Health Plan Weekly

After 2020 proved to be a banner year for initial public offerings, three separate startup health insurers — Alignment Healthcare, Clover Health and Oscar Health — rode the wave and launched IPOs in the early months of 2021. Now, Bright Health Inc. is reportedly poised to become the fourth insurer to do so, and in the meantime has picked up a telehealth asset for good measure.

Industry experts tell AIS Health that while many aspects of Bright Health’s business will become clearer if it does end up trading publicly, the company so far looks more likely than some of its fellow startups to succeed.

Several recent studies indicate that providers have been slow to fully comply with a 2019 Trump administration final rule requiring hospitals to disclose pricing information to consumers. The hospital price transparency regulation, which met stiff legal opposition from industry groups including the American Hospital Association, has not been enforced with gusto by the Biden administration, but experts say that might change — and that the rule isn’t going anywhere.

The price transparency rule requires hospitals to release “a machine-readable file containing a list of all standard charges for all items and services” to the public. The rule was part of the Trump administration’s larger push to make cost of care and medical data more transparent for consumers, a strategy that also includes a price transparency mandate for insurers (HPW 11/6/20, p. 1). Because of the pandemic, the hospital rule’s effective date was pushed back from November 2019 to January 2021. Hospitals that are not compliant can be assessed a penalty of up to $300 per day by CMS, a fine that would amount to $109,500 over a full year.

✦ Brian Thompson will become the new CEO of UnitedHealthcare, the health insurance arm of United- Health Group. Thompson has worked for UnitedHealth since 2004, “and most recently was CEO of UnitedHealthcare’s government programs including the Medicare & Retirement and Community & State businesses,” according to a press release announcing the move. Thompson replaces Dirk McMahon, who was promoted to president and chief operating officer of UnitedHealth Group. New UnitedHealth Group CEO Andrew Witty also announced other major appointments, according to the Minneapolis Star-Tribune. Dan Schumacher, president and CEO of Optum, will be promoted to UnitedHealth Group’s chief strategy and growth officer; John Prince will move up from head of PBM OptumRx to lead all of Optum; and Heather Cianfrocco will take over OptumRx. Read more at https://bwnews.pr/3g7lw4P and http://strib.mn/3s2HCro.

✦ More than 500,000 people signed up for health plans using HealthCare.gov between Feb. 15 and March 31, during the pandemic special enrollment period (SEP), according to CMS. The SEP, which will run through Aug. 15, is a centerpiece of the Biden administration’s pandemic response and larger agenda to expand health insurance enrollment. CMS touted higher enrollment among disadvantaged communities in a press release announcing the enrollment results: “Of applicants who identified a race, 17% identified as Black — compared to about 11% in both 2020 and 2019 during the same time period. Among consumers requesting financial assistance, 41% report being at or slightly above the federal poverty level, compared to 38% in 2020 and 33% in 2019.” Read more at https://go.cms.gov/3d2Js7j.

Both insurers and the federal government are pushing hard to promote the special enrollment period for the federal health insurance exchange: America’s Health Insurance Plans (AHIP) is launching an online decision tool for consumers, while CMS will spend $50 million to promote the SEP and educate potential enrollees.

The SEP began on Feb. 15 and will run through Aug. 15. CMS’s educational campaign, which will last until the end of the SEP, focuses on raising awareness among the uninsured about the new savings opportunities associated with recently expanded premium assistance for those who qualify. In addition, CMS says it is communicating with current enrollees to let them know they can update their enrollment information and access the expanded financial assistance.