Health Plan Weekly

During their Dec. 12 investor day, Centene Corp. executives promised 12% to 15% in annual earnings growth and declared victory in their multiyear value creation and cost-cutting plan. Wall Street analysts responded warmly to the firm’s presentation, which featured a bold plan to grow Affordable Care Act marketplace enrollment by courting small businesses. 

That plan would leverage Individual Coverage Health Reimbursement Arrangements (ICHRAs) to exploit what CEO Sarah London called a “long-term disruption opportunity” in the small-business health insurance market. Centene is the first major carrier to promise long-term, substantive growth in ICHRAs. The long-term growth prospects of ICHRAs, which allow employers and employees to buy marketplace plans, are far from clear. 

Nutrition is a key social determinant of health (SDOH), and the Medicaid program increasingly is an important conduit for connecting beneficiaries with healthy foods. According to state Medicaid officials from Delaware and Nevada, and home care caterer Mom’s Meals, managed care organizations have a critical role to play — and a clear financial incentive — in improving their members’ nutrition. 

Using health plan benefits to cover food as medicine — making sure that patients aren’t hungry and are eating a diet that does not exacerbate their chronic ailments — are a popular Medicare Advantage supplementary benefit, with nearly one-quarter of MA plans offering nutrition and dietary services. Medicaid plans are also increasingly viewing hunger and poor nutrition as a SDOH that can, if unaddressed, drive preventable care utilization.  

The outpatient prices Medicaid managed care insurers pay to hospitals vary considerably based on geography and type of service, according to a cross-sectional study published on Nov. 28 in JAMA Network Open. The authors examined publicly available data and noted the results suggest the prices could affect government health expenditures and access to care for Medicaid members.  

However, Jeffrey Marr, a Ph.D. candidate at Johns Hopkins University and the study’s lead author, acknowledges the analysis “raises more questions than it answers” in part because the researchers could not determine the reasons for the variation. Two health care insiders tell AIS Health, a division of MMIT, that the study reinforces there are still questions related to the usefulness of the hospital price transparency rule that went into effect in 2021 and the various definitions for prices. 

Here’s how major U.S. health insurers performed financially in the third quarter of 2023. Health Plan Weekly subscribers can access more health plan financial data — including year-over-year comparisons of leading health plans’ net income, premium revenue, medical loss ratios and net margins. Just email support@aishealth.com to request spreadsheets for current and past quarters.

AHIP appointed a new president and CEO: Mike Tuffin, UnitedHealth Group’s senior vice president for external affairs. Tuffin succeeds Julie Simon Miller, who has been the health insurance trade group’s interim CEO since September, when Matt Eyles stepped down. Eyles helmed AHIP for nearly five years and said in May that his move to resign was a “personal decision.” Tuffin is no stranger to AHIP, having served as the group’s executive vice president for public affairs from 2002 to 2012. Before his role at UnitedHealth, Tuffin was managing director of APCO Worldwide’s Washington, D.C. headquarters.