Health Plans Share Their Roadmaps to HIX

Margaret Dick Tocknell, for HealthLeaders Media , August 7, 2013

Humana plans to participate in the health insurance exchanges in 14 states where it already sells insurance and has provider networks and clinical infrastructure in place. HIX participation is part of Humana's long-term goal to provider coverage to people for their lifetime. "This is a nice opportunity to create a relationship with somebody who is under age 65 and have them age into our Medicare programs," said James E. Murray, Humana's CFO and executive vice president.

The insurer is in the process of acquiring American Eldercare, which will enable Humana to provide long-term care management for Medicaid recipients. Bruce Broussard, Humana's CEO, noted that the acquisition will enable Humana to bring in-house services for that market that it has been outsourcing.

While UHC officials remain committed to Medicare Advantage, concerns about significant underfunding have lead the giant insurer to exit some of its MA markets, reduce its plan offerings, and reduce benefits. Officials expect these steps to mean MA membership growth will be slower in 2014 than it has been in recent years.

In addition, UHC is reshaping its local MA provider networks to emphasize collaboration and consistency of care, especially for members with chronic conditions. It also will increase its use of in-home health reviews and services.

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