Cariten Healthcare, a small provider-owned health plan based in Knoxville, walked away from the crowded field of contenders for the east Tennessee region TennCare contract, a contract viewed as highly lucrative for deep-pocketed national Medicaid players. In walking away, Cariten has opted to lose its 14-year involvement in the TennCare program and the chance to almost double its membership, in favor of pursuing its Medicare and commercial insurance lines.
Tennessee collected bids for both east and west Tennessee regions, with roughly 350,000 enrollees in each region to be split between two vendors. All the major national Medicaid plans were expected to bid, even though the winners of the middle Tennessee contract have so far suffered multi-million-dollar losses on the business.
HealthSpring, Tennessee's largest Medicare HMO, has created a new select provider network in middle Tennessee, continuing its focus on pay-for-quality and other initiatives to control costs while enhancing care.
The state's e-prescribing initiatives have yet to move large numbers of prescriptions away from the doctor's trusty pen-and-pad, but backers of the efforts say they're making headway, one practice at a time….
And while BlueCross BlueShield of Tennessee remains the enrollment leader in the state by far, Aetna appears to be gaining ground, with premium increases holding at a moderate 6-10 percent.