Health Plan Weekly

Several months after UnitedHealthcare first revealed that it would eliminate “nearly 20%” of current prior authorizations, the health insurance giant has outlined which specific procedure codes will be subject to the PA-elimination effort.  

In an Aug. 1 bulletin to health care providers, UnitedHealthcare said it will remove PA requirements from five of its benefit plans in a two-phased approach. On both Sept. 1 and Nov. 1, the insurer will eliminate PA for select sets of procedure codes in its Medicare Advantage, commercial, Oxford and individual exchange plans. The company will eliminate a swath of PA codes in its UnitedHealthcare Community Plan (for Medicaid enrollees) on Nov. 1. 

At first blush, The Cigna Group’s second-quarter financial results largely impressed equities analysts, with a higher-than-expected risk adjustment payable representing one of the few headwinds reported by the company.  

“Overall, 2Q results look solid and generally in line with expectations versus a backdrop of elevated concern around trend,” Leerink Partners’ Whit Mayo advised investors in an Aug. 3 research note. The latest round of managed care earnings reports has been closely watched by investors amid disclosures from industry bellwether UnitedHealth Group that the firm is seeing elevated medical utilization. 

Cigna reported adjusted earnings per share (EPS) of $6.13 for the quarter, beating the Wall Street consensus estimate of $6.04. The diversified health care company — which owns insurer Cigna Healthcare and PBM Express Scripts, among other assets — raised its full-year 2023 revenue projection by $2 billion to $190 billion, and it reaffirmed its adjusted EPS guidance of at least $24.70. 

Although the topic of Medicaid eligibility redeterminations loomed large over the second-quarter earnings calls held by Centene Corp. and Molina Healthcare, Inc., the companies’ Affordable Care Act marketplace business lines offered a positive — albeit partial — counterweight to concerns about member attrition. 

Centene “delivered another strong quarter of marketplace growth,” with membership growing 62% year over year and “running ahead of our and management’s expectations,” Truist Securities analyst David MacDonald advised investors.  

More than 710,000 people lost their Medicaid or Children’s Health Insurance Program (CHIP) coverage in April, and about 55,000 of those individuals have transitioned to Affordable Care Act marketplace coverage, according to CMS’s first data release on the restarted Medicaid eligibility redeterminations process. Starting April 1, states were permitted to start disenrolling people from Medicaid who no longer qualify after a multiyear pause during the COVID-19 public health emergency.

Of the 2.2 million enrollees due for renewal in April across 18 states, 45.5% had their coverage renewed, with more than 55% receiving automatic renewals. About one-third of the group lost their coverage, and 79% of those coverage losses were due to procedural reasons — meaning individuals didn’t return their renewal form within a specific time frame or the state was unable to reach them.

In March, the national uninsured rate hit an all-time low of 7.7%, according to new data from the Centers for Disease Control and Prevention. Citi analyst Jason Cassorla wrote in an Aug. 3 investor note that the low rate “is not surprising” since Medicaid continuous enrollment provisions enacted during the pandemic were still in effect at that time – as were enhanced Affordable Care Act marketplace subsidies and the “generally stable to improving employment rate.” However, now that states have been permitted to restart Medicaid eligibility checks, the uninsured rate is almost certain to go back up, he pointed out.  

Amazon.com., Inc. is expanding its virtual care offering, Amazon Clinic, to all 50 states and the District of Columbia. “In addition to message-based consultations in 34 states, Amazon Clinic now supports video visits nationwide,” the retail giant said in an Aug. 1 press release. Amazon first rolled out Amazon Clinic last November, but it was not available in all states at that time. Customers using the Amazon Clinic can access services via the Amazon website or mobile app, where they can “compare response times and prices from multiple telehealth provider groups, complete an intake form, and connect with their chosen provider,” the release stated. Patients do not need insurance to access the Amazon Clinic’s services and it doesn’t accept insurance; but the release noted that “medication prescribed by clinicians may be covered by insurance.”