Health Plan Weekly

Health insurers have begun to phase out the COVID-19 treatment cost-sharing waivers that they have had in place for most of the pandemic. As vaccines have become broadly available in the U.S., insurers are starting to see the novel coronavirus as a “normal” disease — and plan sponsors like Delta Air Lines Inc. are beginning to see health benefits as another means to steer employees toward vaccination.

During most of 2020 and the first half of this year, most carriers took on the full cost of COVID-19 treatment for their fully insured members, waiving copays and other cost sharing. Many self-funded employer plan sponsors did the same. However, both types of health plans have begun to make COVID-19 care a normal health benefit with standard hospitalization and outpatient cost sharing applied.

✦ UnitedHealth Group will acquire fellow Minnesota-based health plan PreferredOne from University of Minnesota-affiliated provider Fairview Health Services, according to the Minneapolis Star-Tribune. UnitedHealth will take on nearly 280,000 members, according to AIS Health’s Directory of Health Plans. PreferredOne’s main emphasis is on the self-funded employer market, with approximately 230,000 lives enrolled in that book. Terms were not disclosed, though the Star-Tribune reported that “the financial impact from the sale [to Fairview] is ‘north of $100 million.’”

✦ The Dept. of Justice on Aug. 7 forged a timing agreement with UnitedHealth and Change Healthcare Inc., indicating how long the investigation into their proposed transaction will last. The two firms will file additional information with DOJ, and they have also agreed not to complete the transaction before Jan. 13, 2022 — unless DOJ concludes its investigation and authorizes the deal before then. The agreement came amid ongoing rumors that DOJ would sue to block the deal.

The return of some deferred care and an uptick in COVID-19-related utilization weighed on the financial results of a variety of managed care companies during the second quarter of 2021 — a trend that was also evident among a quartet of newly public startup insurers. However, the performance of Alignment Healthcare, Inc., Bright Health Group, Inc., Clover Health Investments Corp. and Oscar Health, Inc. across various metrics paints a more complicated picture.

All four insurers posted net losses in the second quarter and saw their medical loss ratios (MLRs) increase — some dramatically so (see infographic, p. 8). Oscar’s MLR, for example, jumped from 60.7% in the second quarter of 2020 to 82.4% in the most recent quarter. Medicare-focused Clover saw its net loss increase from $5.4 million in the second quarter of 2020 to $317.6 million during the same period in 2021, while its MLR rose year over year from 70% to 111%. And fellow Medicare Advantage startup Alignment Healthcare went from posting an $8.3 million profit during last year’s second quarter to losing $44.7 million in the most recent quarter.

In acquiring Aetna, CVS Health Corp. promoted the value of integrating health benefits with the company’s thousands of existing pharmacies and retail clinics (see story, p. 1). Other health insurance carriers seem to have taken heed, as national health plans such as Anthem, Inc. and Humana Inc. recently have sought to establish or expand clinics in a variety of markets.

Anthem is contracting with CareMax Inc. “to build medical centers in areas where Anthem will offer a value-based care model to improve patient outcomes,” per an Aug. 13 press release. Meanwhile, Humana will expand its Humana Neighborhood Centers line of clinics, which already operate in Asheville and Greensboro, to several other North Carolina markets including Charlotte.

Aetna, the health insurance arm of CVS Health Corp., has launched what it calls the first national health plan built around virtual primary care. The benefit design, which is a further expansion of CVS’s longstanding relationship with virtual care provider Teladoc Inc., will be available to self-funded plans — and experts say that the model could generate strong demand from such clients, which are looking to cut costs and increase member satisfaction.

According to a CVS press release, the new plan is designed with an emphasis on continuity of care and convenience, starting with “a continuous relationship with a virtual care physician beginning from the first 30-45 minute comprehensive primary care visit and extending to every visit thereafter,” and it promises “timely primary care appointments.” The plan also aims to keep incidental care events like testing and urgent care in-house by offering members a “$0 co-pay for virtual primary care visits and select in-person services at MinuteClinic and CVS HealthHUB locations.” In addition, members will have access to “a virtual nurse care team through unlimited in-app text or phone” while retaining access to “in-person visits with in-network health care providers with no referral requirements [and] existing Aetna virtual care offerings such as mental health counseling, dermatology services, and 24/7 urgent care.”