Envision Healthcare considering bankruptcy filing

https://mailchi.mp/0d4b1a52108c/the-weekly-gist-april-24-2020?e=d1e747d2d8

KKR-backed Envision Healthcare hires restructuring advisers ...

 

National physician staffing firm Envision Healthcare is considering filing for bankruptcy, according a report from Bloomberg. Sources say the company, backed by private equity (PE) firm KKR, which acquired Envision for $9.9B in June 2018, has hired restructuring advisors and is working with an investment bank. The abrupt halt to elective surgeries and reduction in emergency room volumes due to COVID-19 has caused Envision’s business to shrink by 65 to 75 percent in just two weeks at its 168 open ambulatory surgery centers (ASCs), compared to the same time period last year.

The Nashville-based company, which employs over 25,000 physicians and advanced practitioners, has already been reducing pay for providers and executives, in addition to implementing temporary furloughs. Envision is also struggling with a debt load of more than $7B, resulting from its 2018 leveraged buyout, and has been unable to convince its bondholders to approve a debt swap.

It remains to be seen whether Envision will be a bellwether for how other PE-backed physician groups will weather the ongoing COVID crisis. While Envision’s composition of mainly hospital- and ASC-based providers, coupled with its huge debt load, leave it on especially shaky financial footing, many PE-backed physician groups will struggle this year to achieve anything close to the 20 percent annual rate of return often promised to investors.

If high-profile PE-backed groups like Envision end up declaring bankruptcy, it will likely impact the calculus of the many independent practices which may have previously looked to PE firms for acquisitionand temper the enthusiasm of investors, who might see physician staffing and practice roll-ups as less attractive as volumes continue to fluctuate.

 

 

 

39 hospitals get negative rating outlook from S&P amid pandemic

https://www.beckershospitalreview.com/finance/39-hospitals-get-negative-rating-outlook-from-s-p-amid-pandemic.html?utm_medium=email

Standard & Poor's lowers credit rating outlook to negative

S&P Global Ratings has revised the rating outlook for 39 hospitals to negative from stable due to the financial hit caused by the COVID-19 pandemic.

The affected hospitals have speculative-grade ratings or have about 100 days’ cash on hand or less, S&P said.

A negative outlook reflects S&P’s view that there is a 33 percent chance that operating and economic conditions will worsen to a degree that will cause a rating downgrade.

Below are the 39 hospitals or obligated groups, and their current rating:

1. Atrius Health (Auburndale, Mass.) — “BBB”
2. Bibb County Healthcare Authority (Centreville, Ala.) — “BB”
3. Dawson County Hospital District (Lamessa, Texas) — “CCC”
4. Delta (Colorado) County Memorial Hospital District — “BB”
5. Ector County Hospital District (Odessa, Texas) — “BBB”
6. Genesis HealthCare System (Zanesville, Ohio) — “BB+”
7. Grand River Hospital District (Rifle, Colo.) — “BB+”
8. Griffin Health Services (Derby, Conn.) — “BB+”
9. Guadalupe Regional Medical Center (Seguin, Texas) — “BB”
10. Hardin Memorial Hospital (Elizabethtown, Ky.) — “A-”
11. Holy Name Medical Center (Teaneck, N.J.) — “BBB”
12. Jackson Hospital and Clinic (Montgomery, Ala.) — “BBB-”
13. Jefferson County Public Hospital District No. 2 (Port Townsend, Wash.) — “BB+”
14. Jennie Stuart Medical Center (Hopkinsville, Ky.) — “BB+”
15. Lifespan (Providence, R.I.) — “BBB+”
16. Loma Linda (Calif.) University Medical Center — “BB-”
17. Madison Memorial Hospital (Rexburg, Idaho) — “BB+”
18. Milford (Mass.) Regional Medical Center — “BB+”
19. Mohawk Valley Health System (Utica, N.Y.) — “BB+”
20. National Jewish Health (Denver) — “BB+”
21. Nicholas H. Noyes Memorial Hospital (Dansville, N.Y.) — “BB”
22. North Oaks Health System (Hammond, La.) — “BB+”
23. Oak Valley Hospital District (Oakdale, Calif.) — “BB”
24. Opelousas (La.) General Hospital Authority — “BB+”
25. Oroville (Calif.) Hospital — “BB+”
26. OU Medicine (Oklahoma City) — “BB+”
27. Palomar Health (Poway, Calif.) — “BBB”
28. Pomona (Calif.) Valley Hospital Medical Center — “BBB”
29. Pullman (Wash.) Regional Hospital — “BBB-”
30. Rochester (N.Y.) General Hospital — “A-”
31. Ryder Memorial Hospital (Humacao, Puerto Rico) — “CCC”
32. Samaritan Medical Center (Watertown, N.Y.) — “BBB-”
33. Southeastern Regional Medical Center (Lumberton, N.C.) — “BBB+”
34. SoutheastHealth (Cape Girardeau, Mo.) — “BBB-”
35. Southwest Louisiana Hospital Association (Lake Charles) — “BB+”
36. Temple University Health System (Philadelphia) — “BBB-”
37. Westchester County Health Care Corporation (Valhalla, N.Y.) — “BBB-”
38. White River Health System (Batesville, Ark.) — “BBB-”
39. Winkler County Hospital District (Kermit, Texas) — “BB+”

