Moda’s Financial Downfall Began Months Ago

Now the partnership between OHSU and Moda could be at stake.

Moda Health’s spiral downward began long before the Oregon Insurance Division stepped into the picture earlier this week. The insurer actually started showing signs of distress last summer with mounting claims and few dollars to pay providers.

“Everyone was wondering when the Insurance Division was going to do something; these guys didn’t have any capital left. What’s going on now could close them down,” a confidential source told The Lund Report.

A.M. Best Downgrades Moda Health

This is the second time in the last few months that Moda’s credit rating has spiraled downward.

Moda Health has been stung with yet another downgrade of its credit rating by A.M. Best. This is the second time in the last several months that Moda’s taken a smacking from the world’s most authoritative insurance rating and information source.

Is Moda Health Ripe for a Takeover?

Conversations are taking place between executives from Legacy Health and PacificSource. Moda, Inc. just announced that it has made a $50 million investment in Moda Health Plan -- their press announcement appears at the end of this story. ..

The latest news about Moda’s failure to negotiate a contract with Providence Health & Services has onlookers speculating that the health plan could be on the chopping block – ripe for a takeover.

Moda Dominates Health Insurance Exchange

Preliminary numbers released by the Oregon Insurance Division on individual enrollment in the health insurance exchange once again show Moda has a dominant lead over its competitors.

Once again Moda Health Plan has walked away with the highest number of individual members on the health insurance exchange in Oregon – 101,374 people for a growth of 19 percent over last year.

Moda Health Doubles in Size But Ends Up in the Red

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Major insurers Regence BlueCross BlueShield, Kaiser Permanente and PacificSource see their enrollments go down at the end of the third quarter, while co-ops pick up steam.

Moda Health has more than doubled in size since Jan. 1, when federal rules surrounding health coverage went into effect. Over the same period, Oregon’s largest insurers have shed tens of thousands of members, according to third-quarter statements filed with regulators. 

Moda Health May Help Boost Medical Residencies in Oregon

The Portland-based health insurance company has proposed funding the start-up costs for a nonprofit consortium that would work to recruit faculty and raise cash to fund new medical residencies in the state, the number of which have been largely frozen in place by a 1997 federal law that doesn’t give Oregon its fair share.

Oregon may move to increase the number of medical residencies in the state that have been all but frozen in place since 1997, with an assist from Moda Health.

Hospital Trends, New Insurance Rates, Moda’s Network Panel

During the next two weeks, the hospital association, the state’s insurance commissioner and Moda Health are expected to announce new developments.

Oregon’s dominant healthcare players are expected to make major announcements in the coming weeks that could transform the landscape, The Lund Report has learned.

Moda Health’s Double-Digit Rate Increase Faces Scrutiny

Price-conscious consumers would be well advised to do some shopping this fall before signing back up with Moda Health. Several health plans, including Atrio and Oregon’s Health Co-Op, are not only offering cheaper rates than Moda, they’re asking for reductions in price that would set them below Moda’s 2014 rates.

Moda Health may have some more explaining to do if it’s going to get the full 12.5 percent rate hike it’s requested from Oregon’s Insurance Division for its 2015 individual health plans.


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