Humana Inc.'s latest stop on its buying spree was in East Tennessee where the Kentucky-based insurer agreed to purchase Cariten Healthcare, a provider-owned company doing business in commercial, Medicare and Medicaid sectors. Although Humana inherits more than 34,000 fully insured commercial customers, it may be most interested in the 46,000 Medicare Advantage members on Cariten's books. The latest acquisition announcement makes the Tennessee health plan market even more consolidated with the PPO competition essentially between BlueCross BlueShield of Tennessee and national insurers – including Humana – while the HMO market is dominated by CIGNA HealthCare in the east and middle and UnitedHealthcare of the River Valley in the east. BlueCross has launched a new Web-based tool that provides quality indicators on the almost 4,000 of the company's contracted physicians. BlueCross and AmeriChoice are preparing to launch new at-risk managed care contracts in the TennCare program; the western portion of the state goes live with the managed care plans on Nov. 1 while the east is implemented on Jan. 1, 2009 – the middle region enrollees have been enrolled with either AmeriChoice or AMERIGROUP since 2007. Meanwhile, AMERIGROUP's rocky start in Tennessee may get smoother now that it renegotiated rates with the TennCare Bureau for home healthcare services, yet it still faces a lawsuit from a Chattanooga-based hospital system over the payment of services for AMERIGROUP's TennCare enrollees.