 

 

 

$100B federal hospital aid won’t fully compensate lost revenue, Moody’s says

https://www.beckershospitalreview.com/finance/100b-federal-hospital-aid-won-t-fully-compensate-lost-revenue-moody-s-says.html?utm_medium=email

Moodys | HENRY KOTULA

The $2 trillion federal coronavirus aid package signed into law that includes $100 billion for nonprofit hospitals won’t completely cover the revenue hospitals will lose as a result of the pandemic, Moody’s Investors Service wrote in an April 3 note.

While the aid package includes several provisions like compensation for lost revenue, increased Medicare reimbursement and advances on future Medicare reimbursement, cash flow at nonprofit hospitals will still likely be materially lower for the next several months. Postponed services alone are likely to reduce hospital revenue by 25 percent to 40 percent a month on average, Moody’s said, a reduction that is affecting even hospitals that aren’t treating large COVID-19 case loads.

“The $100 billion aid package provides some relief to hospitals by supporting their operations and providing access to critical supplies,” Dan Steingart, vice president at Moody’s, said. “However, it is unlikely to fully compensate the sector for the two main financial challenges facing providers as a result of the coronavirus outbreak. The first is a material decline in revenue and cash flow as profitable elective surgeries, procedures and other services are postponed to preserve resources and avoid spreading the virus. The second is difficulty curbing expenses as surge preparation costs offset any expense reductions from postponed or canceled services.”

Moody’s maintained its negative outlook on nonprofit hospitals. 

 

 

 

Nonprofit hospitals vulnerable to coronavirus-related market fallout, Fitch says

https://www.beckershospitalreview.com/finance/nonprofit-hospitals-vulnerable-to-coronavirus-related-market-fallout-fitch-says.html

I Like Boats Dump- Especially Boats Crashing Into Waves - Album on ...

Continued market losses prompted by the COVID-19 pandemic will likely weaken key liquidity metrics and pressure the ratings of some nonprofit hospitals, according to a new Fitch Ratings report. 

About half of Fitch’s rated nonprofit hospitals have 10 percent to 40 percent of their portfolios invested in equities, but other nonprofit hospitals exceed this range by a wide margin, Fitch noted.

Throughout the last month, the stock market suffered historic losses, which caused hospitals with more aggressive asset allocation to underperform their more conservative counterparts by 10 percent to 25 percent, Fitch said. 

Fitch said that hospitals in the last few weeks have seen a median loss of about 30 days of cash on hand. It noted this metric is not “an immediate concern yet, given the ample liquidity these hospitals have.”

But Fitch said most hospitals have cash on hand to fund about 200 days of operations.

The ratings agency said the market likely will remain volatile, and “time will tell if and how the stock market declines eat into a hospital’s reserves.”

