Health Plan Weekly
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Mobile Health Clinics May Reduce Disparities in Care, Help Companies Reach Business Objectives
Mobile health clinics can help health care organizations achieve their business objectives and reduce disparities in care, according to a report released on July 6. The researchers involved in the project tell AIS Health, a division of MMIT, that insurers and other payers can benefit by helping care for people who otherwise would not receive treatments and reduce overall spending by improving people’s health over the short and long term.
The report was sponsored by the Mobile Healthcare Association, a nonprofit trade group, and Mobile Health Map, an initiative led by Harvard Medical School and MHA to provide an online resource to track, research and analyze mobile health clinics. The researchers conducted interviews via telephone or video conferencing with 25 health care leaders, including executives at Harvard Medical School, Cedars-Sinai Medical Center, Kaiser Permanente and Blue Cross Blue Shield of Massachusetts.
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Optum Looks to Create Industry Standard for Genetic Testing Management
Optum says it hopes to create the industry standard for genetic testing benefit management programs — across all business lines and payers nationwide — with a solution that the UnitedHealth Group subsidiary is launching with Avalon Healthcare Solutions using genetic testing codes and other assets licensed from Palmetto GBA.
The solution is part of a comprehensive laboratory benefit management program that the companies unveiled June 22. Although 99% of all lab tests conducted today are routine tests, 10 new genetic tests are coming to the market each day, says John Hoffman, vice president of payer market at Optum. He and colleagues from Optum and Avalon outlined the solution at AHIP 2022 in Las Vegas.
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Pandemic’s Long Tail Will Shape 2023 Premiums
Researchers from the American Academy of Actuaries expect the most notable factors in 2023’s health insurance premium rate-setting will be COVID-19 variants, the expiration of enhanced premium subsidies in the individual marketplace, the resumption of Medicaid eligibility redeterminations, inflation and provider labor shortages — a combination of public health, policy and economic factors that represent the long tail of the COVID-19 pandemic.
The impact of COVID-19 is still difficult to model. New variants to the virus and regional outbreaks mean that plan-level analysis is fraught. But the cost of hospitalization and a consistent standard of care mean that plans have a useful base for modeling.
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ACA Plans Deny 18% of Claims in 2020; Enrollees Rarely Appeal
About 18.3% of in-network claims were denied by non-group qualified health plans (QHPs) offered on HealthCare.gov in 2020, according to a recent Kaiser Family Foundation analysis. Among the 144 issuers in HealthCare.gov states with complete data on claims received and denied, 52 of them had a denial rate between 10% and 19%. In 2020, the majority of denials (72%) were classified as “all other reasons,” while one in five of the roughly 765,000 medical necessity denials involved behavioral health services. In addition, of the more than 42 million denied claims in 2020, marketplace enrollees appealed fewer than 61,000 claims — a 0.1% appeal rate — and insurers upheld 63% of denials that were appealed.
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MCO Stock Performance, June 2022
Here’s how major health insurers’ stock performed in June 2022. UnitedHealth Group had the highest closing stock price among major commercial insurers as of June 30, 2022, at $513.63. Molina Healthcare, Inc. had the highest closing stock price among major Medicaid insurers at $279.61.
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