Health Plan Weekly

  • Poor Mental Health Care Access Increases Systemic Costs

    Health insurers have long struggled to administer behavioral health benefits, which won’t get easier any time soon: Demand for mental health services is high due to the opioid crisis and the mental health strains of the COVID-19 pandemic. Experts from clinical, financial and policy backgrounds say that coordinating behavioral health care with traditional medical benefits — and bringing behavioral health care providers into insurer networks — are both essential to managing costs and ensuring access to care.

    Despite decades of policymaking that has attempted to streamline access to mental health care benefits, most notably through mental health parity, mental health care remains expensive and hard to access. (Several federal laws mandate mental health care parity: Health plans are not allowed to impose benefit limitations on mental health care that are more severe than limits placed on medical and surgical benefits.) What’s more, mental health care providers are usually siloed from other clinicians on a patient’s care team, which tends to exacerbate medical conditions and increase costs.

  • Centene CEO London Addresses Issues With Medi-Cal Rx Launch

    Sarah London, Centene Corp.’s new CEO, acknowledged during the insurer’s April 26 first-quarter earnings call that “there were challenges out of the gate” when the company’s Magellan Health unit took over California’s Medi-Cal Rx program in January. But, she added, “I think the team recovered incredibly well.”

    London’s comments came after the California Department of Health Care Services (DHCS) said it is investigating Centene’s PBM practices following a California Healthline article earlier this month that detailed numerous issues with the launch. A DHCS spokesperson confirmed the investigation via email to AIS Health, a division of MMIT, but would not elaborate on details.

  • Favorable Pharmacy Results Power Humana’s Solid Earnings

    Humana Inc.’s financial performance in the first quarter of this year received mostly positive reviews from Wall Street. Revenue growth from the health insurer’s mail-order pharmacy business alongside modest care utilization allowed the firm’s executives to raise their end-of-year earnings guidance.

    The firm took in $23.9 billion in total revenue in the quarter, an increase from $20.6 billion in the first quarter last year. Humana’s pretax income for the quarter was $1.2 billion, up from about $1 billion in the first quarter of 2021. The firm’s adjusted earnings per share also increased year-over-year, going up to $8.04 from $7.67.

  • Key Financial Data for Leading Health Plans — Fourth Quarter 2021

    Here’s how major U.S. health insurers performed financially in the fourth quarter of 2021. Health Plan Weekly subscribers can access more health plan financial data — including year-over-year comparisons of leading health plans’ net income, premium revenue, medical loss ratios and net margins. 
  • News Briefs: CMS Finalizes Rule Mandating Standard ACA Exchange Plans

    CMS on April 28 finalized the 2023 Notice of Benefit and Payment Parameters for Affordable Care Act exchange plans, cementing its proposal to require insurers to offer standardized plans on HealthCare.gov. In a provision opposed by the insurance industry at large, the Biden administration will require issuers offering Qualified Health Plans (QHPs) on the federal exchange to offer standardized plan options at every network type, at every metal level and throughout every service area where non-standardized options are offered, starting in 2023. Those plans also will be differentially displayed on HealthCare.gov “to help consumers make more informed choices about their coverage.” Another major provision included in the annual omnibus rule governing the ACA exchanges is the addition of new network adequacy standards that require QHPs to “ensure that certain classes of providers are available within required time and distance parameters.”
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