Q3_2019

Executive Summary

Highlights from this issue:


  • MCO Leader SurveyMCOs are assessing impact of the Public Charge Rule and Interoperability Rule.
  • Industry InterviewsRobert Garnett of Amerigroup Tennessee talks about the Medicaid Block Grant Proposal and David Tamburri of Health Equity Partners gives his thoughts on the next stage in healthcare investment.
  • MCO Financial PerformanceRevenues flat for most MCOS, with some increases in EBIDTA for smaller plans. Hiring spikes in August for several plans. Note: Multiple new analyses added to standard MCO reporting this issue
  • RegWatch-Hospital pricing transparency rule moves forward. New study on 340B inconsistencies released. 
  • M&A and Investment- Trends in ABA provider buys. Navigant Consulting sold. 
  • Vendor Reviews- 6 tech companies, 2 consulting firms, 1 HCBS provider network and 1 device company independently reviewed using our 55-point evaluation. 

Latest MCO leader survey results 

This iteration of the survey asked about PBM/MCO issues, the Public Charge Rule and the Interoperability Rule.

Industry Interviews

Each issue we interview a Medicaid Managed Care executive and an Investment Leader

Robert Garnett

President, Amerigroup Tennessee at Anthem, Inc.

David Tamburri

Managing Partner at Health Enterprise Partners, LP

MCO Financial Performance

Summary

Most MCOs reported Q2 financials during the period, with Q3 expected in October/November. For those reporting updated data, revenues were fairly flat. Market interest varied by plan.


Note: Several new analyses were added to the standard package this issue including:

-Buy/sell recommendation trends
-Moving average and S&P performance as benchmarks for the        monthly-close snapshots
-Hiring trends (vs sector)
-Innovation scoring (based on R&D and similar investments)
-Insider sentiment scoring


Latest MCO Quarterly Financials

Note: due to Q3 MCO reporting lag some data not available at time of writing. See detailed analysis for more information. 

Revenue

Gross Profit

Earnings Before Interest and Taxes

Detailed Analysis

Anthem

$25.5B

$5.4B

$2.1B

Cigna

$38.8B

$6.3B

$2.4B

Centene

$18.4B

$2.3B

$921M

CVS (Aetna)

$63.4B

$11.4B

$4.4B

Humana

$16.2B

$2.6B

$847M

Molina

$4.2B

$583M

$301M

UnitedHealth

$59.9B

$14.2B

$5.7B

WellCare

$7B

$828M

$343M

RegWatch

A Quick Glance At Key Regulations With Possible Impact to Medicaid Plans
  • Most health IT execs unaware of CMS interoperability rile
  • Hospital pricing transparency rule moves forward
  • New program integrity rule strengthens disbarment penalties
  • Physicians oppose relaxing Medicaid access rule
  • New study on 340B challenges published
  • Tennessee’s Block Grant Proposal released

Mergers, Acquisitions and Investment Activity 

Highlights

Multiple smaller market acquisitions in play this quarter

WellCare/Centene deal move forward, including negotiated plan divestments

Details of Evolent / Passport deal emerge

Google continues to try and break into insurance market with new MA plans

Hospitals continue strategy of divesting internal services shops into for-profit organizations

Multiple transactions in the Applied Behavior Analysis (ABA) provider space

Multiple transactions in the hospice and home health provider space

Continued investment activity around substance abuse treatment providers

Navigant Consulting sold



Vendor Reviews

Your staff are constantly asked to sit through vendor demos and pitch meetings. Is it worth the time? 

Our simple grid below helps you decide. 

Vendor Name

Category

Overall Assessment for Medicaid Readiness

Detailed Analysis

Certifi

Tech>Exchange

Consumer Direct Care Network

Provider network>HCBS

Eccovia Solutions

Tech>Case Management

Geneia

Tech>Analytics (for providers)

hCentive, Inc.

Tech>benefits management

Healthify

Tech>SDH assessments and referrals

HealthTech Solutions, LLC

Consulting>Technology assessments (MITA), EHR integrations and exchange technologies

LivaNova PLC

Medical devices

Mediware (WellSky)

Tech>Case Management

Village MD

Physician practice management

Need to update info in one of our reviews? Disagree with our assessment? Send us a note to clay@mostlymedicaid.com to schedule a call with one our analysts to provide more information. 

Evaluation methodology