Health Plan Weekly

Humana Inc. on Dec. 3 announced the hiring of a new chief financial officer, Celeste Mellet, who will replace Susan Diamond after she steps down on Jan. 11 after more than three years as CFO. While Mellet does not have a background in health care, she is an experienced financial executive who nonetheless faces a challenging situation as Humana struggles with high care utilization among its members. 

Wells Fargo analysts wrote in a Dec. 3 note that Diamond “had expressed interest in transitioning out of the role” and added “while there is never a perfect time to make a CFO transition, [Humana] is pleased to have identified who it sees as the right fit.” Meanwhile, Raymond James analysts in a Dec. 3 note wrote that Diamond “appears to be stepping down voluntarily for personal reasons and was not forced out of the company” and that Humana had been looking for a new CFO for three months. Diamond, who has worked at Humana since 2006, will continue in an advisory role at the company through the end of next year.  

Policy changes — particularly those aimed at eliminating hospital facility fees — are top of mind for stakeholders and health benefits purchasers eager to stem the tide of rising health care costs, according to recent research from Catalyst for Payment Reform (CPR). 

The State Policy Assessments Project included interviews with 34 stakeholders in Michigan, Florida and Nevada — states chosen for their economic, geographic and political diversity. The participants included self- and fully insured health care purchasers, health plans, physicians, hospital systems, and other experts. The question researchers sought to answer was: Do stakeholders have an appetite for specific policy solutions to address commercial health care prices in certain states? 

Affordable Care Act (ACA) marketplace nongroup insurers paid providers significantly less than employer small-group insurers paid for professional services, outpatient hospital services and inpatient hospital services in 2021, according to a recent Health Affairs study.

Using 2021 claims data from CMS, the researchers estimated prices for three market segments: nongroup plans sold on the ACA marketplaces, nongroup plans sold off the marketplaces and small-group employer plans. They found that overall, ACA marketplace prices were 152% of Medicare prices, whereas the prices paid by small-group insurers were 179% of Medicare prices. Weighted average price ratios — also known as price indices — relative to Medicare payment rates were highest for outpatient services, followed by inpatient and professional services.