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Anthem acquires Florida Medicare Advantage plan and network HealthSun

Acquisition helps position Anthem as a dominant player in a market projected to increase in enrollment, revenue, but shrink in the number of insurers

Susan Morse, Associate Editor

Credit: AnthemCredit: Anthem

Anthem is acquiring HealthSun, a Medicare Advantage health plan and delivery network that will add 40,000 members to the insurer's business in Miami-Dade and Broward counties in Florida.

The integrated network offers primary care and other services through 19 Pasteur and WellMax providers and unaffiliated medical centers, according to Anthem.

The financial terms of the transaction are not being disclosed. The acquisition is expected to close by the end of the year.

[Also: Kaiser Permanente first in Medicare Advantage consumer satisfaction, study finds]

"The acquisition of HealthSun, which offers a unique integrated care delivery model serving mainly dual-eligible (Medicare and Medicaid) members, fits well with our plans for continued growth in the Medicare Advantage and dual-eligible populations," said Anthem CEO Joseph Swedish. "In addition, the HealthSun acquisition will further the industry leading commitment of Anthem's affiliated health plans in offering a wide variety of value- based care models that benefit our members through high quality care and improved outcomes."

The investor-owned HealthSun received a 4.5 out of a top 5 star rating from the Centers for Medicare and Medicaid Services for 2017 and 2018, according to Anthem. CMS offers bonus payments to plans with higher star ratings.

[Also: Medicare Advantage market turns nursing homes into insurer business]

CMS projected last year that within three years, 73 percent of the total MA membership will be serviced by plans with four or more stars, up from 34 percent today, according to information published in strategy + business. This is due to consumers gravitating towards plans with higher ratings.

Because of this, the number of payers is expected to decrease as a smaller number of higher-performing plans dominate the $10 to $15 billion per year market, the report said.

[Also: GAO study: 35 Medicare Advantage plans losing large numbers of sicker patients]

MA now makes up about a third of Medicare enrollee plans and enrollment is projected to grow.

Annual revenue is expected to rise from $215 billion in 2017 to more than $500 billion by 2025, according to strategy + business, citing a Strategy& report from PwC's consulting company.

With the addition of HealthSun, Anthem's affiliated Medicare and Medicaid plans will grow to 650,000 members in Florida, according to Peter D. Haytaian, Anthem executive vice president and president of the government business division.

"HealthSun has been recognized for providing superior care coordination and better health outcomes through a network of primary care clinics, pharmacy support, and transportation services; as well as a narrow network of physician specialists and integrated medical cost management," Haytaian said.

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com

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