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Miami Herald
6 days ago
- Business
- Miami Herald
Aetna, AvMed fought to run Miami-Dade County employee health care plan. Who won?
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.
Miami Herald
12-08-2025
- Health
- Miami Herald
As Miami-Dade faces budget crunch, fight over healthcare heads for a showdown
Managing healthcare bills for Miami-Dade's roughly 31,000 county employees is big business, and that's prompting a big fight at the County Commission. At issue is a proposal by Mayor Daniella Levine Cava to drop the county's longtime healthcare provider, AvMed, for a national competitor, Aetna — something the mayor claims would save the county about $40 million as it faces a major budget crunch. The fight to win the county's healthcare contract has gotten messy enough that commissioners are holding a special meeting Wednesday dedicated solely to picking a winner. AvMed, based in Doral, argues Levine Cava is rushing the effort ahead of a fall open-enrollment period that's bound to be chaotic if a new provider takes over. AvMed also points to high customer-service rankings as a selling point — particularly with management based in the Miami area. But Levine Cava points to a pair of consultant studies showing that Aetna's national purchasing power would bring Miami-Dade cheaper healthcare costs in a year of budget strains. AvMed, based in Doral, and Aetna, a Connecticut-based subsidiary of the CVS drugstore chain, each want to manage the crucial billing process — including reimbursement rates for healthcare providers. Unions representing county employees are divided. The police union backs keeping AvMed, while the transit union wants to switch to Aetna. In a recent Miami Herald op-ed, Levine Cava said Aetna will bring both savings and expanded options for county employees. 'Partnering with Aetna means not only financial savings for the county but better healthcare access and quality for our workforce,' she wrote. AvMed, which has contracts across Florida, rejects the notion that Aetna will be cheaper for Miami-Dade and points to a recent J.D. Power ranking giving it the top scores for customer service in Florida. AvMed first won the county contract in 2016 and is encouraging Miami-Dade to stick with a healthcare company that has proven itself. 'By continuing its partnership with AvMed, Miami-Dade County can ensure uninterrupted access to the #1 ranked health plan in Florida,' the company said in a statement, referencing the J.D. Power ranking. If the county switches providers, Aetna would earn administrative fees from Miami-Dade worth about $15 million a year. AvMed's fees are lower, at $10 million. But the fight comes over the much larger county expense involved in the agreement: what Miami-Dade pays providers for medical care and supplies, including prescriptions. Like most large governments, Miami-Dade uses its own cash to pay medical expenses, rather than relying on an insurance company to reimburse providers. Under the 'self-insured' model, Miami-Dade can save money if reimbursement rates drop for doctors, pharmacies and other providers used by county employees. Miami-Dade's medical expenses currently hover around $600 million a year, according to county estimates. The county's insurance company negotiates the rates behind those expenses, and Aetna claims it can lower Miami-Dade's healthcare costs over the life of the seven-year contract. Two healthcare consultants hired by Miami-Dade back up that contention, estimating yearly savings of around $40 million when calculating how much the county would pay under each competitor's reimbursement rates. Commissioners have devoted a rare special meeting to deciding the contract award, placing board members in the position of refereeing between competing claims in the complicated realm of healthcare finances and reimbursement rates. 'I'm not for Aetna. I'm not for AvMed,' Commissioner Roberto Gonzalez said during a July 16 discussion of the healthcare contract. 'I'm for whatever is best for the employees of Miami-Dade County.'
