Health Plan Weekly

In the fourth quarter of 2020, health care spending patterns experienced by the country’s largest health insurer “returned to seasonal baselines” even as COVID-19 cases surged all over the U.S. Such is one major takeaway from UnitedHealth Group’s fourth-quarter 2020 earnings report, which offers an instructive look at the unique ways that the pandemic continues to affect health care economics.

During a Jan. 20 conference call with investors, UnitedHealth Chief Financial Officer John Rex explained that two opposing forces caused health care spending to align with historical levels. While the amount that UnitedHealth spent on COVID-19-related care increased compared with the third quarter, overall outpatient activity dipped below baseline as the end of the year drew closer, reflecting the fact that more people started deferring routine and elective care as coronavirus cases rose.

Health insurers face dozens of technological challenges in coming years, as federal regulations mandating electronic health record interoperability and price transparency mean that every health insurer has had to start developing new information technology and data capabilities.

Praveen Thadani, the new president of Priority Health, has the background to do just that. Priority is a nonprofit payer with nearly 900,000 members, according to AIS Health’s Directory of Health Plans, making it the carrier with the second-highest membership in the state of Michigan. Thadani says he was drawn to Priority’s “amazing heritage of innovation” in accepting the role.

Since the start of the COVID-19 pandemic, the managed care industry has wrestled with how to project utilization of normal care and assess the risk of funding care related to the virus, especially since most carriers have elected to waive cost sharing for COVID-19 treatment. While insurers generally seem to be in good financial shape, experts say that plans face continuing uncertainty — and one actuary suggests that pandemic-related financial risk has met or exceeded the conditions of his modeling’s worst-case scenario.

In the early days of 2021, the U.S. confronted a grim milestone when the tally of Americans who died from COVID-19 reached 400,000. Meanwhile, the Trump administration was criticized for how it handled vaccine rollout and denounced critical public health tactics including mask wearing, while states reopened their economies and public spaces to varying degrees, despite the objections of public health officials.

✦ On Jan. 15, CMS finalized a rule that compels Medicaid, CHIP and Affordable Care Act (ACA) exchange plans to streamline their prior authorization processes. The regulation, which the administration proposed in December (HPW 12/18/20, p. 1), would also require the affected plans to add new capabilities to the Patient Access APIs that they had to build in order to comply with a previously finalized data interoperability rule. Read more at https://go.cms.gov/2LDw8eL.

✦ CMS on Jan. 14 finalized several provisions in the 2022 Notice of Benefit and Payment Parameters (NBPP), cementing controversial new regulations for the ACA exchanges. Payer trade groups criticized the draft rule on various points, particularly an unusually short comment period and a provision that would allow states to abandon a centralized health insurance exchange in favor of relying on brokers, agents and insurers (HPW 1/8/21, p. 5). While that provision was among those finalized, CMS said it “anticipates continuing to review comments and finalizing other proposed policies in a second final rule to be published at a later date.” Read more at http://go.cms.gov/3sku3Vs.