Health Plan Weekly

SCAN Group, parent company of SCAN Health Plan, said last week that it plans to combine with CareOregon to become HealthRight Group. But the deal has yet to be approved by regulators — and because of Oregon’s strict antitrust laws and proactive regulators, the successful execution of the deal isn’t a given, experts tell AIS Health. 

If the deal goes forward, the two nonprofit health plans will become one organization with revenues of $6.8 billion. SCAN operates Medicare Advantage plans in California, Arizona and Nevada, with MA operations launching in Texas starting in 2023. CareOregon serves about 500,000 members of Medicaid and CHIP plans, alongside some dual-eligible members. Together, they expect to serve nearly 800,000 health plan members. 

An estimated 16 million working-age U.S. residents are afflicted with “long COVID,” but the risk factors and mechanisms of the condition — let alone how to treat it — are poorly understood, which means caring for patients with the disease is a daunting challenge for health plans. According to one health insurance leader, identifying members struggling with long COVID and proactively coordinating their care are crucial to contain costs and help members manage the disease. 

Long COVID is a loose term for a condition with a variety of symptoms that persist after acute COVID-19 infection has passed. According to the National Institutes of Health (NIH), clinicians refer to the term as Post-acute Sequelae of SARS-CoV-2 Infection (PASC). Typical symptoms include fatigue, post-exertional malaise, shortness of breath, coughing, chest pain, heart palpitations, gastrointestinal issues, and joint and muscle pain, according to the Centers for Disease Control and Prevention. Medical researchers have yet to arrive at a consensus on the risk factors behind long COVID and have yet to develop a standard of care. For the most part, practitioners are just trying to manage symptoms as they come. 

Here’s how major U.S. health insurers performed financially in the third quarter of 2022. 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. Just email support@aishealth.com to request spreadsheets for current and past quarters.

Centene Corp. on Dec. 14 made several C-suite changes in order to “position the company for its next stage of growth.” Ken Fasola, who is currently the firm’s executive vice president of Health Care Enterprises, will be Centene’s new president, while current Executive Vice President and Chief Transformation Officer Jim Murray will become EVP, chief operating officer and report to Fasola. In addition, Dave Thomas will transition from EVP of Markets to CEO of Markets and Medicaid, and President and Chief Operating Officer Brent Layton will become senior adviser to CEO Sarah London “as he begins his transition towards retirement,” the company said. 

Separately, Centene on its investor day projected total revenues in the range of $137.4 billion to $139.4 billion and adjusted diluted earnings per share (EPS) in the range of $6.25 to $6.40 in 2023. The firm also said it expects a health benefits ratio (also known as medical loss ratio) of 87.2% to 87.8% next year. “CNC’s ’23 outlook included EPS as expected, though revenue was light,” Jefferies analyst David Windley advised investors in a Dec. 18 research note. He added that Centene’s long-term targets for revenue growth by segment and consolidated EPS growth “are favorable to recent performance, and squarely within a common range across MCOs.” 

While Americans are shopping for 2023 Affordable Care Act marketplace plans, CMS is already looking ahead to the next plan year, as the agency on Dec. 12 issued its annual omnibus proposed rule governing marketplace plans for 2024.  

Experts say the policy shifts likely to draw the most industry attention are the newly proposed limits on non-standardized exchange plans, which build on regulations that have already drawn the ire of health insurers. However, CMS seems to give a nod to potential pushback by offering up an alternative means of limiting the dizzying array of plan options consumers now face.