CVS Health foresees Aetna’s declining Medicare Advantage star ratings impacting its 2024 outlook, while also focusing on value-based care. Aetna Better Health of Virginia incentivizes screenings with $7.3 million in payments. Lawmakers seek details on claims denials from major Medicare Advantage insurers, including Aetna. Tom Moriarty joins Albertsons as EVP and General Counsel. A settlement of $4.6 million is reached over unapproved rates for student insurance. Baton Rouge General signs a contract with Cigna but remains out of network with Aetna. Bryan Baier becomes President of Healthy Blue Kansas.
Here are seven recent updates regarding Aetna and its parent company, CVS Health, reported by Becker’s since May 8.
1. Outlook Impact: CVS Health expects Aetna’s Medicare Advantage star ratings to negatively impact its 2024 outlook. Due to a significant decrease in the number of Aetna’s Medicare Advantage members enrolled in four-star plans, the company anticipates a potential decrease in Aetna’s operating income by up to $1 billion next year. The figures show a drop from 87 percent in 2022 to 21 percent in 2023 for members enrolled in four-star plans.
2. Value-Based Care: Aetna Better Health of Virginia has provided $7.3 million in value-based care incentive payments to 22 federally qualified health centers in the state. The aim is to encourage screenings for diseases such as diabetes, breast cancer, cervical cancer, and colon cancer.
3. Claims Denials: Lawmakers are seeking more information on claims denials from major Medicare Advantage insurers, including Aetna. The Senate Permanent Subcommittee on Investigations has sent letters to CVS Health, Humana, and UnitedHealth Group, requesting internal documents outlining how these companies make decisions regarding claims approval or denial. The subcommittee is particularly interested in understanding the role of artificial intelligence in this process.
4. Leadership Announcement: Tom Moriarty has been appointed as Executive Vice President and General Counsel of Albertsons, a grocery chain. Moriarty, previously serving at CVS Health as Executive Vice President, Chief Policy and External Affairs Officer, and General Counsel, will assume his new role on June 5.
5. Settlement on Unapproved Rates: Aetna, UnitedHealthcare, and two other insurance companies have agreed to pay a combined $4.6 million to settle allegations that they charged unapproved rates for student insurance in New York state.
6. Network Status: Baton Rouge General, a healthcare system, has reached a new contract agreement with Cigna but remains out of network with Aetna. Since November, Baton Rouge General’s hospitals have been out of network with Aetna, and their physician clinics went out of network in mid-April. This split has affected approximately 5,000 patients.
7. Leadership Appointment: Bryan Baier, formerly the Executive Director of Government Programs at Aetna, has been named the President of Healthy Blue Kansas.
These updates shed light on various aspects of Aetna and CVS Health, including financial implications, value-based care initiatives, legal settlements, network agreements, and leadership appointments.
