Health Plan Weekly

Although improving Medicare Advantage margins has been the hottest topic recently in managed care, executives at Elevance Health, Inc. at a recent investor conference made some noteworthy comments about the firm’s commercial and Affordable Care Act exchange businesses — both of which insurers are talking more glowingly about amid government-business headwinds.

Regarding the company’s ACA exchange business, “we certainly aren’t looking for membership over margin,” Morgan Kendrick, president for the insurers commercial and specialty health benefits segment, said during a June 12 question-and-answer session at the Goldman Sachs Global Healthcare Conference.

There are persistent challenges around the collection and transmission of that data between providers and payers. The same is true of the quality of the data itself. It's a key challenge for the health insurance industry as payers try to measure provider quality and transition to value-based contracting.

"I'll just say the accuracy of our directory is bad. It just is," said Mike Kane, senior vice president for provider data operations at UnitedHealthcare. Kane was speaking on a June 12 panel organized by the Council for Affordable Quality Healthcare (CAQH) at the 2024 AHIP Conference in Las Vegas. "About half of every single provider [data profile] that our members call, there's at least one data element in our directory that's wrong."

"It's a horrible, horrible experience," Kane said.

Uninsured rates among Black, Latino, Asian and Native American communities plummeted from 2010 to 2022, as more people gained health care coverage through federal health care programs and employer-sponsored plans, according to reports released by HHS.

The uninsured rate for Black Americans under age 65 dropped from 20.9% to 10.8% between 2010 and 2022, and the rate dropped from 32.7% to 18.0% for Latino Americans during that time. Meanwhile, the uninsured rate went from 16.6% to 6.2% for Asian Americans, Native Hawaiians and Pacific Islanders (AANHPI), and from 32.4% to 19.9% for American Indians and Alaska Natives (AI/AN).

The Illinois legislature recently passed several health insurance reform regulations, most notably banning step therapy for covered services, prohibiting prior authorization for inpatient mental health services and eliminating short-term health plans. Health policy experts tell AIS Health, a division of MMIT, that the Healthcare Protection Act (HPA) goes further than other state laws by banning step therapy outright — a move other states could opt to follow. 

Democratic Gov. JB Pritzker, who proposed the HPA in his fiscal year 2025 budget address in February, is soon expected to sign the act into law. It will apply to Medicaid, Affordable Care Act exchange, fully insured employer sponsored and state employee health plans, but it will exclude self-insured and Medicare plans that are regulated at the federal level.