Health Plan Weekly

CareFirst BlueCross BlueShield, one of the largest insurers in the mid-Atlantic region, recently announced its involvement in a program for early stage technology companies looking to develop artificial intelligence (AI) products for the health care sector. A CareFirst executive tells AIS Health that the payer hopes to learn more about what is happening in the AI space for potential use within the company. One expert, however, says insurers for the most part are still contemplating how to implement AI in their workflows while also being cognizant of its potential flaws. 

CareFirst is partnering with Johns Hopkins University for the TechStars AI Health accelerator that will take place in March 2025 in Baltimore. TechStars is a company that invests in and provides guidance and money to startup companies in several industries. The firm hosts numerous so-called accelerators, which are months-long programs where founders of young companies meet with experienced industry leaders and investors. TechStars invests $120,000 in the companies it chooses for the accelerators in exchange for a 6% to 9% equity stake. Most accelerators receive hundreds of applicants, of which TechStars usually selects 20 or fewer to participate. 

In the first quarter of 2024, annual growth in health care spending exceeded the levels seen before the COVID-19 pandemic. Yet hospital inpatient admissions, on a per capita basis, remained lower than pre-pandemic levels, reflecting a shift to outpatient centers, according to a recent Peterson-KFF Health System Tracker analysis.

As many elective hospitalizations were canceled or delayed at the beginning of the pandemic, health care spending dipped in late 2019 and early 2020. Shortly after that, year-over-year growth in health services spending rebounded to pre-pandemic levels and remained high, with double-digit growth since early 2023. Nursing and residential care facilities spending saw year-over-year growth ranging from 10.0% to 13.4% since the beginning of 2023.

David Cordani, CEO of The Cigna Group, made it clear during a Sept. 5 presentation at the Morgan Stanley Healthcare Conference that the firm doesn’t view the elevated medical costs facing health insurers this year as a threat to its diversified portfolio. 

Cigna Healthcare, the firm’s health insurance business, in the “recent timeframe” has been able to deliver “good, predictable” medical loss ratios (MLRs), Cordani said, referring to a closely watched metric that shows the percentage of premiums spent on medical claims.  

A California law designed to help people transition from the state’s Medi-Cal Medicaid program to Affordable Care Act exchange plans has been successful at keeping people insured since its launch last year, according to a recent report from the nonprofit California Health Care Foundation. JoAnn Volk, the study’s lead author, tells AIS Health the analysis is based on “early data,” so it is too soon to draw any long-term conclusions, although she noted that insurers have praised the rollout. 

Starting in July 2023, people in California who lost Medi-Cal coverage could opt to be automatically enrolled in Covered California, the state’s marketplace. Those people were enrolled in a zero-premium or subsidized marketplace plan as the default option, although they also had the chance to opt out of coverage or select a different plan.  

Elevance Health, Inc. will offer Affordable Care Act exchange plans in three new states next year. The insurer’s Wellpoint-branded plans will expand into Florida, Maryland and Texas — all states where it has a managed Medicaid presence. According to AIS’s Directory of Health Plans, Elevance Health has approximately 1 million members enrolled in ACA exchange plans, making it the insurer’s smallest market segment. As of 2024, the insurer offered exchange plans in 10 states, with California, Virginia and New York representing its three largest markets. 

The value of Affordable Care Act marketplace plans decreased from 2014 to 2023, according to a Paragon Health Institute report published on Sept. 3. The authors — actuaries Daniel Cruz and Greg Fann — noted that just 11% of exchange customers were enrolled in plans with broad provider networks in 2023, down from 36% in 2014. During that same period, gross premiums in the individual marketplace increased 50% more than premiums for people enrolled in employer plans. The authors argued that “the ACA insurance rules caused premiums to increase and led insurers to offer narrower and more restrictive networks over time” and that “the design of the ACA premium tax credits has also incentivized enrollees to select lower-quality plans.”