Health Plan Weekly

✦ Humana Inc. announced a deal with IBM Corp. that will offer the insurer’s commercial group members an online chat virtual assistant based on IBM’s Watson Health conversational artificial intelligence software. The service will be available to all of Humana’s 1.3 million employer group medical members and 1.8 million of Humana’s employer group dental members. A press release noted that “consumers who do not understand how their health plan works or how to estimate out-of-pocket costs are more likely to delay or avoid essential care,” and positioned the agreement as a solution to that problem. Read more at http://huma.na/3qcVnn3.

✦ The American Hospital Association (AHA) sent a letter to CMS calling on the agency to investigate UnitedHealth Group’s diagnostic testing and specialty pharmacy benefit designs. The letter accused UnitedHealth’s recently announced “Designated Diagnostic Provider” program of being an attempt to “eliminate coverage for diagnostic tests at most freestanding and hospital labs while continuing to portray these providers as ‘in-network’ to health plan enrollees.” It also criticized UnitedHealth’s policy requiring providers to use drugs purchased and handled by the health plan and its OptumRx specialty pharmacy subsidiary. The AHA suggests that the policy might prevent “appropriate storage and handling of those drugs.” Read the letter at https://bit.ly/375XGkq.

COVID-19 relief legislation under consideration by key committees in the House of Representatives includes provisions aimed at helping Americans afford health insurance, many of which could be beneficial to consumers and health insurance organizations alike.

A proposal from the House Ways and Means committee would alter Affordable Care Act subsidies, effective only in 2021 and 2022, to ensure that no marketplace enrollee pays more than 8.5% of their income on premiums. That would mean that people earning above 400% of the federal poverty level (FPL) would be eligible for ACA subsidies for the first time. People with income below 150% of the FPL also would see the premiums for a benchmark ACA plan (the second-lowest cost silver-tier plan) fully subsidized.

Centene Corp. said it would eliminate 4,500 jobs, including 3,000 current employees and another 1,500 open positions, as it focuses on “innovation, growth and agility” after posting a $12 million fourth-quarter loss. However, its overall fourth-quarter and full-year 2020 financial results largely met analysts’ expectations, and company executives pledged strong growth in both their Medicaid and Medicare business lines in 2021.

The insurer’s medical loss ratio (MLR) for the fourth quarter came in worse than expected at 88.4% versus the 88% that analysts had anticipated, driven by higher costs for care of members with COVID-19, particularly within the individual health insurance exchanges. However, “the higher cost is not necessarily surprising given the COVID spike at year-end and commentary from peers,” wrote Citi analyst Ralph Giacobbe in a Feb. 9 investor note.

Testing for the novel coronavirus still has an important role to play in saving lives and ending the pandemic, but it will require significant investment and attention to become effective. As testing is scaled up by the Biden administration, in a notable pivot from the Trump administration’s hostility to testing, carriers and plan sponsors may have to foot the bill for higher volumes of a broader array of tests.

Through a Jan. 21 executive order, President Joe Biden launched the COVID-19 Pandemic Testing Board, which will coordinate “a Government-wide, unified approach” with the goals of “establishing a national COVID-19 testing and public health workforce strategy; working to expand the supply of tests; working to bring test manufacturing to the United States, where possible; working to enhance laboratory testing capacity; working to expand the public health workforce; supporting screening testing for schools and priority populations; and ensuring a clarity of messaging about the use of tests and insurance coverage.” The membership of the board does not appear to have been announced as of press time.