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Modern Healthcare - - LATE NEWS -

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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