Humana scales back plans on ACA exchanges, and other briefs

Modern Healthcare

  • Humana will scale back its presence in the Affordable Care Act's exchanges in 2017, selling individual plans in 11 states compared with 19 states this year. The Louisville, Ky.-based insurer detailed the ACA retreat while upping its profit estimates for the year. The reduction is even starker at a local level. Humana's individual plans will be offered in “no more than 156 counties” next year, compared with 1,351 counties this year. Humana expects to collect $750 million to $1 billion in premiums from its individual ACA plans in 2017, a reduction of almost 80% from the $3.4 billion premiums projected for 2016. Humana pre-recorded a $176 million loss on 2016 ACA plans in February, and last week the insurer added another $208 million in expected losses.

  • Ahead of the release of its star ratings for overall hospital quality, the CMS published data showing how the ratings are distributed by hospital characteristics. The agency said it would post ratings for individual hospitals “shortly” on its Hospital Compare website and that the more general analysis was intended to “address any questions or concerns about the data from stakeholders.” Out of 4,599 hospitals, only 2.2%, or 102 institutions, received a five-star rating, while 20.3% received four stars, 38.5% received three, 15.7% earned two stars and 2.9% received one star. The distribution was similar when hospitals were sorted by size, though a larger percentage received two stars. About 20% of hospitals are exempt from the rating system.

  • More than a dozen Florida doctors and provider groups will seek nearly $350 million from integrated system Health First in a trial scheduled to begin next month for allegedly violating antitrust law. A federal judge refused to dismiss most of the allegations against Health First, clearing the way for the trial to begin Aug. 15 in Orlando. Multispecialty physician group Omni Healthcare and several other physicians and groups allege Health First maintains a monopoly by “intimidating physicians or otherwise obstructing their ability to practice medicine in southern Brevard County if they do not 'play ball' with Health First.” Health First Vice President Matthew Gerrell said in an email Friday that the evidence will show the allegations have no merit.
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