Health Plan Weekly

One day after the Dec. 4 shooting death of UnitedHealthcare CEO Brian Thompson sent shock waves through the industry, new details have begun to emerge that suggest anger at health insurers as a possible motive in the crime. Seemingly in response, some insurers started taking precautionary steps, while the sector’s main trade group condemned the notion that threats against people who work in the industry are “ever acceptable.” 

Multiple news outlets have reported that there were words written on bullet casings left at the scene of the shooting, which occurred outside a New York City hotel where UnitedHealth Group was set to hold its annual Investor Day conference. Accounts vary about what those words were, but most outlets reported that one of the words was “deny.” Other words on the casings included some combination of “defend,” “depose” and “delay,” according to various news reports.  

UnitedHealthcare CEO Brian Thompson was shot and killed outside the New York Hilton Midtown hotel on Dec. 4, ahead of the annual Investor Day meeting held by UnitedHealth Group, New York Police Department officials confirmed in a midday press conference.

“We are deeply saddened and shocked at the passing of our dear friend and colleague Brian Thompson, the CEO of UnitedHealthcare,” UnitedHealth Group said in a statement posted to its website. “Brian was a highly respected colleague and friend to all who worked with him. We are working closely with the New York Police Department and ask for your patience and understanding during this difficult time. Our hearts go out to Brian’s family and all who were close to him.”

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.