Health Plan Weekly

Struggling health insurer Bright Health Group Inc. raised eyebrows with its recent announcement that CEO George Mikan III and other top executives earned more than $3.7 million in performance bonuses — despite posting a net loss of more than $600 million last year. The troubled startup insurer is under supervision by at least two state regulators, and one persistent critic of the firm’s executives tells AIS Health, a division of MMIT, that the bonuses are “outrageous.” 

Bright’s 2022 Form 10-K, an annual filing all publicly traded companies are required to submit to the Securities and Exchange Commission (SEC), revealed that Mikan received $1.69 million, with other notable officers of the company receiving between $190,115 and $765,000 in bonuses. Each of the executives who were awarded a bonus received the full amount they could have received based on performance incentives. Bright added in the filing that Mikan’s total compensation was $9,993,169, while the median compensation for a Bright employee was $71,500, meaning Mikan earned 140 times the average Bright employee. 

Point32Health, the nonprofit health care company that was formed two years ago through the merger of Harvard Pilgrim Health Care and Tufts Health Plan, earlier this year launched a partnership with Included Health to better serve LBGTQ+ health plan members and their families.  

Starting on Jan. 1, Tufts Health Plan’s fully insured commercial beneficiaries began gaining free access to Included Health’s LBGTQ+ Health product through which they can connect with care coordinators who can answer questions and refer them to services such as in-network gender-affirming care providers. Harvard Pilgrim’s fully insured commercial members will gain access to the product later this year.  

In the space of less than a month, a health care technology company called Aledade has announced new alliances with two health insurers and expanded an existing partnership with another. Those insurers — CareFirst BlueCross BlueShield, Humana Inc. and Cigna Healthcare — say their goal in working with the company is two-fold: (1) to help physician practices remain independent rather than opting for corporate ownership, and (2) to hasten the move from fee-for-service to value-based payment models.

Aledade says it has a “proven, scalable model” aimed at bolstering independent primary care practices. That model includes data analytics, guided workflows, health care policy expertise and “integrated care solutions.” The company says it currently participates in risk-based arrangements with more than 1,500 practices in 45 states and the District of Columbia. Aledade’s CEO, Farzad Mostashari, M.D., is the former national coordinator for health information technology at HHS during the Obama administration.

Outpatient visits to a physician’s office, urgent care center or emergency department were coded at higher levels from 2004 to 2021, leading to substantial increases in health care spending, according to Peterson-Kaiser Family Foundation Health System Tracker.

Providers and facilities bill outpatient evaluation and management claims based on visit complexity at five levels. Level 1 visits have the lowest complexity cases, with less time required or straightforward medical decision-making, while level 5 visits are the highest complexity cases, with more time required or very complex medical decision-making. Payers generally pay larger reimbursements, and patients with deductibles may pay more out-of-pocket, for visits with higher complexity.

Nearly 16.4 million people selected or were automatically reenrolled in coverage during the 2023 open enrollment period for Affordable Care Act marketplace plans, the Biden administration said on March 23. That represents a 13% increase compared to the 2022 open enrollment period and a 36% increase over enrollments during the signup window for 2021 coverage. Enrollment has also doubled compared to when the exchanges debuted in 2014, when there were about 8 million signups, CMS said. The administration revealed the final signup numbers on the 13th anniversary of the ACA, using the opportunity to tout the law’s positive effect on insurance coverage through both the exchanges and Medicaid expansion.