Health Plan Weekly

UnitedHealth Group’s Surest brand has become a hot product in recent months, with sales of the alternative benefit design accounting for one third of the health care giant’s new commercial business, according to some accounts. UnitedHealthcare, the firm’s managed care arm, pitches commercial clients on Surest by promising lower costs and higher quality — without sacrificing a broad network.  

Alternatives to conventional PPO plans are more appealing than ever for commercial insurance plan sponsors, who have struggled with sharp medical cost and premium increases in recent years. But restrictive narrow network plans are often unpopular with plan members, and payer stakeholders have begun to shy away from models that shift costs to members. 

Insurers that participate in the individual, small-group and large-group markets are estimated to pay a total of $1.1 billion in medical loss ratio (MLR) rebates to their customers in 2024 — falling short of record-high $2.5 billion in rebates in 2020 but staying similar to rebates levels in 2022 and 2023, according to a KFF analysis on preliminary data filed by insurers.

Under the Affordable Care Act, insurers that spend less than a certain percentage of their premium income on health care claims and quality improvement must rebate customers. Individual/small group plans must issue rebates if their MLRs fall below 80%, while the cutoff is 85% for large group plans. About half of the total rebate amount will go to individual market enrollees this year. Nearly $12 billion in rebates in total have been issued since the ACA required insurers to pay back excess profits to customers starting in 2012.

Although the outcome of a Dept. of Justice investigation into UnitedHealth Group is far from certain, it recently led UnitedHealth shareholders to file a lawsuit claiming that the company deceived investors before the DOJ investigation came to light. 

In February, news broke that the DOJ had been quietly looking into UnitedHealth’s buyup of physician practices — including how that vertical consolidation affects rival providers and health insurers — as well as Medicare Advantage billing issues. UnitedHealth’s shares tumbled on the news, which came to light after the New York-based Examiner News obtained an internal email showing the firm first became aware of the investigation in October 2023. 

Momentum to roll back health care consolidation is building in Washington, D.C. Lawmakers in both parties have attacked the trend in recent weeks, and prominent senators trained their sights on MultiPlan Corp., with one senator accusing the firm and its insurer clients of collusion, a violation of antitrust law. 

Given all the scrutiny on health care consolidation, one antitrust expert says Congress might be motivated to grant federal authorities the ability to review the kind of health care transactions that federal regulators are currently unable to block. 

Two committees of the House of Representatives held hearings on health care consolidation last week, and both featured continuous attacks by members of both parties on routine health care dealmaking.