Health Plan Weekly

Centene Corp. will expand its ACA marketplace footprint by more than 60 counties across 12 states where it already has a presence in 2023, as well as enter Alabama for the first time, the company said on Oct. 17. The firm also changed the name of its ACA exchange branded plans from Ambetter to Ambetter Health, “reflecting its commitment to putting better health at the forefront of its mission.” In addition, Centene will offer a product in nine new states called Ambetter Health Virtual Access, which “supports affordable and convenient access to licensed virtual primary care providers as well as access to specialists, mental health providers, and other support services.” 

Bright Health Group, Inc. — the startup health insurer that recently revealed it was pulling out of the Affordable Care Act exchanges and all but two Medicare Advantage markets — closed a $175 million investment round on Oct. 17, according to a Securities and Exchange Commission filing. In the transaction, the firm sold 175,000 shares of Series B Convertible Perpetual Preferred Stock. Bright’s recently announced market exits, meanwhile, are “expected to release excess regulated capital of approximately $250 million upon settlement of all medical liabilities and approval from state regulators,” the company has said. 

Elevance Health, Inc. last month invested $35 million in GoHealth, an e-broker for Medicare Advantage plans that has struggled this year and seen its stock market value plummet. Michael Abrams, managing partner of Numerof & Associates, tells AIS Health that the investment was “equivalent to a life-saver” for GoHealth. 

GoHealth received a total of $50 million, with the other $15 million coming from a company referred to as GH 22 Holdings, Inc. in an SEC filing. A GoHealth spokesperson writes in an email to AIS Health, a division of MMIT, that GH 22 is “a significant partner” of GoHealth.  

As the U.S. population ages and as payers and providers increasingly embrace home-based care — especially in light of the COVID-19 pandemic — a program that one expert calls the “best-kept secret in health care” seems poised to finally have its moment in the sun. However, there are a variety of barriers that need to be tackled in order for Programs of All-Inclusive Care for the Elderly to significantly grow, and recent compliance issues at the largest PACE participant raise questions about the involvement of private equity-owned, for-profit companies. 

The PACE model employs comprehensive medical care and social supports to help frail, elderly Americans remain at home when they otherwise would require a nursing home level of care. Eligible enrollees — who never have to pay cost sharing — receive health care services at an adult day center, which is staffed with interdisciplinary care teams and also offers classes, games and other wraparound services.  

Medical costs are going up and employer plan sponsors are feeling the pressure, according to several recent surveys of health benefit purchasers. Large-group purchasers are pursuing a variety of strategies, including direct contracting and new coverage models, to offset rising medical costs and the anticipated impact of inflation on medical trend, while small-group participation seems to have grown in recent years and could see even more adoption through new coverage models. 

Most surveys of plan sponsors found that purchasers, particularly large purchasers, expect medical trend around 6% next year: 

Bright Health Group, Inc., a startup health insurer that has struggled to reach profitability, said on Oct. 11 that it will fully exit the Affordable Care Act exchanges next year and only sell Medicare Advantage products in Florida and California.  

“I believe this is regulator driven,” says Ari Gottlieb, principal of the consulting firm A2 Strategy Group, who has been following the performance of newly public startup insurers such as Bright Health, Oscar Health, Inc. and Clover Health Investments Corp. Gottlieb points to the fact that 2023 rates have already been finalized for exchange plans, and Bright Health went back and forth with insurance regulators over rates in states like Florida — suggesting that, until recently, it planned to be in the individual/family plan market next year.