6 Modern Healthcare | August 19, 2019
MIDWEST
SSM Health forms
primary-care joint ventureSSM Health and primary-care spe-
cialist Paladina Health have created a
joint venture to offer a direct-to-em-
ployer primary-care service to St. Louis
businesses.
Under the model, employers will pay
a flat fee for each employee’s prima-
ry-care services. That will give workers
access to a personal physician without
co-pays and other out-of-pocket costs,
including in-house pharmacy and lab
services.
The venture expects to open its first
St. Louis-area clinic by year-end, and itNORTHEAST
Harvard Pilgrim,
Tufts plan merger
Two not-for-profit
Massachusetts-based
health insurers,
Harvard Pilgrim Health
Care and Tufts Health
Plan, have announced
merger plans.
The yet-to-be-
named combined
company will serve
about 2.4 million
members in Connecticut, Maine, Massachusetts, New Hampshire
and Rhode Island in employer-sponsored, Medicare, Medicaid and
Affordable Care Act individual plans.
In a joint statement, the insurers said their merger will improve
the affordability of coverage through scale and administrative
cost efficiencies while improving quality through investments in
population health.
The insurers did not disclose the financial details of the combination.
A Tufts spokeswoman declined to comment.
Tom Croswell, CEO of Tufts Health Plan, will serve as chief executive
of the combined company, while Harvard Pilgrim CEO Michael Carson
will be president. The insurers said the new company’s board of
directors will have equal representation from both organizations.
—Shelby Livingstonwill be available to businesses in ear-
ly 2020. The new care model, using by
Paladina’s data-driven, direct-to-em-
ployer primary-care model with qual-
ity-based incentives and SSM Health’s
acute-care infrastructure, will also be
offered to SSM employees and their
dependents covered by SSM Health’s
health plan.
The two organizations will share
ownership in the joint venture, with
Denver-based Paladina directing op-
erations. The new company will ex-
plore expanding to other communities
outside the St. Louis area, although it
declined to specify how many clinics it
aims to open and how revenue will be
split.Kansas says Aetna
still not living up to
Medicaid contract termsKansas health regulators said Aetna
is still not living up to the terms of its
$1 billion contract with the state’s Med-
icaid program.
The state rejected a corrective action
plan Aetna submitted in response to
a noncompliance letter Kansas sent it
last month. The Kansas Department of
Health and Environment released Aet-
na’s proposed plan. The company said
it addressed several concerns and many
others are “well on their way to being
brought into compliance” under the
contract.
But the state contends the company’s
plan doesn’t adequately address its con-
cerns. It asked Aetna to submit a new
one and plans to negotiate with compa-
ny officials for a resolution.Anesthesiology group sues
Trinity Health for trying to
hire away providersAnesthesia Associates of Ann Ar-
bor, the largest anesthesiology and
pain-management medical group in
Michigan, sued Trinity Health Mich-
igan in Washtenaw County Circuit
Court over an allegation the 13-hospital
health system improperly tried to hire
away some of its providers.
The lawsuit contends Trinity has
“chosen to ignore (Anesthesia Associ-
ates’) valid noncompetes and its own
nonsolicitation obligations and recent-
ly attempted to recruit our certified reg-
istered nurse anesthetists,” according to
Anesthesia Associates, also known as
A4.
On Friday, a county circuit court
granted A4’s motion for a temporary
restraining order against Trinity Health.
That means Trinity can not contact any
of A4’s physicians for employment pur-
poses.
Trinity Health Michigan had no im-
mediate comment on the lawsuit. CEO
Rob Casalou addressed some of the
issues Trinity has with A4 in an Aug. 9
letter to A4 CEO Gregory Bock and Dr.
Traci Coffman, president of A4 Manage-
ment Co. in Ann Arbor.
“We have heard that large numbers of