HealthComp Announces Partnership with New Mountain Capital

HealthComp Holding Company LLC (“HealthComp” or “the Company”), a leading independent Third Party Administrator (TPA) of healthcare benefits for self-funded employers, announced today that the Company has partnered with New Mountain Capital, a leading growth-oriented investment firm with $28 billion in assets under management. Founded in 1994 and headquartered in Fresno, California, HealthComp is the largest independent Third-Party Administrator (TPA) of healthcare benefits in the U.S., serving more than 400,000 members in the self-funded employer industry. The Company offers best in class technology for healthcare benefits administration, payment integrity and care management services to address the “dual mandate” in the U.S. healthcare system: reducing costs and improving clinical outcomes and experience for employees.

As Supreme Court Weighs Obamacare, Health Insurers See Law’s Survival

The health insurance industry doesn’t see the U.S. Supreme Court overturning the entire Affordable Care Act and leaving tens of millions of Americans without medical coverage. The nine-member Supreme Court will hear arguments Tuesday on a lawsuit brought by Republican attorneys general and backed by the Donald Trump White House who want the ACA invalidated. But health insurance executives including Centene chief executive Michael Neidorff said he remains “relatively confident” the Supreme Court won’t strike down the law.

Providence Joins Anthem Blue Cross’ Vivity Health Plan as Joint-Venture Partner in Southern California

Anthem Blue Cross (Anthem) today announced Providence Southern California (Providence) has agreed to join its Vivity Health Plan (Vivity) as a joint-venture partner effective November 1, 2020. The addition of Providence marks Vivity’s first expansion since it launched in 2015, bolstering the plan’s provider network offerings and collaboration in Orange and Los Angeles counties. Vivity is the first-in-the-nation joint venture between a health plan and like-minded health systems aligned to enhance the health of members and utilizes a unique provider reimbursement structure that includes shared savings from community risk pools.

WebTPA to Join GuideWell’s Family of Companies

GuideWell Mutual Holding Corporation (GuideWell), the parent to a family of forward-thinking companies focused on transforming health care, announced today that they have signed a definitive agreement to acquire WebTPA, an innovative and market leading administrator of self-funded employer health plans. WebTPA provides integrated and highly customizable administration solutions and products to employers, health systems and insurance companies. Through its technology, operating platform and deep expertise, WebTPA is able to uniquely serve the needs of its customers. Terms of the transaction, which is expected to close by the end of the year, were not disclosed.

UnitedHealth Group Subsidiary Must Revamp Behavioral Healthcare Coverage, Judge Rules

A federal judge ordered a UnitedHealth Group subsidiary to revamp its behavioral health claims processing after the insurer wrongfully denied mental health and substance use disorder treatment coverage to tens of thousands of its members. Chief Magistrate Judge Joseph Spero wrote that United Behavioral Health manipulated internal guidelines to deny mental health coverage so it could “protect its bottom line.”

CareCentrix, Backed by Summit, Shelves Sale Process

CareCentrix, the Summit Partners-backed home- and post-acute care benefits manager, has scrapped potential sale plans after talks with Anthem fell apart, sources with knowledge of the situation said.

UnitedHealthcare Advances Home Strategy, Expects to Make 1.7M House Calls in 2020

A number of major Medicare Advantage (MA) carriers are expanding their supplemental benefit offerings shaped around in-home care next year. UnitedHealthcare, the insurance arm of UnitedHealth Group (NYSE: UNH), is among them. Overall, UnitedHealthcare partners with more than 1.3 million physicians and care professionals across the U.S., plus another 6,500 or so hospitals and other care facilities. In 2020, UnitedHealthcare had more MA enrollees than any other group. In 2021, most of its plans will include HouseCalls, a program that offers Medicare and Medicaid members a yearly in-home visit with a licensed clinician. Apart from its HouseCalls program, at least six UnitedHealthcare plans are offering in-home support services under the “primarily health-related” supplemental benefit pathway in 2021.

Cigna Seeks to Revive Claims against Anthem over Failed Merger

Cigna Corp. will ask Delaware’s top court to resurrect its claims against Anthem Inc. over the collapse of their planned $54 billion merger, which would have created the country’s largest health insurer, after a Chancery Court judge denied each company’s bid for billions in damages.

CMS Set to Bump MA Rates for 2022 in Win for Payers

Medicare Advantage organizations may see capitation rates rise as much as 2.8% for 2022, according to a CMS proposal released Friday. SVB Leerink analysts said Monday the hike was positive and a “strong starting point” for the year. They noted it was higher than the 1.7% increase last year. CMS is also proposing to rely entirely on encounter data to calculate patient risk scores in 2022 instead of using a blend of encounter data and diagnoses submitted to the Risk Adjustment Processing System. The move has been opposed by commercial insurers.

Medicare Advantage 2021 Spotlight: First Look

Over the last decade, Medicare Advantage, the private plan alternative to traditional Medicare, has taken on a larger role in the Medicare program. In 2020, more than 24 million Medicare beneficiaries are enrolled in a Medicare Advantage plan. This brief provides an overview of the Medicare Advantage plans that are available for 2021 and key trends over time.