Tag: Insurers

Little footsteps toward data mobility?

Aug 6, 2008• 5

By Matthew Holt

These few stories may be straws in the wind, or may be little streams rushing to a Athena bigger confluence. You be the judge!

AthenaHealth kicks butt in its most recent quarterly numbers, showing a 35% increase in revenue and a change to a profit compared to a loss the same quarter a year before. This marks the second quarter that once the post-IPO euphoria cooled down, they’ve been delivering on their numbers. Now stock-wise this may all remain tricky—the PE ratio still looks like 90’s dotcom stock, but what’s more interesting is the strategy.

After adding the Clinicals EMR to the core practice management Collector product, yesterday AthenaHealth bought a little company called MedicalMessaging for $7.7 million. What’s interesting about that is that it provides a front end for doctors using the AthenaHealth system to provide those little functions to their patients like online visits, record summaries, Rx refills, appointment booking and all the other stuff that needs to go online to make today’s doctor office more user friendly.

Mega Life parent “hurt a lot of people”

Jul 22, 2008• 13

By Matthew Holt

Is this what Blackstone, Credit Suisse & Goldman Sachs want said about their investment?

"The severity of their actions certainly warranted that level of penalty. They hurt a lot of people," says Washington Insurance Commissioner Mike Kreidler, whose state and Alaska led the investigation.

Today a group of insurance commissioners handed down a $20-million fine to parent company HealthMarkets for the behavior of Mega Life & Health, and also its corporate siblings Chesapeake Life and Great West

$20 million isn’t exactly a huge fine, and it doesn’t put HealthMarkets out of business. It’ll be interesting to see whether Mega changes the quasi-fraudulent structure of its benefit plans. After all, they’ve been ruled legal in California, and my sources tell me that the medical-loss ratio is around 30 percent.

My guess is that they know that eventually they can’t stay in business this way. So they face the choice of either changing the business completely to become more worthy and less profitable, or instead to try to bleed every last dollar out of their subscriber base and semi-trained sales team. I wonder which they’ll try.

AHIP starts smoking astroturf

Jul 17, 2008• 8

By Matthew Holt

Let’s say you ran a lobbying organization that may (or may not) be staring into a political storm. And say that you’d just lost a battle with opponents within the health care industry that you thought you’d won in 2003.

Now, say you “believe” that the 47 million people — who are uninsured in part (but to be fair, only in part) due to your members’ greed, political choices and incompetence over the years — represent a market for your members.

Say your organization had some members who could possibly adapt to a new world, where tightly regulated organizations were contracted under strict terms to provide care to the whole population in a social insurance scheme — with appropriate risk-adjustment and other mechanisms in place to promote the care management you say your members do so well.

And say then it had other members, who are mere sharks and who would go out of business the minute they were banned from cherry-picking only the best customers and selling them quasi-fraudulent products.

Interview with Trizetto & Eliza

Jul 16, 2008

By Matthew Holt

Due to poor planning on my part, this morning I was up scandalously early to talk with Gene Drabinksi, who runs the CareAdvance unit of Trizetto, and Alexandra Drane, President of Eliza.

Last week they announced a partnership that integrates the care management aspects of Trizetto’s services with the automated phone outreach provided by Eliza. It’s another step in the evolution of phone-based contact and personalization in health care — which, the careful THCB reader will have noted, I think is an important channel for delivering and capturing health information.

Of particular importance, is making useful that vast glob of data stored within a health plan by communicating about it with the members. It’s also always good to hear from some experienced and passionate players, and Alex and Gene certainly fit that bill. As I hadn’t had any coffee, I wouldn’t claim the same for myself!

Here’s the interview.

The Managed Care Roller Coaster

Jul 16, 2008• 19

By MAGGIE MAHAR & NIKO KARVOUNIS

At a health care forum held last year in Las Vegas, then-presidential candidate Hillary Clinton declared that she was intent on “taking money away from people who make out really well right now” in order to fund health care reform. When asked exactly which fat cats she was referring to, Clinton responded, “Well, let’s start with the insurance companies.”

Clinton’s sentiment — that private insurers are making out like bandits while our health care system crumbles — is part of the received wisdom these days, especially among progressives who believe that for-profit health insurance doesn’t add much value to our health care system. But the reality is that in recent years, private insurers haven’t been doing so well financially.

Consider United Health Care (UHC), the nation’s biggest private insurer. Joe Paduda of Managed Care Matters reports that UHC will be cutting 4,000 jobs as part of a restructuring plan that includes eliminating Uniprise, one of its major brands. Since last fall, UHC stock has plummeted from $53 to $22 a share. WellPoint, another huge private insurer, has watched its stock drop from $82 a share in 2007 to $49 a share in June.

