Health Plan Weekly

While some state officials have had more success than others, most states struggle to enforce mental health parity requirements set by federal law, according to a new report from the Georgetown University Center for Health Insurance Reforms (CHIR) and the Robert Wood Johnson Foundation (RWJF). One of the report’s authors and a mental health patient advocate both say that states need more resources to enforce parity requirements. 

State officials have the responsibility of enforcing federal statutes such as the Mental Health Parity and Addiction Equity Act (MHPAEA) in the individual and fully funded employer health plan markets. Many states also have their own parity statutes as well. However, as the report puts it, “federal and state regulators have found that enforcing the complex law is challenging. While insurers’ quantitative barriers to treatment such as cost-sharing or visit limits can be relatively straightforward for regulators to assess, certain ‘non-quantitative’ treatment limits [NQTLs], such as the use of prior authorization, provider reimbursement, and formulary design are much more difficult.” 

As health insurers endeavor to improve care and lower costs for members with chronic conditions, they’re increasingly turning to companies that offer high-tech data analytic capabilities for help. Michigan-based nonprofit insurer Priority Health is one of those insurers, as it recently unveiled a partnership with the medical technology firm pulseData to “identify, notify and engage members with care management options” related to chronic kidney disease (CKD), which currently costs Priority Health roughly $225 million annually to treat. 

CKD affects an estimated 37 million Americans — or 1 in 7 U.S. adults — but as many as 90% of people who have the disease don’t know it, Priority Health noted in a Sept. 27 press release. Because early-stage CKD typically has no symptoms, many diagnoses are missed until cases become more advanced.  

Elevance Health, Inc. (formerly Anthem) released its third-quarter financial results on Oct. 18, beating Wall Street consensus earnings projections and receiving praise from financial analysts. The insurer — which claims it passed UnitedHealth Group in total enrollment this year — said growing membership, the performance of the commercial insurance and health care services divisions, and lower-than-expected utilization all contributed to the strong results. 

The managed care giant reported $7.53 in adjusted earnings per share (EPS), beating the Wall Street consensus projection of $7.15. Membership grew by 232,000 to 47.3 million total members during the quarter, raising the year’s cumulative enrollment growth to 2.2 million. Executives project a fourth-quarter dividend of $1.28 per share, with end of year EPS “greater than $28.95 per share,” according to a press release.  

During UnitedHealth Group’s recent conference call to discuss third-quarter 2022 financial results, executives discussed a variety of topics in addition to the company’s earnings — including broad-based trends like inflation and the looming return of Medicaid redeterminations, as well as UnitedHealth’s strategies for integrating a recent acquisition and furthering risk-based payment models. 

Overall, equities analysts seemed satisfied with both UnitedHealth’s quarterly performance and its plans to overcome potential headwinds going forward.