Highmark Health posts record 6-month performance with $505M operating surplus

http://www.beckershospitalreview.com/finance/highmark-health-posts-record-6-month-performance-with-505m-operating-surplus.html

Image result for hospital financial turnaround

Pittsburgh-based Highmark Health, the parent company of insurer Highmark and Allegheny Health Network, reported an operating gain of $505 million in the first six months of fiscal year 2017, compared to $35 million the same period last year.

“Highmark Health delivered its strongest financial performance for the six-month period ending June 30 since the formation of Highmark in 1996,” Karen Hanlon, executive vice president and CFO of Highmark, said.

Highmark attributed its financial turnaround to improvements in its government health plan business, as well as its commercial and senior health plan segments. The company’s nealry 5 million-member health plan achieved an operating gain of $480 million in the six months ended June 30, up $399 million compared to the same period a year prior, mostly fueled by its government business.

On the provider side, Highmark’s Allegheny Health Network in Pittsburgh saw its strongest financial performance since its establishment. AHN recorded $28 million in excess revenue over expenses in the first six months of this year, an improvement of $47 million from the same period in 2016.

While intentional enrollment reductions decreased Highmark’s operating revenues year-over year by $100 million to $9.1 billion in the six-month period, at the same time the organization’s expenses dropped $50 million. Highmark attributed the decrease to reduced costs related to its Epic EHR and other technology implementations.

Health plans that attract the working uninsured

http://managedhealthcareexecutive.modernmedicine.com/managed-healthcare-executive/news/health-plans-attract-working-uninsured?cfcache=true

Baby-Hand-Holding

http://files.kff.org/attachment/supplemental-tables-the-uninsured-a-primer-key-facts-about-health-insurance-and-the-uninsured-in-the-era-of-health-reform

 

NCQA will ask health plans to report infections acquired at network hospitals

http://www.modernhealthcare.com/article/20160706/NEWS/160709990/ncqa-will-ask-health-plans-to-report-infections-acquired-at-network

C Difficile Bacteria

  • On Tuesday, the National Committee for Quality Assurance (NCQA) added four new quality measures to the Healthcare Effectiveness Data and Information Set (HEDIS), which currently consists of more than 80 measures.
  • The four new measures are rates of :
    • Standardized healthcare-associated infection ratio,
    • Follow-up after emergency department visit for mental illness,
    • Follow-up after emergency department visit for alcohol and other drug dependence,
    • Depression remission or response for adolescents and adults.
  • The first measure — standardized infection ratios — will measure ratios for central line-associated bloodstream infections, catheter-associated urinary tract infections, MRSA infections, and Clostridium difficile intestinal infections. According to Gail Wilensky, a senior fellow at Project HOPE, “These infection rates ‘shouldn’t occur with appropriate, high-quality care.’”

DOJ Sues Carolinas HealthCare Over Steering Restrictions

http://www.healthleadersmedia.com/leadership/doj-sues-carolinas-healthcare-over-steering-restrictions?spMailingID=9041425&spUserID=MTMyMzQyMDQxMTkyS0&spJobID=940977537&spReportId=OTQwOTc3NTM3S0#

carolinas-medical-center-1200xx2800-1575-186-0

Federal and state officials claim that the healthcare system used its market power to leverage steering restrictions in its contracts with major insurers, resulting in higher costs for consumers.

Don’t panic about House v. Burwell.

Don’t panic about House v. Burwell.

US Court of Federal Claims

The Affordable Care Act obligates the federal government to reimburse health plans for cutting their low-income customers a break on their out-of-pocket payments. Whether or not there’s an appropriation for the cost-sharing reductions, that statutory obligation is enforceable in court—specifically, in the Court of Federal Claims.

Health plans that get stiffed can therefore sue the federal government for the cost-sharing reductions. Winning those cases should be easy: the plans will just have to show that they’re owed money under the ACA. And here’s the kicker: Congress has permanently appropriated the money to pay court judgments, even if it hasn’t appropriated money for the cost-sharing reductions.

The right question isn’t whether health plans will get paid. It’s when.

Old-School Health Plans Fading Away

http://healthleadersmedia.com/content.cfm?topic=HEP&content_id=316548##

Earth

A longtime standard-bearer of medical underwriting calls it quits and puts itself on the block. Its fatal flaw? Being out of sync with post-PPACA market realities.