prioritizing investments to create a more flexible infrastructure that can quickly respond to the evolving needs of our customers and the changing healthcare environment.”

 

Adventist Health, St. Joseph Health sign definitive agreement for Northern California joint venture

http://www.healthcarefinancenews.com/news/adventist-health-st-joseph-health-sign-definitive-agreement-northern-california-joint-venture?mkt_tok=eyJpIjoiT1RrME5HWmxNV0kyTkRZeCIsInQiOiJzQ2N6dzlKclF2QmpZaGZraHhUYWRwZThOSit4NjFJZ003dUtnU3NKem9WSkN0QXZUdVJVcUFIRWhMRHJZQ2I3a0N6YWNiR1pLVVFTdzdcL0hvSFl3WVR5ZVpJRWFhSUM1Y3Jyd0FRZVk0YXdOYjF3bXRWUXFXMkN1VlwvMkRMTGNpIn0%3D

 

Details are still being worked out about physical locations or shared access to care services and they hope to finalize the arrangement this year.

Adventist Health and St. Joseph Health will partner on a new joint operating company that will integrate clinical activities and services across clinics and facilities in Northern California.

The joint operation will include a new president and CEO, and a few other positions still to be determined. A governing board of consisting of 5 appointees from each system will also be formed. Adventist and St. Joseph facilities would keep their existing hospital names, licenses, capital assets and employees.

“By establishing a network that combines the parties’ footprints in this six county area, we intend to increase patients’ access to care,” said Kevin Klockenga, President & CEO, St. Joseph Health Northern California. “We intend to improve our ability to deliver better care on a number of fronts, including developing a comprehensive care continuum strategy; collaborating on centers of excellence, health information sharing, and care management; and developing a value based provider network.”

Adventist Health President of the Northern California region Jeff Eller added that “patients will benefit from more access points, better health outcomes and controlled costs by coordinating their care across the spectrum of their health needs.”

The new operation will serve municipalities of Humboldt, Mendocino, Sonoma, Lake, Napa and Solano counties.

A definitive agreement has been signed, which covers a joint venture, not a merger. The proposed operation will be under regulatory review. Officials at Adventist Health and St. Joseph Health are working toward a closing of the proposed transaction sometime later this year.

A St. Joseph Health spokesperson said details are still being worked out and it is not clear whether services at the included facilities will expand or whether the joint venture simply means patients in both systems will have access to the other system’s facilities under the new network.

Atrium Health releases 92 physicians looking to break away

https://www.beckershospitalreview.com/hospital-physician-relationships/atrium-health-releases-92-physicians-looking-to-break-away.html

Hospital-Physician Relationships

Charlotte, N.C.-based Atrium Health said April 25 it will grant the request of a group of physicians looking to separate and end their employment agreements with the health system Sept. 1, according to The Charlotte Observer.

In an emailed statement to Becker’s Hospital Review April 25, Atrium confirmed it will release a group of roughly 92 Mecklenburg Medical Group physicians from their noncompete agreements, effective Sept. 1. The physicians will continue practicing as part of the health system until Aug. 31.

“While we were hopeful that our many months of discussions would lead to an acceptable solution for everyone involved, we will not seek to prevent these physicians from forming a standalone practice,” the health system told Becker’s.

Atrium said it will also offer the physicians new employment agreements “in the hopes they remain at Atrium Health and their MMG practice … and join the other 1,900 physicians who provide care for our patients,” the health system told Becker’s.

The group of roughly 92 Mecklenburg Medical Group physicians filed a lawsuit against Atrium April 2, arguing the health system engaged in monopolistic and anticompetitive behavior. Atrium said the same day it would allow the physicians to leave the organization. On April 16, the physicians filed a complaint against the health system with the North Carolina Medical Board, alleging the health system violated board regulations by intentionally misleading patients.

Atrium acquired Mecklenburg Medical Group in 1993, according to The Charlotte Observer. In a statement to the publication, the physicians said their attorneys will meet with Atrium’s lawyers to further assess the situation.

Atrium Health CEO Eugene Woods told The Charlotte Observer the health system is in the process of hiring roughly 20 physicians to help fill the vacant positions left by physicians planning to leave Mecklenburg Medical Group. The health system also previously offered to give employees who choose to say a bonus of up to 10 percent of their salary if they remain through the end of the year.

“We feel for our staff, and our first concern was making sure that they feel that we’re with them,” Mr. Woods told the publication. “We offered them retention bonuses because some of them were scared about what the future is going to be.”

 

 

Health Care and the Midterms

1 big thing: health care and the midterms

More than half of voters in Arizona, Nevada and Tennessee want Congress to modify the Affordable Care Act, while less than a third want it to be completely repealed and only 6% think Congress should “let it fail.”

Why it matters: Arizona and Nevada are seen as the states where Democrats have the best chance in November to take Senate seats currently held by Republicans, and Tennessee is working its way up the list. One of Democrats’ most unifying and effective messages this cycle is health care, and they’ll be sure to campaign hard against the GOP’s repeal effort in these states.