Health Plan Weekly

Not long after UnitedHealth Group sparked an insurer-stock selloff by revealing that it is seeing higher-than-usual outpatient care utilization, Humana Inc. disclosed that it, too, is seeing elevated medical costs due to an increased use of services.  

“At this point it appears that there may be a new trend brewing with a rise in utilization and claims, particularly in the Medicare Advantage segment,” A.M. Best Senior Director Sally Rosen remarked in a new video released by the insurance-focused credit rating firm.  

And that’s significant for the managed care industry writ large, Rosen tells AIS Health, a division of MMIT. “Medicare Advantage comprised more than one-third of the industry’s underwriting income in 2022, and while the dollar amount has fluctuated, the percentage of underwriting income coming from Medicare Advantage has made up about one third for each of the past three years,” she says. 

Late last year, nonprofit, government-focused carriers SCAN Health Plan and CareOregon announced plans to merge and form the HealthRight Group. CareOregon manages nearly 550,000 Medicaid enrollees in Oregon, while SCAN covers over 280,000 lives in four states, according to the AIS Directory of Health Plans. 

Eric Hunter is CareOregon’s CEO, while Sachin Jain, M.D. is SCAN’s CEO. If regulators approve the merger, Jain will hold the top spot of the combined organization. Hunter will continue to lead CareOregon, the larger of the two plans — and a Medicaid division that they say will pursue managed care contracts nationally. 

AIS Health, a division of MMIT, caught up with the CEOs on June 15 at the 2023 AHIP Conference in Portland, Oregon, and learned more about the ambitious plans that brought the organizations together. 

North Carolina and Colorado recently became the latest in a string of states that have taken over the reins of Friday Health Plans Management Services Company, Inc.’s subsidiaries in a bid to ensure consumers and providers aren’t harmed by the insurer’s implosion. The company’s downfall has implications for health insurers, too, as they may not receive the risk-adjustment funds they’re expecting if Friday can’t pay its share, an industry expert previously told AIS Health. 

Insurance Commissioner Mike Causey said June 20 that Friday Health Plans of North Carolina Inc. “consented to being placed into receivership to protect North Carolina policyholders due to its reported insolvency and inability to raise additional funds from outside investors.” Technically, the action is not yet completed, as the state said it filed its receivership petition with the Wake County Superior Court and will post the order on the North Carolina Dept. of Insurance's website once it is signed. 

Private equity (PE) ownership of physician practices and other providers has, on a national scale, led to higher prices in health care, experts said during a June 6 panel convened by the National Institute for Health Care Management (NIHCM) Foundation. One expert also added that health insurers are poised to benefit from the PE ownership trend in health care delivery, as insurers frequently snap up providers when PE entities “exit” their takeover of providers. 

In his presentation, Atul Gupta, Ph.D., assistant professor of health care management at the University of Pennsylvania’s Wharton School of Business, made the case that “private equity [ownership of providers] has dramatically increased over the last few years.”