Anthem executive taking over top role at Optima Health
Dennis Matheis, Anthem’s president of the central region and the company's Affordable Care Act (ACA) exchange plans, will soon take over for Optima Health CEO Michael Dudley, who will retire at the end of the year. Matheis will join Optima on Nov. 1 and shadow the outgoing CEO until his departure.
Matheis, who has been with Anthem for 13 years and led the proposed Anthem-Cigna merger, will become president of Optima and senior corporate vice president of Sentara Healthcare, the nonprofit health system that owns Optima.
Dudley, who has been with the health plan for 21 years, initially announced his decision to retire in November 2016, which sparked a candidate search that culminated in Matheis’ hiring.
Anthem has had an eventful year, and Matheis has been involved in two of the bigger pieces of news — the ACA exchanges and the failed merger with Cigna.
Also, Anthem is reducing the footprint in or leaving nine of the 13 states in which it has an ACA plan presence, including Virginia, where Optima Health is located. While Anthem is pulling out of Virginia's ACA exchange, Optima is staying and even expanding to more counties. Matheis' exchange experience with Anthem should serve him well in his new role.
Virginia Beach, Virg.-based Optima Health, announced in September that it will remain in the ACA exchange in Virginia in 2018. Anthem, Aetna and UnitedHealthcare are all pulling out of Virginia next year, which will mean 350,000 Virginians will need to find new coverage for 2018.
Optima, which has about 450,000 members in employer-sponsored, individual market, Medicare Advantage and Medicaid, is limiting individual plans to areas near Sentara Healthcare hospitals and physicians. The company said this decision will allow the health plan to “better manage chronic conditions to keep members healthy.”
Though Optima is staying in the Virginia exchange, many of the company's ACA plans will seek a large premium increase in 2018. Optima Health said 70% of its individual plan members qualify for a subsidy, which will keep premium increases to only 1.5% on average for those members. However, the remaining 30% will see their premiums skyrocket an average of 81.8%.
Optima said it had already planned a 20% increase and added another 23 percentage points because of uncertainty surrounding cost-sharing reduction (CSR) payments. The remaining 38 percentage point increase is because other payers are dropping ACA plans, the company said.
Optima's departing CEO said: “The only other alternative would have been to completely exit the exchange, and that goes against our mission.”
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