Nar­rower ex­change losses put High­mark Health back in black

Modern Healthcare - - REGIONAL NEWS - —Dave Barkholz

High­mark Health, a Pitts­burgh­based health plan that owns eight-hos­pi­tal Al­legheny Health Net­work, re­turned to the black last year af­ter stanch­ing losses that plagued it the year be­fore.

The Blues-af­fil­i­ated plan in 2016 nar­rowed its losses on the Af­ford- able Care Act in­di­vid­ual in­sur­ance ex­changes to $180 mil­lion, down 70% com­pared with ex­change losses of $590 mil­lion in 2015.

With other op­er­at­ing im­prove­ments across the sys­tem, High­mark posted an op­er­at­ing gain of $64 mil­lion in 2016, com­pared with an op­er­at­ing loss of $565 mil­lion the prior year. Rev­enue rose to $18.2 bil­lion last year from $17.7 bil­lion in 2015.

High­mark’s hos­pi­tal and provider op­er­a­tions, Al­legheny Health Net­work, re­ported a slightly higher op­er­at­ing loss of $39 mil­lion last year com­pared with $36 mil­lion in 2015. The wider losses were largely the re­sult of spend­ing on elec­tronic health record sys­tems and in­vest­ing in physi­cians and key sup­port staff.

In­pa­tient and out­pa­tient vol­umes also in­creased in 2016, High­mark noted.

High­mark is su­ing the fed­eral gov­ern­ment to re­cover money owed un­der the risk-cor­ri­dor pro­gram for plans sold on the ACA’s in­sur­ance ex­changes. The law­suit, filed in the U.S. Court of Fed­eral Claims, ar­gues High­mark is owed at least $223 mil­lion in risk-cor­ri­dor pay­ments.

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