Health Plan Weekly

Customer satisfaction with commercial health plans declined year over year, according to J.D. Power’s 2023 Commercial Member Health Plan study. The data analytics firm noted that overall satisfaction decreased by 13 points (on a 1,000-point scale), while there were declines in satisfaction with customer service by 33 points, coverage and benefits by 20 points, provider choice by 16 points, and information and communication by 16 points.

During the previous five years, overall satisfaction increased by 17 points, although there was no change from 2021 to 2022.

Christopher Lis, Ph.D., who is J.D. Power’s managing director of global health care intelligence, tells AIS Health, a division of MMIT, that plans can improve their members’ satisfaction in a few ways. He notes that plans can become “an active health partner” and provide timely and transparent information to beneficiaries and provide individualized support and service.

Venture-backed Friday Health Plans will cease operating after several state regulators placed it into receivership due to its rocky finances. The Colorado-based insurer operated in seven states — Colorado, Georgia, Nevada, New Mexico, North Carolina, Oklahoma and Texas — and as of December 2022 covered almost 400,000 enrollees, according to AIS’s Directory of Health Plans.

The insurtech, founded in 2015 with a focus on the Affordable Care Act exchanges, raised over $306 million in venture capital and debt funding. Yet in late 2022, it announced it would scale back from operating in seven states to five states, pulling out of Texas and New Mexico. In March 2023, it was placed into receivership in Texas and soon other states took similar actions.

UnitedHealth Group’s Optum division on June 5 made an unsolicited, $3.3 billion all-cash offer to acquire home health care and hospice provider Amedisys, Inc. The offer, in which UnitedHealth would spend $100 per share, would trump a May merger agreement between Amedisys and fellow home health provider Option Care Health Inc., which valued Amedisys stock at $97.38 per share. The Option Care offer involved debt and stock, rather than cash. The UnitedHealth deal is just the latest home health care transaction from the integrated insurance and care delivery giant: Optum closed its $5.4 billion acquisition of home care provider LHC Group in February this year.

Humana Inc. opened its 250^th senior primary care center on June 6, following several years of its own provider-acquisition spending spree. Humana plans to open “30-50 new centers per year through 2025,” per a press release, and operates primary care centers in Arizona, Florida, Georgia, Kansas, Kentucky, Louisiana, Missouri, Nevada, North Carolina, South Carolina, Tennessee and Texas. Humana closed a deal to fold the former Kindred at Home into its CenterWell provider brand in 2021.

For years, payers and plan sponsors have pushed to broaden so-called site neutral policies, which generally aim to prevent hospital outpatient departments from commanding greater reimbursement for the same services as those provided in doctor’s offices. In the latest salvo, the sponsors of newly proposed legislation are aiming for a seemingly easier-to-achieve goal: billing transparency. 

That legislation, sponsored by Reps. Kevin Hern (R-Okla.) and Annie Kuster (D-N.H.), is called the Facilitating Accountability in Reimbursements (FAIR) Act. The legislation would require all off-campus hospital outpatient departments to have separate national provider identification (NPI) numbers by Jan. 1, 2025. It would also direct CMS to prioritize auditing provider facilities that were recently purchased by large health systems “to ensure they are meeting the remote location of a hospital facility requirements,” according to Hern’s office.