People with high-deductible plans make riskier decisions

Jul 14, 2008• 5

By Jane Sarasohn-Kahn

Healthaffairs People enrolled in high-deductible health plans tend to make more risky health
decisions than those enrolled in lower-deductible plans, according to a study published in the July/August issue of Health Affairs.

In Do Consumer-Directed Health Plans Drive Change In Enrollees’ Health Care Behavior? the authors find the answer is, "yes," probably.

Enrollees in the high-deductible CDHP were more likely to forgo medical care to save money.

If California can’t protect consumers, who can?

Jul 7, 2008• 1

By Robert Laszewski

Crazy as it sounds an Associated Press story from Thursday reported that the California Department of Managed Care "didn’t even try to enforce a million-dollar fine against health insurer Anthem Blue Cross because they feared they would be outgunned in court."

Last year, the department announced that it would fine the insurer for improperly rescinding individual heath insurance policies in the midst of the California rescission controversy. Since then, most insurers have announced policy changes in the way they rescind coverage.

UnitedHealth trying to regroup for an uncertain future

Jul 3, 2008

By Matthew Holt

In an attempt to put that messy options back-dating business behind it, yesterday
UnitedHealth Group settled with CalPERS (the ever vigilant pension fund of California state employees) and other class action suit members. And they settled for a bunch — $985 million. That’s even more than ex-CEO Bill McGuire gave back in his long running attempt to apologize without admitting criminal liability. Although, of course, United’s stock is down so much from the halcyon days of 2006 that it would require me to take my socks of both feet to work out if McGuire’s remaining options are worth anything these days!

Meanwhile, the CEO of Brocade is in jail (or may be out on appeal, I’m not sure) for back-dating options that helped his employees — and hurt his shareholders. Yet, McGuire (and for that matter Steve Jobs) seem to my untrained eye to have done the same thing without severe consequences. I’m still baffled.

United’s business seems to be heading into more trouble. Profits are down, lay-offs are up, and overall membership is down. More people and employers can’t afford health insurance in a weakening economy. And don’t forget total enrollment in commercial employment-based insurance plans fell during the most recent economic expansion!

The only logical rescue comes from an expansion of government plans. But there’s of course the little issue of how much they get paid for those government plans! The long-term question is whether they will lose more on the Medicare Advantage roundabout under the next Administration than they make up on any universal health care swings.

UPDATE: Wall Street didn’t like it too much. UNH is down 9% today

Today’s news today, doctors, Peel, and individual insurance

Jun 30, 2008• 4

By Matthew Holt

I just noticed that THCB today is all about last week and Sunday’s news—including Merrill Goozner and me jumping separately on the same magic quote in the NY Times CT piece. So how about three little pieces of news about stuff reported today.

First off, in a desperate attempt to keep the Republicans from losing all 33 Senate seats in November, CMS is freezing the cuts in Medicare fees which were due to go automatically into effect this week. Bob Laszewski has a just excellent explanation of how the Dems finally seem to have figured out how to play hardball with the Republicans and AHIP. Perhaps they’ve taken on Tom Delay as an advisor, now he’s not so busy. Meanwhile Bob thinks that the 7 missing Republican votes will return from July 4 and the Medicare Advantage and PFFS plans will get their comeuppance. Wall Street isn’t so sure, and those health plan stocks are trading higher today.

The mutli-factorial equation of individual insurance

Jun 27, 2008• 3

By Matthew Holt

I’m up at Spot-on talking about the perils of being in the individual insurance market and wondering whether I should get out. As ever, come back here to comment if you please.

I want to ask your help. I have to make a financial decision
regarding my health insurance and given the confusion of the system –
one I’m supposedly expert in – I need advice.

Now realistically you’re not likely to be much good to me. Why do I say this? Well, the data says you’re dummies.

Last week Trizetto, a private tech company, put out a survey that said as much. While 80% of consumers surveyed were concerned about health care costs, less than a third knew how much their family spent.

It gets worse. Around 60% of Americans, including the vast majority
of those under 65, get their insurance from their employer. How much
are employers paying each year? Well according to Joe Public, not that
much. Most don’t know, or they think it’s less than $5,000 per family. In
reality it’s around $9,000.

But I’m not one of the blissfully ignorant who gets his
insurance at the company trough. Well, not quite. And hence my cry for
help. Read the rest