 

Financial updates from Scripps, Providence, 5 more health systems

https://www.beckershospitalreview.com/finance/financial-updates-from-scripps-providence-5-more-health-systems.html?utm_medium=email

The following seven health systems recently released financial updates:

1. Phoenix-based Banner Health saw its revenue climb 10.6 percent year over year to $9.4 million in 2019. The revenue growth was attributed to a 7 percent growth in care delivery revenue and a 29 percent increase in revenue from its insurance division. Overall, Banner saw its net income climb from $44 million in 2018 to $726.8 million in 2019 due to strong investment gains.

2. Henry Ford Health System, based in Detroit, recorded a net income of $354.5 million in 2019, more than four times the $86.8 million reported in 2018. In 2019, the health system generated $6.3 billion in revenue, up from $5.9 billion the same period one year prior. Part of the revenue increase was attributed to a rise in net patient revenue from outpatient visits and expanded specialty pharmacy activity.

3. Portland-based MaineHealth reported an operating gain of $82.8 million in the year ended Sept. 30, 2019, a 21.9 percent increase from an operating gain of $67.9 billion reported in the same period in 2018. MaineHealth’s revenue increased to $2.7 billion, compared to $2.5 billion reported in the same period one year prior. Overall, the system recorded a net income of $119.1 million, up slightly from the $118.2 million reported in fiscal 2018.

4. New York-based Montefiore Health System posted an operating revenue of $6.24 billion in 2019, which compares to an operating revenue of $5.91 billion in 2018. After factoring expenses, nonoperating gains and the revenue it generated from a vital access provider program, the health system ended the year with a net income of $8.67 million, down from the $53.48 million reported in 2018. Montefiore attributed the financial setback in net income to participation in some value-based contracts and underpayments from government-run insurance programs.

5. Renton, Wash.-based Providence posted a net income of $1.36 billion in 2019, compared to a deficit of $445 million in 2018. The health system reported revenue of $25.03 billion in 2019, up 2 percent from the $24.43 billion reported in 2018. The revenue increase was largely attributed to patient volume increases. The system’s operating expenses rose to $24.65 billion in 2019. This compares to $24.26 billion in 2018.

6. Trinity Health, based in Livonia, Mich, recorded an operating income of $102.6 million in the first half of fiscal year 2020, which ended Dec. 31. That’s compared to the same period of fiscal 2019, when the health system recorded operating income of $113.4 million. After factoring in nonoperating gains, Trinity reported a net income of $805.7 million in the first half of fiscal 2020, compared to an operating loss of $301.5 million in the same period one year prior.

7. San Diego-based Scripps Health reported revenue of $780.2 million in the first quarter of fiscal year 2020, which ended Dec. 31. This compares to the same period in fiscal 2019, in which Scripps recorded revenue of $747.2 million. The health system’s expenses also increased 4.3 percent year over year in the first quarter of fiscal 2020. In the first quarter of fiscal 2020, Scripps posted an operating income of $1.9 million, more than triple the $607,000 in operating income posted in the same quarter in fiscal 2019. Scripps ended the first quarter of fiscal 2020 with a net income of $141.5 million, compared to a net loss of $171 million in the same period a year earlier.

 

 

14 health systems with strong finances

https://www.beckershospitalreview.com/finance/14-health-systems-with-strong-finances-03032020.html?utm_medium=email

Here are 14 health systems with strong operational metrics and solid financial positions, according to reports from Fitch Ratings, Moody’s Investors Service and S&P Global Ratings.

Note: This is not an exhaustive list. Health system names were compiled from credit rating reports and are listed in alphabetical order.

1. Roanoke, Va.-based Carilion Clinic has an “Aa3” rating and stable outlook with Moody’s and an “AA-” rating and stable outlook with S&P. The health system has a leading market position, strong operating cash flow and healthy debt metrics, according to Moody’s.

2. Wilmington, Del.-based ChristianaCare has an “AA+” rating and stable outlook with S&P, and an “Aa2” rating and stable outlook with Moody’s. The health system has excellent cash flow and a light debt burden, according to S&P. The credit rating agency expects ChristianaCare’s operational performance to remain near recent levels over the next two years, as the health system capitalizes on its cost containment initiatives and strong business position.

