Health Plan Weekly

During the company’s July 15 call to discuss second-quarter 2021 financial results, UnitedHealth Group executives — perhaps unsurprisingly — fielded a question about how the company is approaching Aduhelm (aducanumab), the pricey new Alzheimer’s disease therapy that continues to be shrouded in controversy.

Chief Medical Officer Richard Migliori, M.D., told analysts that “we are continuing to develop our clinical policy as well as our ultimate position on coverage, but in doing so we’re looking forward to getting the guidance that we need from Medicare.” CMS on July 12 said it was opening a National Coverage Determination analysis on Aduhelm, which will ultimately specify how Medicare will cover the $56,000 per year treatment. In the meantime, coverage will be determined at a local level by Medicare Administrative Contractors, the Biden administration said.

by Jinghong Chen

People with employer-sponsored and individually purchased private insurance were more likely to report poor access to health care, higher costs of care and less satisfaction with care compared with individuals covered by public insurance programs, according to a recent study published in JAMA Network Open. The researchers studied data from the 2016-2018 Behavioral Risk Factor Surveillance System on nearly 150,000 individuals and found that Medicare beneficiaries were more likely to have a health care provider and were the most satisfied with their care compared with individuals enrolled in other programs. Meanwhile, individuals with private insurance were more likely to have medical debt.

As Democrats in Congress move toward passing an ambitious economic agenda, much is undecided about health care — including how the federal government might further push holdout states to expand Medicaid. Experts say the shape of any changes to Medicaid is still forming, and that a new bill introduced by Democratic Georgia Sens. Raphael Warnock and Jon Ossoff and Wisconsin Democrat Sen. Tammy Baldwin is highly preliminary.

The Medicaid bill, titled the Medicaid Saves Lives Act (MSLA), was introduced July 12, and its main policy would be creating “a program to provide health care coverage to low-income adults in States that have not expanded Medicaid,” according to text released by Warnock’s office. The bill was introduced as Democratic leadership agreed to a $3.5 trillion budget framework that includes much of President Joe Biden’s agenda.

UnitedHealth Group — which in recent months has been tightening the screws on spending drivers like unnecessary emergency care and out-of-network utilization — is signaling that its greater goal for cost containment comprises much more than simply site-of-care management. Rather, the diversified managed care company’s emphasis on its care-delivery assets during its second-quarter earnings conference call may suggest that UnitedHealth is increasingly pursuing the strategy of “if you can’t beat them, own them.”

“I think you’re really starting to see OptumHealth…starting to demonstrate [its] capacity for growth because of the scale of the footprint that they now [have] established across the country,” UnitedHealth CEO Andrew Witty said of the company’s health services division during a July 15 call to discuss quarterly earnings.

In President Joe Biden’s new executive order aimed at promoting competition in the American economy, he directs HHS Secretary Xavier Becerra to “implement standardized options in the national Health Insurance Marketplace” in a bid to “ensure that Americans can choose health insurance plans that meet their needs and compare plan offerings.”

Standardized plans on the federally run health insurance exchange, HealthCare.gov, are not a new concept: They were initially introduced during the Obama administration before being rolled back by the Trump administration. And several states that run their own exchanges currently have some form of standardized plans. But industry experts tell AIS Health that a move to standardize plans at the federal level will only work this time around if it’s done with several key principles in mind.