BETA
This is a BETA experience. You may opt-out by clicking here

More From Forbes

Edit Story

Amid Executive Shuffle, Anthem Looks To Expand Health Services

Following
This article is more than 5 years old.

With Gail Boudreaux just a few months shy of her first anniversary as Anthem chief executive, some are looking for the health insurer’s new management team to buy and grow additional businesses, particularly as rivals form closer ties with providers of medical care via acquisition.

In response, Anthem has hired Dr. Prakash Patel as executive vice president and president, “Diversified Business Group,” effective Aug. 6 to lead an array of emerging businesses including its AIM specialty benefit management firm; CareMore, which offers provider services like nurse practitioners, pharmacists and other medical professionals to seniors and HealthCore, an outcomes and clinical research company.

“Leadership is deeply focused on achieving connectivity across the touch points of these building blocks, while determining the next move for capital deployment,” Leerink Partners Ana Gupte said in a June 29 note after Patel was hired to Anthem, which operates Blue Cross and Blue Shield plans in 14 states.

Patel will join Anthem from his post as a senior executive at GuideWell Enterprise and Florida Blue, one of the nation’s largest Blue Cross plans. “His breadth and depth of healthcare experience will serve us well in our efforts to develop innovative approaches to care that deliver higher value for Anthem and our Diversified Business Group customers while deepening our relationships within the healthcare community,” Boudreaux said in announcing Patel.

Patel takes over the duties of Dr. Craig Samitt, who is leaving Anthem as chief clinical officer after less than three years to become President and CEO of Blue Cross Blue Shield Minnesota. The diversified business group at Anthem has been described as a “mini-Optum" within the insurer by Leerink’s Gupte.

Analysts would like to see Anthem mimic the growth of the real Optum, which has become one of the nation’s largest providers of medical care under the umbrella of UnitedHealth Group, the nation’s largest health insurer. In the first quarter, Optum revenues jumped 11% to $23.6 billion, UnitedHealth said.

Optum includes a fast growing business acquiring doctor practices, clinics and urgent care centers under the MedExpress brand. Optum also operates the pharmacy benefit manager (PBM), OptumRx.

PBMs – middlemen between drug manufacturers and employers when it comes to purchasing drugs - are forming closer ties with health insurers amid questions about whether they are passing along all of the savings they could to employers, taxpayers and consumers.

Drugstore giant CVS Health, which owns the PBM Caremark, is working toward completion of its acquisition of Aetna, the nation’s third-largest health insurer. And the health insurer Cigna has agreed to buy the PBM Express Scripts.

Meanwhile, Anthem’s PBM is still in search of a permanent CEO to replace Brian Griffin who left Anthem in May to run a specialty pharmacy services company. Anthem is creating its own PBM, IngenioRx which will begin operations in January of 2020 after ending a long relationship with Express Scripts, which will continue to be Anthem's PBM vendor through Dec. 31, 2019, and through a “transition period in 2020," Anthem has said.

While Anthem continues its “external search” to replace Griffin, IngenioRx chief operating officer Deepti Jain is leading the PBM. Some investors are expecting an update on the PBM operation when Anthem reports second-quarter earnings July 25.

Follow me on Twitter or LinkedInCheck out my website or some of my other work here