3. Santa Barbara, Calif.-based Cottage Health has an “AA-” rating and stable outlook with Fitch. The health system has a leading market position and strong profitability and cash flow, according to Fitch. Going forward, the rating agency expects Cottage Health to see moderate revenue growth.

4. Honolulu-based Hawaii Pacific Health has an “AA-” rating and stable outlook with Fitch. The health system has a solid market position and healthy operating profitability, according to Fitch. The credit rating agency expects the health system to sustain continued capital and strategic investments without the need for incremental debt in the foreseeable future.

5. Baltimore-based Johns Hopkins Health System has an “Aa2” rating and stable outlook with Moody’s. The six-hospital system has a national and international brand that supports resilient clinical demand, according to Moody’s. The rating agency expects the health system to continue to see benefits from its strong regional market position.

6. Philadelphia-based Main Line Health has an “Aa3” rating and stable outlook with Moody’s and an “AA” rating and stable outlook with S&P. The health system, which operates four acute care hospitals and a rehabilitation hospital, is a leading provider in the Philadelphia suburbs, according to Moody’s. The credit rating agency expects the health system to maintain recently improved cash flow margins, which are driven by better patient volume trends.

7. Dallas-based Methodist Health System has an “Aa3” rating and stable outlook with Moody’s. The health system has healthy balance sheet measures and operating performance as well as favorable leverage metrics, according to Moody’s. The credit rating agency expects Methodist Health System’s expense control initiatives and revenue growth opportunities to continue to drive sustainable operating performance.

8. Evanston, Ill.-based NorthShore University HealthSystem has an “AA-” rating and stable outlook with S&P and an “Aa3” rating and stable outlook with Moody’s. The health system has a strong balance sheet, good market presence and a management team that continues to execute its strategic plan, according to S&P. The rating agency expects NorthShore to maintain strong balance sheet metrics and low leverage.

9. Columbus-based OhioHealth has an “AA+” rating and stable outlook with Fitch. The 12-hospital system has a leading market position and solid liquidity, profitability and leverage metrics, according to Fitch.

10. Fort Wayne, Ind.-based Parkview Health System has an “AA-” rating and stable outlook with S&P. The nine-hospital system has stable operating performance and an excellent liquidity profile, according to S&P.

11. Chicago-based Rush University System for Health has an “AA-” rating and stable outlook with Fitch. The health system has a broad reach for high-acuity services as a leading academic medical center and its operating risk profile is strong, according to Fitch. The credit rating agency expects Rush to maintain strong capital-related ratios over the next five years.

12. Norfolk, Va.-based Sentara Healthcare has an “Aa2” rating and stable outlook with Moody’s. The health system has a leading market position in its core service area, strong patient demand, and solid margins, according to Moody’s. The credit rating agency expects Sentara’s liquidity and debt metrics to remain at recent levels.

13. Livonia, Mich.-based Trinity Health has an “AA-” rating and stable outlook with Fitch and S&P. The health system has a significant market presence in several states and a strong financial profile, according to Fitch. The credit rating agency expects the health system’s operating margins to continue to improve.

14. Madison, Wis.-based UW Health has an “Aa3” rating and stable outlook with Moody’s. UW Health has healthy margins from a large and growing clinical footprint, according to Moody’s. The rating agency expects UW Health’s margins to remain strong.

 

30 latest hospital credit rating downgrades

https://www.beckershospitalreview.com/finance/30-latest-hospital-credit-rating-downgrades.html

OR Efficiencies

The following 30 hospital and health system credit rating downgrades occurred in the past six months. They are listed below in alphabetical order.

