Health Plan Weekly

Medicare beneficiaries who shopped and made a coverage change during this last Annual Election Period (AEP) were more likely to stick with their current insurer than in years past, illustrating the dual need for insurers to engage with consumers throughout the year and to innovate with benefits that will attract and retain satisfied members, according to experts speaking at a recent webinar co-hosted by Deft Research and GHG Advisors. At the same time, Medicare Supplemental (MedSupp) customers are showing increased interest in Medicare Advantage, presenting more opportunities to disrupt that market.

Outside of a few dozen rural counties where it’s hard to create an attractive plan network, MA insurers across the country are seeing solid growth, with close to 43% of Medicare eligibles enrolling in the individual and group MA market — moving ever closer to CMS’s estimate that MA penetration will reach 50% by 2025, observed Deft Executive Vice President George Dippel during the April 8 webinar, “2021 AEP: How the Results Will Drive Plan Decisions for 2022 and Beyond.”

UnitedHealth Group began the first quarter of 2021 on a high note, reporting earnings per share (EPS) and a medical loss ratio (MLR) that both beat the Wall Street consensus estimate and saying it expects to achieve greater full-year earnings than it previously estimated. However — mirroring much of the messaging last year when the COVID-19 pandemic was massively depressing routine and elective care — executives warned that the majority of the unfavorable COVID impact they’re expecting will transpire in the second half of the year.

In fact, UnitedHealth expects roughly 70% of the predicted COVID-related $1.80 EPS hit to occur in the back half of the year, Chief Financial Officer John Rex said during an April 15 conference call to discuss the company’s financial results. He said that projection is based on UnitedHealth’s prediction that as the year wears on and vaccination rates rise, people will increasingly be able to access higher-acuity, previously deferred care.

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.