Becker's Hospital Review

27 CFO / FINANCE UnitedHealthcare dumps Envision contract: 4 things to know By Morgan Haefner U nitedHealthcare opted to terminate its agreement with Nashville, Tenn.- based Envision Healthcare no later than Jan. 1, 2019, according to recent court documents. Here are four things to know about the ongo- ing dispute. 1. In an April 6 court filing, UnitedHealth- care — the health insurance arm of Unit- edHealth Group — said it's terminating its contract with Envision because the provider has been "unwilling to address matters with UHC in a reasonable and satisfactory manner — demonstrated most recently by the filing of this lawsuit in blatant disregard of the parties' valid and enforceable arbitration provision." 2. UnitedHealthcare argued Envision wrong- fully sued the payer, and by doing so, broke an arbitration clause in their agreement. e in- surer also called Envision's emergency room billing practices "egregious." 3. The termination notice is the latest in the feud between UnitedHealthcare and Envi- sion. In late March, UnitedHealthcare cre- ated a website targeting Envision's ED billing policies. On March 14, Bloomberg reported UnitedHealth tossed its attempt to acquire Envision's ambulatory services unit, ac- cording to sources familiar with the matter. That news came as Envision sued United- Health for allegedly lowering contracted payments to Envision physicians and not allowing new Envision medical practices to join its network. 4. In a statement to Becker's Hospital Review, Envision said, "From our perspective, these are two separate issues that United has cho- sen to combine to distract from the original breach of contract complaint. Regarding the litigation, as stated in our complaint, Unit- edHealthcare is in breach of contract by fail- ing to recognize Envision medical providers, unfairly adjusting rates it pays Envision and refusing to comply with the contract's pro- cess for handling disputes. is is the next step aer multiple attempts to resolve the situation. We are asking the courts to hold United accountable for its contractual agree- ments and obligations under terms of the contract they signed. "Regarding the separate issue of future con- tracting with United Healthcare, as we public- ly declared earlier in 2018, Envision Health- care's goal is to be in-network with as many payors as possible … we hope to come to an agreement for 2019 and beyond that provides for fair and reasonable reimbursement for the care we provide to patients." n America's uninsured rate climbs to 15.5% By Morgan Haefner T he number of working-age Americans without health insur- ance grew by an estimated 4 million since March 2017, ac- cording to the Commonwealth Fund's ACA Tracking Survey. The U.S. uninsured rate among working-age Americans now rests around 15.5 percent, compared to 12.7 percent about one year ago. Lower-income families earning less than $61,000 saw the biggest jumps in uninsured rates when compared to 2016 num- bers, according to the Commonwealth Fund. The Commonwealth Fund attributed the increase to two factors: a lack of legislative fixes to the ACA's weaknesses and changes to the law initiated by President Donald Trump's administration. These include cutting ACA advertising and the open enrollment period for ACA marketplace coverage. That being said, 11.8 million Americans enrolled in health plans on the ACA marketplace during the 2018 open enrollment period, down about 1 million from 2016, prior to the Trump administra- tion's changes. Still, "signs point to further erosion of insurance coverage in 2019: the repeal of the individual mandate penalty included in the 2017 tax law, recent actions to increase the availability of insurance pol- icies that don't comply with ACA minimum benefit standards, and support for Medicaid work requirements," according to the re- port. n Aetna reorganizes business lines ahead of possible CVS Health tie-up By Morgan Haefner A etna will realign its business segments as it gears up for a pending $69 billion merger with CVS Health. Effective for its first quarter 2018 results, Aetna will operate under two segments: healthcare and corporate/other. The healthcare segment encom- passes commercial health plans, employer-based plans, and Medicaid and Medicare businesses. The healthcare segment will also include medical products and services. The remainder of Aetna's operations will fall un- der its corporate/other segment. These business lines include products Aetna no longer solicits or accepts new customers for; contracts the insurer divested through reinsurance and other agree- ments; and expenses like transaction- and integra- tion-related costs. The changes will be reflected in Aetna's first quar- ter results scheduled for May 1. Aetna will not hold a first quarter earnings call due to the pending CVS Health deal. n

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