1. Altru Health System (Grand Forks, N.D.) — from “A-” to “BBB” (Fitch Ratings); from “Baa1” to “Baa2” (Moody’s Investors Service)

2. Augusta (Ga.) University Health System — from “Baa1” to “Baa3” (Moody’s Investors Service); from “BBB” to “BBB-” (S&P Global Ratings)

3. Bibb County Medical Center (Centreville, Ala.) — from “BBB+” to “BB” (S&P Global Ratings)

4. Boone Hospital Center (Columbia, Mo.) — from “Baa2” to “Ba1” (Moody’s Investors Service); from “A-” to “BBB” (Fitch Ratings)

5. Covenant Health (Tewksbury, Mass.) — from “BBB+” to “BBB” (Fitch Ratings)

6. Delta (Colo.) County Memorial Hospital — from “BB+” to “BB” (S&P Global Ratings)

7. Erlanger Health System (Chattanooga, Tenn.) — from “Baa2” to “Baa3” (Moody’s Investors Service)

8. Excela Health (Greensburg, Pa.) — from “A3” to “Baa1” (Moody’s Investors Service)

9. Fairfield Medical Center (Lancaster, Ohio) — from “Baa3” to “Ba2” (Moody’s Investors Service)

10. Hospital Sisters Health System (Springfield, Ill.) — from “AA-” to “A+” (S&P Global Ratings)

11. Indiana (Pa.) Regional Medical Center — from “Ba1” to “Ba2” (Moody’s Investors Service)

12. Integris (Oklahoma City) — from “A1” to “A2” (Moody’s Investors Service)

13. Mercy Medical Center (Des Moines, Iowa) — from “A” to “A-” (S&P Global Ratings)

14. Methodist Hospitals (Gary, Ind.) — from “BBB” to “BBB-” (S&P Global Ratings)

15. Murray (Ky.) Calloway County Hospital — from “Baa3” to “Ba2” (Moody’s Investors Service)

16. Nicklaus Children’s Hospital (Miami) — from “A+” to “A” (S&P Global Ratings)

17. OSF HealthCare (Peoria, Ill.) — from “A2” to “A3” (Moody’s Investors Service)

18. Parmer County (Texas) Hospital District — from “Baa1” to “Baa2” (Moody’s Investors Service)

19. Princeton (W.Va.) Community Hospital — from “BBB+” to “BBB” (S&P Global Ratings)

20. ProMedica Health System (Toledo, Ohio) — from “Baa1” to “Baa3” (Moody’s Investors Service); from “BBB+” to “BBB” (Fitch Ratings)

21. Regional West Health Services (Scottsbluff, Neb.) — from “BBB” to “BB+” (Fitch Ratings)

22. Sanford Health (Sioux Fall, S.D.) — from “A1” to “A2” (Moody’s Investors Service)

23. South Nassau Communities Hospital (Oceanside, N.Y.) — from “Baa1” to “Baa2” (Moody’s Investors Service)

24. Southeastern Regional Medical Center (Lumberton, N.C.) — from “A-” to “BBB+” (Fitch Ratings)

25. Sparrow Health System (Lansing, Mich.) — from “A1” to “A2” (Moody’s Investors Service)

26. St. John’s Riverside Hospital (Yonkers, N.Y.) — from “B-” to “CCC+” (S&P Global Ratings)

27. St. Luke’s Hospital (Chesterfield, Mo.) — from “A+” to “A” (S&P Global Ratings)

28. Tower Health (West Reading, Pa.) — from “A” to “BBB” (Fitch Ratings); from “A3” to “Baa2” (Moody’s Investors Service)

29. University of Chicago Medical Center — from “A1” to “Aa3” (Moody’s Investors Service)

30. Winkler County Memorial Hospital (Kermit, Texas) — from “AA” to “BB+” (S&P Global Ratings)

 

 

 

7 health systems with strong finances

https://www.beckershospitalreview.com/finance/7-health-systems-with-strong-finances-01072020.html

Here are seven health systems with strong operational metrics and solid financial positions, according to reports from Fitch Ratings, Moody’s Investors Service and S&P Global Ratings.

1. Durham, N.C.-based Duke University Health System has an “Aa2” rating and stable outlook with Moody’s. The three-hospital system benefits from its role as the academic medical center of Duke University’s School of Medicine and is a nationally recognized and leading provider of tertiary and quaternary services, according to Moody’s. The credit rating agency expects the health system to maintain operating cash flow margins in the double-digit range.

