Health Plan Weekly

In recent weeks, Anthem Blue Cross Blue Shield has faced intense backlash over a policy change that would have allowed some plans to reject claims for anesthesia services that go beyond a set time limit. Although Anthem ultimately backed off the policy, the outrage that fueled the reversal may be tied to the anti-insurer sentiment that bubbled up after the killing of UnitedHealthcare CEO Brian Thompson. 

In fact, Anthem posted a bulletin retracting its new policy Dec. 5, one day after Thompson was killed in what authorities said was a targeted shooting outside a New York City hotel.  

The fierce fallout from the shooting death of UnitedHealthcare CEO Brian Thompson continues unabated as suspect Luigi Mangione gains folk hero status and the insurer tries to clear up what it calls “grossly misleading information.” 

Twenty-six-year-old Mangione was indicted Dec. 17 on charges of murder as an act of terrorism. Mangione is accused of waiting outside a Midtown Manhattan hotel and shooting Thompson as he arrived for UnitedHealth Group’s annual Investor Day conference. The crime was largely met with an outpouring of anger toward UnitedHealthcare and the insurance industry and support for Mangione. GoFundMe quickly shut down fundraisers for Mangione, while GiveSendGo has featured such a fundraiser on its front page. Photos have circulated of tattoos of bullets reading “Defend, Deny, Depose,” which reportedly was written on shell casings found at the scene, while many other people have created merchandise ranging from shirts to stickers.  

The Purchaser Business Group on Health (PBGH) has launched a value-based care initiative, starting in the Puget Sound region of Washington state, in which employer-sponsored plans directly contract with primary care provider groups. Elizabeth Mitchell, PBGH’s president and CEO, says the organization plans to roll out the advanced primary care-driven network model in other markets next year and beyond.  

The Boeing Co., eBay Inc. and other PBGH members in the Puget Sound region are participating in the program. Those companies all have self-insured plans and have removed all cost-sharing for their members who visit three primary care provider groups in the area. The companies chose those practices based on meeting certain quality and patient care standards, according to Mitchell, who adds that more providers could join in the future. 

In 2023, U.S. health care spending increased 7.5% to $4.9 trillion, up from 4.6% growth in 2022, according to new research from CMS published on Dec. 18 in Health Affairs. This translates to $14,570 per person and a 17.6% share of the gross domestic product (GDP), the researchers said. Several factors contributed to this growth, including the use of higher intensity services and increased Affordable Care Act marketplace and Medicaid enrollment. 

Perhaps the biggest increase in spending came from hospital services, which grew a whopping 10.4% in 2023 vs. 3.2% in 2022. This explosion of growth came not from inflation and higher health care prices, but greater demand for higher-intensity services, an increase in outpatient Medicare services, and post-pandemic rebounds after utilization dipped in 2020. In fact, price growth was stable from 2022 to 2023 at 2.8% and 2.7%, respectively. While inflation does influence prices — which increased 2.6% from 2020 to 2023 vs. 1.4% from 2016 to 2019 — price growth in the medical sector lags the general economy, said Anne Martin, lead study author from the CMS Office of the Actuary.