Managed Care Report
July 19, 1999 3 minutes read
Managed Care Report
• Texas regulators have approved Aetna’s (Hartford, CT) proposal to buy Prudential Health Care and are requiring the company to cover any quarterly losses by existing Prudential HMOs. Aetna plans to convert current PruCare customers to Aetna, reported Best’s Insurance News, but the company will maintain the PruCare HMO and dental plan as subsidiaries for now. Aetna must file a business plan with Texas regulators for the PruCare subsidiaries within 120 days after the $1 billion transaction closes, Best’s reported. To gain approval from the Department of Justice’s Anti-Trust Division, Aetna has agreed to sell its NYLCare Health Plans of the Gulf Coast (Dallas) subsidiary, which has about 260,000 policy holders. It is also selling NYLCare Health Plans of the Southwest (Houston), regulators told Best’s.
• UnitedHealthcare of Illinois (UHI; Chicago) has signed an agreement with Extendedcare.com (Northfield, IL), an on-line extended care information resource. Under the agreement, Extendedcare.com will provide UHI with a discharge planning management system via the Internet. The new system, ExtendedCare Professional, was implemented to enhance and improve UHI’s Medicare discharging planning process and increase their referrals to the extended care providers with which they contract. The program will provide UHI’s Medicare case managers with a searchable database of more than 40,000 extended care providers nationwide, including home healthcare providers.
• Coventry Health Care (Bethesda, MD) last week announced the launch of Senior Life Management, a program designed to provide total health and lifestyle management to the Medicare population. The 5,000-member Pittsburgh pilot for Senior Life Management will combine a system of improved delivery of care with specialized life and medical interventions for seniors with varying care needs. Senior Life coordinates non-traditional services and education with disease management programs. The program is a joint venture between Coventry and Merck’s Outcomes Research and Management division.
• Oxford Health Plans (Norwalk, CT) has received accreditation from the National Committee for Quality Assurance (NCQA; Washington). NCQA provided Oxford with accredited status for Oxford’s HMO, POS, and Medicare products in Connecticut, New Jersey, and New York.
• The National Committee for Quality Assurance (NCQA; Washington) will now begin evaluating the quality of the nation’s preferred provider organizations, a sector that historically hasn’t been asked to account for the care and service it provides. Initially, NCQA’s assessment of PPOs will focus on evaluating member experience using a survey tool slated for release in 4Q99.
• Blue Cross and Blue Shield of Maine (BCBSME; South Portland, ME) and Anthem Blue Cross and Blue Shield (Indianapolis) have signed a definitive agreement that will result in an affiliation between the two companies. The affiliation will result in the formation of a new multi-million dollar charitable foundation for residents of Maine. BCBSME announced in January that company officials were considering a number of affiliation options designed to safeguard the company’s future in Maine. Anthem has been building a strong New England region, announcing earlier this year an affiliation with Blue Cross Blue Shield of New Hampshire. For Maine residents, a benefit of this new affiliation will be the creation of a new and independent healthcare foundation with assets expected to be in the range of $90 to $100 million. The foundation’s purpose will be to improve the health of all residents of Maine, particularly those who are uninsured or underinsured. In the transaction, Anthem will pay $120 million to BCBSME for the assets of the plan. From that purchase price, BCBSME will retire its outstanding obligations and commitments. The remaining proceeds will be preserved by BCBSME in the new foundation.
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