Health Plan Weekly

Of all the changes that the COVID-19 pandemic has made to the health care system, one of the most lasting might be the manner in which it has forced organizations of all types to rethink how they engage with consumers.

At Anthem, Inc., for example, the pandemic helped accelerate executives’ efforts to streamline how individuals interact with the health care system, Anthem Chief Clinical Officer Anthony Nguyen, M.D., said during a June 9 panel discussion, titled “What Consumer Engagement Means Today,” during the World Health Care Congress Virtual conference. AIS Health moderated the session.

Health plans enjoyed record results in 2020, according to a June 11 report from A.M. Best. The report concludes that the high earnings were driven by the pandemic-driven drop in health care utilization and bolstered by the industry’s “highest level of net premiums written (NPW), with all lines of business reporting premium growth, including commercial business.”

In 2020, carriers took in $41.6 billion in underwriting gains — 77% more than they did in 2019, when they took in $23.5 billion, per the report. The gains in 2020 were found mainly in the second quarter, when utilization plummeted as the result of stay-at-home orders, care deferrals and a sector-wide move to virtual care — a story borne out in other retrospectives of the 2020 claims environment.

In the latest in a series of purchases in home care, Humana Inc. said on June 14 it will acquire Onehome from private equity firm WayPoint Capital Partners. Experts say the Medicare Advantage-focused carrier is leveraging its substantial cash reserves to differentiate itself in the burgeoning MA market and create synergies and efficiencies in remote care settings. Terms of the deal were not disclosed.

The move is driven partly by the changes to care delivery caused by the pandemic, experts say, but also aligns with a long-running Humana strategy. The pandemic has accelerated the adoption of home care, remote monitoring and virtual care. Regulatory changes, spurred by the need to deliver care away from traditional clinical settings during the worst spikes of COVID-19 infection, have made those systems more viable than they were before, despite the long-held ambitions of payers.

In a move applauded by health insurers that increasingly view the Affordable Care Act exchanges as an attractive market, the Supreme Court on June 17 ruled 7-2 to uphold the ACA in the latest in a string of high-profile legal challenges.

The case, California v. Texas, hinged on whether the ACA’s individual mandate was still constitutional after Congress in 2017 changed the tax penalty to $0 for those refusing to purchase health insurance. And if the mandate is unconstitutional, a coalition of red states argued, the rest of the law is as well because the ACA’s architects intended for that provision to be “inseverable” from the rest of the statute.

✦ HHS Secretary Xavier Becerra on June 9 sent a letter to health insurers and providers warning them that COVID-19 vaccines and tests must be provided free of charge to patients. “In light of recent reports of consumer cost concerns,” he wrote — citing a recent New York Times article that indicated concern over unexpected medical bills was a reason cited by people who indicated they are hesitant to get the coronavirus vaccine — “I am reminding health care providers of their signed agreements to cover the administration of COVID-19 vaccines free-of-charge to patients, and group health plans and health insurers of their legal requirement to provide coverage of COVID-19 vaccinations and diagnostic testing without patients shouldering any cost.” Health plans that fail to comply with those legal requirements may be reported to appropriate state insurance departments or CMS “for possible enforcement action,” Becerra said.

✦ Clover Health Investments, Corp. on June 9 unveiled plans to expand its in-home primary care program, Clover Home Care, through CMS’s Direct Contracting model. The Medicare Advantage-focused startup insurer has bet big on that new model, which aims to lower costs and improve care quality for fee-for-service Medicare beneficiaries, but it also revealed during its first-quarter 2021 earnings report that it will likely have far fewer people covered by that program than it originally anticipated. In its most recent announcement, Clover said that “the goal of Direct Contracting is to make the Medicare program more financially sustainable for taxpayers while improving health outcomes for beneficiaries, which aligns with the work of Clover Home Care.” The company said its first two partners in the new effort, Spiras Health and Upward Health, “were chosen because of their record of exceptional care delivery in the home via a multidisciplinary model, which is core to Clover’s strategy for complex care management.”