Health Plan Weekly

Reforms to telehealth and insulin pricing are stalled in Congress despite notable progress on health care policies like enhanced marketplace subsidies in recent days. D.C. insiders tell AIS Health, a division of MMIT, that comprehensive fixes to either issue are unlikely to make their way into the landmark Inflation Reduction Act of 2022 (IRA), which seems poised to pass the Senate.

Telehealth reforms have passed the House of Representatives, but insiders tell AIS Health that they are unlikely to pass the Senate. They are also not expected to be included as part of a final version of the IRA, which should emerge in the coming days. Some insulin reforms may be included in the IRA, but D.C. experts expect that reforms affecting the commercial market are unlikely to pass as part of the bill. Instead, the insulin price changes are likely to be restricted to Medicare.

In a finding that could serve as a wakeup call for health insurers and their employer clients, a new study has found that significant health disparities exist among workers based on their race, ethnicity, income levels and sexuality.

Caroline Pearson, senior vice president of health care strategy at NORC at the University of Chicago, says the results show companies must do much more than simply offer coverage to their employers and need to focus on other issues impacting their health outcomes. NORC, a nonpartisan research organization, conducted the study of employer-sponsored insurance (ESI), which was sponsored by Morgan Health, the health care arm of JPMorgan Chase & Co.

Cigna Corp.’s ability to rein in medical costs during the second quarter of 2022 impressed equities analysts and led the health insurer on Aug. 4 to surpass the Wall Street consensus earnings per share (EPS) estimate while raising its full-year EPS outlook.

Cigna posted “the largest MLR beat among MCOs this quarter,” with its medical loss ratio of 80.7% coming in 220 basis points below the consensus estimate, Evercore ISI analyst Michael Newshel pointed out in a note to investors. That comes after a 110 basis-point beat in the first quarter of 2022, he added.

And SVB Securities analyst Whit Mayo observed that “medical costs were well-controlled during the quarter,” with Cigna’s MLR “driving the bulk of the [company’s] outperformance.”

Although many people still associate CVS Health Corp. with its ubiquitous retail pharmacy locations, executives during the company’s second-quarter 2022 earnings call highlighted the Health Care Benefits segment — which houses legacy health insurer Aetna — as one of the firm’s strongest business assets. Meanwhile, the Rhode Island-based company said it’s planning to acquire more care-delivery assets by the end of the year.

During an Aug. 3 conference call to discuss quarterly financial results, CEO Karen Lynch touted the Health Care Benefits segment’s “strong quarter,” noting that the business line saw revenue growth of nearly 11% compared to the prior-year period. The firm’s medical loss ratio (MLR) of 82.9% also improved by 120 basis points year over year, “reflecting medical cost trends that remain modestly favorable to our pricing assumptions,” according to Chief Financial Officer Shawn Guertin.

Molina Healthcare, Inc. posted solid results in the second quarter of 2022, earning favorable reviews from Wall Street despite posting a high medical loss ratio (MLR). Executives from the Medicaid- and marketplace-focused carrier touted a recent streak of acquisitions — and teased more transactions and new contract awards.

Total revenues for the second quarter of 2022 amounted to $8.05 billion, up from $6.8 billion in the second quarter of 2021. Profits also increased, with Molina posting $266 million in net income for the quarter with an after-tax margin of 3.3%, up from $199 million and a 2.9% margin in the second quarter of 2021. According to Barclays analyst Steve Valiquette, those results beat Wall Street’s projected margin of 1.2%. Earnings per share (EPS) were $4.55, up from $3.40 in the second quarter of 2021.