Health Plan Weekly

For the fourth quarter and full-year 2021, CVS Health Corp. reported a strong financial performance across its vertically integrated health care business, but its health insurance division Aetna had mixed results. While Aetna delivered higher-than-expected enrollment in Medicare Advantage, it didn’t meet expectations for enrollment on the Affordable Care Act exchanges — a book of business the firm re-entered after several years away from the individual marketplaces.

Aetna took in $20.6 billion in revenue in the third quarter of 2021, according to a CVS press release, up from $19.1 billion in the same period of 2020. It recorded a medical loss ratio of 87%, up from 86.7% in the same period last year; for the full year, Aetna reported an MLR of 85%, up from 80.9% in 2020.

Rhode Island Attorney General Peter Neronha, a Democrat, subpoenaed UnitedHealthcare over a recent data breach that saw the personal data of 22,000 plan beneficiaries get hacked by an unknown third party. The exposed beneficiaries were members of the health plan of the Rhode Island Public Transport Authority, which discovered the breach, Modern Healthcare reported.

The number of telehealth visits has declined as the pandemic has receded, according to analysis of Epic Systems Corp. data by the Kaiser Family Foundation. The research indicates telehealth visits accounted for 13% of outpatient visits between March and August 2020, but declined to 11% of outpatient visits between September 2020 and February 2021 and 8% of such visits from March to August.

In their public comments about a proposed rule that would bring back standardized plans to the Affordable Care Act exchanges, two health insurer trade groups make it clear that they believe such a move will “stifle innovation” in plan design. However, state-based marketplaces that already require plan standardization appear to have found a way to make that policy work for consumers and insurers alike, sources tell AIS Health.

“I’m not aware of anything to suggest that innovation — however one might define that — has been hampered to the detriment of consumers in the states where we see this policy in place,” says Justin Giovannelli, an associate research professor at Georgetown University’s Center on Health Insurance Reforms. Giovannelli co-authored a July 2021 piece for The Commonwealth Fund examining various states’ ACA plan standardization requirements.

Due to a Jan. 27 federal court order, CVS Health Corp.’s Aetna health insurance division could be the defendant in a class-action lawsuit regarding Aetna’s restrictive coverage decisions in breast and prostate cancer treatment. In a lawsuit filed in Florida district court, a federal judge found that Aetna improperly denied coverage of proton therapy to cancer patients who ultimately had to pay for the treatment out of pocket.

Proton beam radiation therapy (PBRT) is a type of cancer treatment “that uses high-powered energy to treat cancer and some noncancerous tumors,” according to the Mayo Clinic, which also notes that “studies have compared proton radiation and X-ray radiation, so it’s not clear whether proton therapy is more effective at prolonging lives.” The therapy isn’t widely available, although new proton therapy centers are being built in the U.S. and in other countries.