Healthcare Medical Pharmaceutical
Health Insurance - MCOs
Market Trends...
  • Managed care organizations ( MCOs) / health insurance companies making significant investments in IT systems, clinical and revenue analytics to assess care / cost outcomes
  • Piloting accountable care organization (ACO) partnership ventures with provider organizations
  • Aetna / Humana and Anthem / Cigna merger deals failed to close; these organizations are regrouping and moving forward with new commercial growth plans and marketing strategy

Assisted Liv
Data Firms
Health Sys
Nursing Fac
Surgery Ctrs

*Plans operated by CareFirst

**Plans operated by Highmark

***Plans operated by Health Care Service Corp.

****Plans operated by Premera

*****Plans operated by Regence Group 

******Plans operate by Wellmark

*******Plans operated by Anthem
... A list of Blue Cross Blue Shield plans...
Two major health insurance company mergers fell apart due to regulatoy approval issues.  Each deal featured sizable break up fees now being contested in the courts.

  • Anthem, seeking to buy Cigna for $54 billion, is likely obligated to pay Cigna a $1.85 billion breakup fee
  • Aetna, seeking to buy Humana for $37 billion, is likely obligated to pay Humana a $1 billion breakup fee

The ongoing exodus of health plans from Obamacare state exchanges is creating issues.  Consumers have less access to care and less options to choose from.  Insurers and managed care plans are hesitant to move forward in the state exchanges based on high numbers of high risk members which are not offset by enough low risk members.  This creates funding issues for the exchanges as their revenues are dependent on monies from plans using the exchanges to market their plans.  In many cases in which there is only one plan remaining, the lone health plan offerings are from a Blue Cross Blue Shield plan.
The proposed CVS Health acquisition of health insurer Aetna is the reverse approach of UHC's deal with SCA.  In January, 2017, UnitedHealthcare (UHC) announced it was acquiring surgical center chain Surgical Care Affiliates (SCA) for $2.3 billion. SCA operates over 200 surgical facilities with more than 7,500 physicians.  The facilities conduct about 1 million procedures annually.  This is part of UHC's ongoing initiatives to change its business model beyond being a healthcare plan to encompass being a healthcare provider organization; its Optum business unit plays a pivotal role.   

As other plans, such as Anthem and Aetna, have chosen to expand their covered lives, UHC has chosen a different route. By acquiring medical practices, UHC has more direct influence on providers, care protocols and costs associated with them. Through adding SCA to the combination of other medical practices they own, it provides different streams of revenue for UHC.  It also improves their position to negotiate rates with other health systems and care providers.  While United Healthcare has a long way to go to reach the scale Kaiser Permanente has in terms of being a healthcare provider, it's investments in the provider sector seem to indicate they have a long term plan to strategically grow the provider side of their business.

The Humana / Kindred deal, at $810 million, is conservative in comparison to the Aetna and UHC deals but Humana needed a way to fortify their position and diversify following Aetna's failed acquisition of their company due to regulatory antitrust concerns.  Kindred also needed a way to maintain commercial vitality against ever-growing healthcare system and specialty provider organizations.  The combination of Humana / Kindred will be lesser scale overall but sets the stage for them to regroup and grow organically --and perhaps acquire or be acquired by another commercial healthcare enterprise.
... This is a list of leading Healthcare Insurance Companies and Managed Care Organizations (MCOs)...
... The Health Insurance industry continues to evolve. Plan designs, digital marketing, ACA and other factors are changing the way health insurance is marketed.  Relationships with pharmaceutical manufacturers and the ongoing exploration of data to develop better treatment outcomes continues ... 
... See the article below to find out how Employers, Healthcare Insurance Companies, MCOs and PBMs are affected by Specialty Pharmacy Benefit Management ...
... Explore the presentations below to learn how the Healthcare Insurance industry continues to globalize and find out about a BCBS global partnership ... 
... Learn more about UHC's changing business model to take advantage of marketplace developments and growth opportunities; read the articles below ...
<img src="84008606.jpg" alt="health insurance executives in a meeting">
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...In December, 2017, CVS Health announced it was acquiring Aetna for $69 billion dollars and Humana (in partnership with private equity firms) announced it was acquiring Kindred Healthcare for $810 million.  Presumably, CVS Health is seeking to acquire Aetna to widen its business model and fortify its position against Amazon who is laying groundwork to enter the pharmacy sector.  The CVS Health / Aetna tandem will have wide impact across multiple healthcare sectors such as employee benefit consultants, PBMs, MCOs, physician practice groups, health systems and retail, mail order and specialty pharmacy.  Humana and its partners have opted for a more focused-care approach in their proposed purchase of Kindred; Humana needed to develop a way to be more competitive due to the sheer size of its competitors such as Aetna, UHC and Anthem.  Check out the link below for more details about the CVS / Aetna deal...
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