Health Plan Weekly

With Humana Inc.’s share price slumping in recent months, one Wall Street analyst points out that conditions may be better than ever for a possible takeover of the Medicare Advantage insurer by The Cigna Group. 

“The math now works for a [Cigna] + [Humana] fusion even with [Humana’s] lower EPS [earnings per share],” wrote Jefferies analyst David Windley in an April 22 note to investors. The two managed care giants were rumored to be in talks to combine at the end of 2023, but the Wall Street Journal reported on Dec. 10 that the firms were walking away from the deal. But that was before Humana cut its full-year EPS outlook when reporting its fourth-quarter 2024 results earlier this year, citing a trend of higher-than-expected utilization that has bogged down the MA-focused carrier’s results since the beginning of 2023. 

The ERISA Industry Committee (ERIC), a benefits trade group for large employers, launched an ad campaign attacking the Biden administration’s mental health parity policies — a notable escalation in plan sponsors’ intensifying opposition to the administration’s approach to mental health care access, which could ultimately lead to litigation.  

In a press release, ERIC said it hopes to influence upcoming mental health parity regulation, noting that “departments of President Biden’s administration, including the U.S. Departments of Health and Human Services (HHS), Labor (DOL) and the Treasury are finalizing proposed rule changes regarding mental health and substance use disorder parity.” The expected rule would be a finalized version of a regulation released in September 2023, which calls for much stricter network adequacy standards than were required in previous parity rulemaking. 

Although Humana Inc. beat Wall Street’s expectations with its first-quarter 2024 earnings per share (EPS), the recently finalized 2025 Medicare Advantage and Part D rate notice nonetheless cast a shadow over the insurer’s longer-term financial projections and thus dimmed analysts’ enthusiasm.  

In fact, Humana withdrew its 2025 EPS guidance of $6 to $10, with CEO Bruce Broussard partially blaming the move on the “significant difference between the final rate notice and our previous funding assumption.”   

When CMS on April 1 released its final rate projection for MA and Part D plans, the agency said it anticipates plans will see a net revenue increase of 3.70% next year. But that figure did not improve compared to the projected rate increase — despite the industry’s urging — and it represents a 0.16% payment decrease excluding the assumption that MA risk scores will increase by an average of 3.86%.  

Chorus Community Health Plans (CCHP) saw significant savings after partnering with telenutrition company Foodsmart, according to a study released by the insurer and company on April 25. CCHP president Mark Rakowski tells AIS Health, a division of MMIT, that the results indicate payers can benefit financially by providing members access to dietitians and tips to improve their eating habits. 

The study matched more than 3,000 CCHP members who used Foodsmart with a control group. After one year of enrollment in the program, the Foodsmart cohort achieved an average $33 per member per month (PMPM) in net savings. CCHP, a Wisconsin-based insurer, saw $32 PMPM savings among the 2,986 Medicaid beneficiaries in the study and $45 PMPM among the 176 Affordable Care Act exchange enrollees who used Foodsmart.