2. Edison, N.J.-based Hackensack Meridian Health has an “AA-” rating and stable outlook with S&P and Fitch. The health system has a solid financial profile and a strong presence in a large and demographically favorable market, according to Fitch. S&P expects the health system’s depth of clinical services and operations to contribute to its stable financial performance.

3. Fountain Valley, Calif.-based MemorialCare has an “AA-” rating and stable outlook with Fitch and S&P. The health system has a strong balance sheet and financial profile, according to Fitch. The credit rating agency expects MemorialCare’s cash flow to improve due to its market strategy, which focuses on revenue diversification.

4. Portland-based Oregon Health & Science University has an “Aa3” rating and stable outlook with Moody’s and an “AA-” rating and stable outlook with S&P. OHSU, which is the only academic medical center in Oregon, has favorable operating performance, strong philanthropy and its clinical offerings draw patients from across Oregon and neighboring states, according to Moody’s. The credit rating agency expects OHSU’s revenue to continue to grow.

5. Boston-based Partners HealthCare, which is changing its name to Mass General Brigham, has an “Aa3” rating and stable outlook with Moody’s. The health system has an excellent reputation in clinical care and research, a seasoned management team, large size and diversity of revenue sources across several locations and lines of business, according to Moody’s. The credit rating agency expects Partners to achieve an operating surplus in fiscal 2020.

6. Norfolk, Va.-based Sentara Healthcare has an “Aa2” rating and stable outlook with Moody’s. The health system has a leading market position in its core service area, strong patient demand, and solid margins, according to Moody’s. The credit rating agency expects Sentara’s liquidity and debt metrics to remain at recent levels.

7. Livonia, Mich.-based Trinity Health has an “AA-” rating and stable outlook with Fitch and S&P. The health system has a significant market presence in several states and a strong financial profile, according to Fitch. The credit rating agency expects the health system’s operating margins to continue to improve.

 

Provider of the Year: Providence St. Joseph Health

https://www.healthcaredive.com/news/provider-providence-st-joseph-health-dive-awards/566477/

The 51-hospital system, which traces its roots back to the 1850s,​ has maintained a stable ratings outlook amid industry headwinds and pursued tech partnerships this year to bolster its portfolio.

Providence St. Joseph Health, the fourth-largest U.S. nonprofit health system by number of hospitals, marked a busy 2019 with multiple efforts to dive into the tech sector and seek out partnerships to tackle the industry’s biggest challenges.

The Catholic system now operates 51 hospitals in eight states as the result of a July 2016 merger of Providence Health and Services and St. Joseph Health. While the organization is the dominant inpatient provider in all its markets, no single area accounts for more than 30% of its net operating revenue, showing good portfolio diversification, ratings agency have noted.

The system, which can trace its roots back to the 1850s when the Sisters of Providence set up hospitals, schools and orphanages throughout the Northwest, posted $24 billion in operating revenue last year. That metric has shown year-over-year increases since the $18 billion posted in 2014.

Providence CEO Rod Hochman told Healthcare Dive the health system hasn’t shied away from seeking partnerships as the industry swings toward value based care and other systemic changes.

“I think the message is: ‘You can’t do it alone,'” he said. “You can’t go out there and just do it yourself — you don’t have the scale to do it.”

In that vein, the system (which is formally rebranding to Providence over the next few years) was one of the founding members of generic drug company Civica Rx, which opened its headquarters and made its first delivery this year. That’s a coalition of hospitals working to make their own drugs, starting with antibiotics.

It’s also grouping up with One Medical to increase access to primary care and teaming with Cedars-Sinai to build a patient tower in southern California. And in February, the organization launched the population health management company Ayin Health Solutions to provide benefits management as well as risk evaluation and care coordination tools.

Providence has maintained a stable outlook from the three main ratings agencies even as other nonprofits struggled to stay above water. Kevin Holloran, senior director at Fitch Ratings, said the system has managed to think about margins the way a public company must while still adhering to the mission-driven thought process nonprofit organizations trumpet.

