Health Plan Weekly

With many companies currently hammering out what their employee benefits will look like in 2022, some health insurers are hoping to woo clients by rolling out products that promise to make navigating the health care system a simpler, smoother and more personalized process.

For example, Blue Cross Blue Shield of Michigan this March rolled out a multi­tiered portfolio of digitally enabled care management solutions called Blue Cross Coordinated Care. The offering comes in three “levels of support” that give employers a range of options to aid their members: Core, Navigator and Advocate.

✦ Nearly 940,000 people have signed up for health insurance plans through HealthCare.gov during the pandemic-related special enrollment period as of May 6, according to HHS. Also, nearly 2 million people who are already enrolled in individual market plans “have returned to the Marketplace and reduced their monthly premiums by over 40 percent, from $100 to $57, on average after premium tax credits.” HHS’s press release also noted that thanks to the premium tax credit expansion enacted in the American Rescue Plan, “the average monthly premium fell over 25 percent, from $117 for those enrolling from February 15 through March 31 to $86 for those enrolling in April.” Read more at https://bit.ly/3vLIMd1.

✦ For the first time, a majority of physicians do not work in private practice, according to a survey from the American Medical Association (AMA). The AMA, the largest professional association for physicians in the U.S., has tracked the number of physicians working in physician-owned medical practices since 2012. The 2020 version of the survey found that 49.1% of physicians work in physician-owned practices, down from 54% in 2018. “There are several contributing factors to the ongoing shifts in practice size and ownership that include mergers and acquisitions, practice closures, physician job changes, and the different practice settings chosen by younger physicians compared to those of retiring physicians. To what extent the COVID-19 pandemic was a contributing factor in the larger than usual changes between 2018 and 2020 is not clear,” said AMA President Susan R. Bailey, M.D. Read more at https://bit.ly/3h416dj.

Last year payers were profitable across multiple business lines, according to a May 3 report from the Kaiser Family Foundation (KFF). The report, which was based on data submitted to the National Association of Insurance Commissioners and compiled by Mark Farrah Associates, examines medical loss ratios (MLRs) and gross margins in the Medicare Advantage, Medicaid managed care, individual and fully insured group (employer) health insurance markets (see infographic, p. 8).

The report found that “health insurers in most markets became more profitable during the pandemic,” with the caveat that “we can’t measure profits directly without administrative cost data.” In particular, the report found that MLRs were lower in 2020 for Medicaid managed care organizations (MCOs) than they were in 2019 and 2018. Also, the brief cited an earlier KFF report that anticipated individual and group market commercial insurers will pay out at least $2.1 billion in MLR rebates for the years 2018 to 2020.

CVS Health Corp. impressed Wall Street analysts with strong first-quarter 2021 financial results, which were largely driven by the performance of its PBM and health benefits segments. Evercore ISI analysts, for example, gushed that the diversified health care giant’s results were “exciting” because they provided “some glimmers of the bull thesis playing out.”

“All three segments rowed in unison and put up better than expected results” despite facing challenges in the retail segment, a weak cough/cold/flu season, and a “re-ramping of health care utilization,” the equities analysts wrote in a May 4 note to investors.

Health insurers across the country are doing what they can to get their members vaccinated against COVID-19, drawing on member communication and big data strategies that they have developed over the last several years. Many payers are helping members schedule appointments, securing their transportation to vaccination sites, and even encouraging skeptical members to get inoculated.

Efforts to get members to vaccination sites build on industrywide trends meant to address challenges related to social determinants of health. Many Medicare Advantage plans already offer transportation to members for clinical appointments, and some non-emergency medical transportation is covered by Medicaid.