Health Plan Weekly

UnitedHealthcare and Centene Corp. have added “virtual first” plan designs to their employer-sponsored offerings, becoming the latest commercial insurance giants to offer benefit designs built around virtual primary and urgent care. Health care insiders tell AIS Health that while there is some demand among employers for such services, they don’t expect the virtual-first model to replace traditional benefit designs any time soon.

UnitedHealthcare, the country’s largest carrier and a subsidiary of UnitedHealth Group, said on Oct. 18 that it will offer employers in nine markets — Little Rock, Ark.; Fort Myers, Fla.; Pittsburgh; Springfield, Mass.; Minneapolis/St. Paul, Minn.; Richmond, Va.; Indianapolis; Dallas; and Houston — what it dubs “NavigateNOW.” Will Shanley, director of public relations at United Healthcare, tells AIS Health, a division of MMIT, that NavigateNOW is currently available only to fully insured employers. The carrier plans to make the benefit design available to self-funded employers for the 2023 plan year. Shanley adds that “we anticipate expanding to 25+ markets by the end of 2023.”

Anthem, Inc.’s third-quarter 2021 financial results — combined with UnitedHealth Group’s strong showing less than a week earlier — have helped to ease investors’ concerns about the Delta variant’s potential impact to insurers’ medical costs, according to equities analysts.

The Blue Cross Blue Shield insurer said on Oct. 20 that its medical loss ratio (MLR) was 87.7% for the quarter, beating the Wall Street consensus of 88.4%. Anthem’s “government business drove MLR upside, with commercial earnings below expectations — consistent with the pandemic pattern of more persistent commercial utilization and more COVID sensitivity/deferred care in Medicare/Medicaid,” Evercore ISI analyst Michael Newshel pointed out in a note to investors.

✦ UnitedHealth Group will reprocess all of its commercial claims for COVID-19 vaccine administration after a federal investigation found the integrated health care giant paid providers less than 40% of the Medicare reimbursement rate for administering inoculations. Sen. Bob Casey, Jr. (D-Pa.), chair of the special committee on aging, wrote in a letter to UnitedHealth that it must inform the committee of the number of claims it expects to reprocess by Nov. 5. UnitedHealth will owe about $15 million for every 1 million claims it reprocesses, according to press reports.

✦ Meanwhile, UnitedHealthcare launched a new prenatal care program in North Carolina with Unified Women’s Healthcare (UWH), an obstetrics and gynecology firm. UWH will introduce new care standards at clinics in Asheville, Hickory, Morehead City and Goldsboro, with the goals of “improv[ing] outcomes and reduc[ing] racial and social disparities among mothers in North Carolina by providing access to quality maternal care,” per a press release.

A growing amount of treatment for substance use disorders (SUDs) has moved to telehealth providers due to the COVID-19 pandemic. This trend likely increased patients’ access to treatment, among other benefits, but researchers and plan sponsors say that the efficacy and value of virtual care modalities in SUD settings is still an open question.

Last year, during the first wave of the pandemic, the entire health care system had to make internet and telephone care available in a short time. SUD treatment was no different. A good deal of SUD treatment traditionally takes place in person, especially in peer support groups and inpatient drug detox. Researchers were already investigating whether remote SUD care is useful before the pandemic, but their work became urgent last spring and summer as providers rushed to meet social distancing requirements.

UnitedHealth Group’s third-quarter 2021 financial results impressed Wall Street, with equities analysts describing the company’s performance as “solid across the board” and “generally positive” even though the company did see health care costs related to COVID-19 rise during the quarter.

The diversified health care giant and parent company of the country’s largest health insurer reported an adjusted earnings per share (EPS) of $4.52 for the third quarter, beating the Wall Street consensus of $4.41. The firm’s revenues increased 11% year over year to $72.3 billion, which it attributed to “balanced, double-digit growth at both Optum and UnitedHealthcare.” And the company’s medical loss ratio for the quarter was 83%, slightly beating the consensus estimate of 83.4% but representing an increase compared to last year’s 81.9%, which UnitedHealth said was due to the repeal of the health insurance tax.