“Blending those two thoughts together sounds easy, but it’s not,” Holloran told Healthcare Dive. “It’s hard to do.”

Moody’s Investors Service issued a credit opinion recently on Providence, finding the system’s integrated structure that includes a health plan and 7,600 employed physicians creates “further cashflow diversification, and strengthens the organization’s competitive position.”

The analysts wrote they expect operating margins to continue to improve going into next year as it implements dozens of initiatives updating operating practices, cost structures and revenue systems. They note, however, the organization faces a challenge in transitioning disparate EHRs and its numerous joint ventures “may also entail a certain amount of execution and integration risk.”

Holloran pointed to two relatively recent hires as leading the way for Providence — both poaches from Microsoft. CFO Venkat Bhamidipati joined the organization two years ago and CIO B.J. Moore came on in January.

They migrated from the tech world to the traditionally loathe-to-change healthcare landscape, and have made a difference for Providence.

It puts the company in a strategic place for growth, Holloran said. “Now they’re sort of adding that missing piece, which is optimizing what they’ve got,” he said. “And a big piece of that is the technology, and they’re doing it in a unique and interesting way.”

This year, Providence acquired Lumedic, which uses blockchain tools for revenue cycle management, and Bluetree, an Epic consultancy. The health system also allows patients to schedule appointments through Amazon’s smart speaker Alexa.

In July, the health system announced an agreement with Microsoft to use the tech giant’s cloud and artificial intelligence tools in an effort to foster interoperability, improve outcomes and drive down costs.

The organization still has traditional struggles, however. Hochman, who is also the incoming chairman of the American Hospital Association, said the ongoing litigation surrounding the Affordable Care Act, coupled with payment changes and other CMS changes, creates a chaotic environment for providers.

“Every day they come up with something new, and it’s been the lack of predictability that’s been the biggest problem for us,” he said.

 

 

 

Health insurers stable, M&A seen diminishing in 2020: Fitch

https://www.healthcaredive.com/news/health-insurers-stable-ma-seen-diminishing-in-2020-fitch/568859/

Dive Brief:

  • The outlook for the health insurance sector remains stable heading into 2020, Fitch Ratings reports.
  • The ratings agency maintains a stable outlook on the “vast majority” of the companies it rates within the U.S. health insurance industry, which includes UnitedHealth Group and Aetna.
  • The insurance sector continues to benefit from “low unemployment, manageable medical cost trend and solid growth in government-funded business,” Brad Ellis, senior director for Fitch, said in the report.

Dive Insight:

Even anticipating an increase in the growth of U.S. health expenditures, Fitch expects insurers to deliver solid operating results, including improved medical loss ratios, for 2020.

There is even a chance for insurers to garner positive ratings outlooks as many look to continue to execute on merger integration and deleveraging, according to Fitch.

Thanks in part to the return of the health insurance fee, Fitch expects medical loss ratios to drop to 82.5% in 2020. A decrease from the expected 83.9% for the full year of 2019 for the nation’s eight largest publicly traded insurers, which cover about 165 million people, according to Fitch.

MLR is an important measure, showing the amount an insurer spends on medical claims as a percentage of premiums. Lower MLRs leave more room for covering administration costs and garnering profit.

Even an upcoming election year and a slate of Democratic presidential hopefuls touting support to expand Medicare, the agency does not expect seismic changes to the system.

“Healthcare will certainly continue to be one of the most prevalent discussion topics among candidates for the U.S. presidency in 2020, but Fitch does not anticipate significant change in the structure of the U.S. healthcare system over the next couple of years,” the report said.

The agency also said it expects major mergers to slow significantly in 2020. The insurance sector has experienced significant M&A activity over the last few years, including CVS Health’s buy of Aetna and Cigna’s acquisition of Express ScriptsCentene is near closing on its purchase of rival WellCare.

Fitch expects consolidation activity next year to focus more on “modest build-out of care delivery opportunities in various regions or care management and technology initiatives.”