Health Plan Weekly

A new study published in the Journal of Clinical Oncology found that cancer afflicting adolescents and young adults cost the health care system $23.5 billion in 2021, and $259,324 for the average patient over a lifetime. The findings come as the American Cancer Society reported that incidence of colorectal cancer is becoming more common among that cohort: 20% of new colorectal cancer diagnoses in 2019 were for patients younger than 55, compared with 11% in 1995, per the Wall Street Journal. Experts say that to help, insurers can educate patients and improve access to screenings and care coordination. 

Fortunately, the overwhelming majority of adolescents and young adults who are diagnosed with cancer have a positive prognosis: in 2019, the 5-year survival rate for people in that cohort was 85% “with prompt diagnosis and timely delivery of appropriate therapy,” per the Journal of Clinical Oncology study. Approximately 90,000 people ages 15-39 in the U.S. are diagnosed with cancer annually — that’s about 5% of all new cancer cases. The increasing incidence of colorectal cancers contrasts with falling adolescent and young adult death rates “each year between 2010 and 2019,” the study said. Experts say systemic issues make detecting and treating cancers in the adolescent and young adult cohort difficult. 

Here’s how major health insurers’ stock performed in February 2023. UnitedHealth Group had the highest closing stock price among major commercial insurers as of February 28, 2023, at $475.94. Humana Inc. had the highest closing stock price among major Medicare insurers at $495.02.

AHIP is leading a new national coalition aimed at supporting a smooth transition for Medicaid beneficiaries during the resumption of eligibility redeterminations starting April 1. The Connecting to Coverage Coalition aims to be “a single source of trusted information” about the Medicaid redetermination process and will “convene stakeholders to support information sharing, build on best practices, and develop solutions to ensure Americans are able to enroll in coverage that is right for themselves and their families.” The coalition rolled out a new website with resources for both consumers and the health care industry, and AHIP released a report that “provides a state-by-state analysis of where people who are no longer eligible for Medicaid are likely to have access to coverage.” Besides AHIP, other members of the coalition include the Association for Community Affiliated Plans, the Blue Cross Blue Shield Association, Medicaid Health Plans of America, the American Benefits Council, the Federation of American Hospitals and the Cystic Fibrosis Foundation, among others. 

Although it’s been more than 10 years since antitrust litigation was first filed against Blue Cross Blue Shield plans, an objection to a settlement reached with one group of plaintiffs has delayed the conclusion of a case that carries significant implications for the health insurance industry. Legal and health policy experts say it could be another year or more before the litigation is finalized — but in the meantime, they suggest that the settlement’s rewriting of Blues plan rules is already sparking consolidation in the market. 

In the circa-2012 litigation, a group of health insurance subscribers (health plans and employers) and a cohort of health care providers allege that certain long-held Blues plan practices violate federal and state antitrust laws. Those practices include allocating geographic markets through license agreements and limiting the percentage of non-Blue revenue each plan can earn, among others. Although the subscriber class and the defendants reached a tentative settlement in 2020, and an Alabama district court judge approved it in 2022, a small group of employers including the Home Depot filed appeals last fall that effectively put the settlement on hold.   

Three publicly traded startup insurers all posted losses for the full year 2022, and one firm — Bright Health Group, Inc. — may be on its last legs. A managed care insider tells AIS Health, a division of MMIT, that while Oscar Health, Inc. may have righted the ship and Clover Health Investments Corp. didn't perform as poorly as expected, Bright is in bad shape.  

Bright took in revenue of $551.4 million and posted a net loss of $188.2 million, or negative earnings before interest, taxes, depreciation and amortization (EBITDA) of $108.5 million over 2022, with a medical loss ratio (MLR) of 93.9%. Oscar took in revenue of $3.96 billion against operating expenses of $4.55 billion, posting a net loss of more than $609 million during 2022, with an 85.3% MLR. Clover took in $3.4 billion and reported $298.7 million in negative EBITDA during 2022, with MLR at 91.8%.