Aetna, AvMed fought to run Miami-Dade County employee health care plan. Who won?

Miami Herald

a day ago

Miami-Dade's more than 31,000 county employees are on track for a new insurance provider after Aetna ousted longtime administrator AvMed in a County Commission vote on Wednesday.
The planned change would bring the county a new insurance administrator for the first time since George W. Bush was president and raises the stakes for Mayor Daniella Levine Cava, who recommended the switch as a way to save money during a budget crunch.
Aetna, a national insurance company owned by the CVS pharmacy chain, claims its national purchasing power produces the kind of discounts that can save Miami-Dade about $40 million a year over rates offered by AvMed, a Florida-based provider with headquarters in Doral.
'We're going to try and reduce the cost curve,' said Carladenise Edwards, chief administrative officer under Levine Cava. 'As we do that, the county will save money over time.'
While Miami-Dade commissioners approved the switch in a 7-to-2 vote, AvMed already has a legal challenge that could stall or overturn the decision.
As commissioners initially prepared to decide the contract in a last-minute vote last month, AvMed sued, with claims that the Levine Cava administration violated bidding rules in how it recommended awarding the contract to Aetna — allegations the county denies. That vote got delayed, prompting a rare special meeting on Wednesday dedicated solely to the proposed Aetna contract recommended by the mayor.
Voting against the switch were Commissioners Roberto Gonzalez and Danielle Cohen Higgins. Commissioners Marleine Bastien, Juan Carlos Bermudez and Eileen Higgins did not attend the meeting.
Barring a judge's intervention, the commission vote sets up a scramble to replace the insurance administrator for one of South Florida's largest workforces just weeks ahead of the open-enrollment session that typically begins in late October. AvMed first won the county health care contract in 2007.
Like most large governments, Miami-Dade pays for its own employee health care costs and hires an insurance company to administer the billing and reimbursement process for about $600 million in claims per year. The administrator earns a yearly fee for the work — Aetna charges $15 million and AvMed, $10 million — but the county's main costs come from the reimbursement rates negotiated by the administrator for prescriptions, medical procedures and hospitalizations.
Two consultants hired by Miami-Dade concluded the Aetna rates would save Miami-Dade about $40 million when compared to AvMed's rates — math AvMed disputed as flawed.
Commissioner Oliver Gilbert, who sponsored the legislation approving the Aetna contract, said it made no sense for board members to try and reach their own conclusions in the complex field of actuarial methods, repriced health care claims and shared savings in self-funded insurance plans.
'I'm left with the people we pay to analyze that,' Gilbert said as the meeting neared its third hour and Cohen Higgins and Gonzalez pressed the administration on the competing numbers. 'This is theater at this point.'
Cohen Higgins said the board lacked the information and explanations needed to justify a major switch in the county's health care landscape on a shortened timetable. 'I need more,' she said.
Levine Cava did not attend the meeting. In the sharpest words of the day, Gonzalez blamed what he called a flawed rollout by Levine Cava last month for causing anxiety among county workers about the proposed Aetna switch.
'I don't trust the mayor — and I want to trust the mayor,' Gonzalez said.
Namita Uppal, the county's procurement director and top negotiator on the health care contract, emphasized insurance fees won't change for county employees or the retirees that continue receiving coverage from Miami-Dade. She also said Aetna was already helping answer employees' questions about the potential switch and whether existing AvMed providers will be covered under Aetna.
'I haven't found an example where Aetna came back and said: 'It's not covered,'' she said.