Health Plan Weekly

Plan sponsor groups say that health insurers have blocked or ignored employers’ requests to obtain information relating to both parties’ role as plan fiduciaries under the Employee Retirement Income Security Act of 1974 (ERISA). That’s despite the fact that insurers are required under a recent law to provide that information to employers on request — and that plan sponsors and plan members have begun to sue insurers to gain access to it. 

Plan sponsors have growing legal risk in their role as ERISA fiduciaries due to ongoing litigation and provisions included in the Consolidated Appropriations Act, 2021 (CAA). The lawsuits, many of which spring from requirements in the CAA, all relate to requirements that say health plans must prove they obtained the lowest prices possible for health care services and prescription drugs.  

During the Bernstein Strategic Decisions Conference, CVS Health Corp. executives directly addressed the company’s rumored desire to find a private equity partner to fund the growth of its Oak Street Health clinics. Meanwhile, managed care stocks took a hit after UnitedHealth Group CEO Andrew Witty called out reimbursement headwinds associated with Medicaid eligibility redeterminations. 

“There’s been a lot of inquiries, you know, based on some recent press reports on Oak Street,” CVS Chief Financial Officer Tom Cowhey said during a May 29 “fireside chat” with Bernstein analyst Lance Wilkes and CVS CEO Karen Lynch. Bloomberg reported on May 23 that the company has reached out to a handful of private equity firms in a bid to generate more capital to support new, senior-focused primary care clinics under the Oak Street brand.  

As of this year, a dozen states provide health coverage to their Medicare-eligible retirees only through Medicare Advantage plans, according to a recent KFF review.

Employer-sponsored health care coverage for retirees was generally designed to coordinate with or wrap around traditional Medicare. Yet over the past few years, many states have shifted to contracts with private insurers to provide all Medicare-covered benefits and extra benefits for their retirees. These moves may help states reduce spending on retiree health costs and simplify administration.

Satisfaction with commercial insurance plans increased on a year-to-year basis by 3 points on a 1,000-point scale, according to the J.D. Power 2024 U.S. Commercial Member Health Plan Study. However, the results, released on May 29, indicate satisfaction varies significantly among carriers. For instance, the highest-performing plans saw their member satisfaction scores increase by 20 points while the lowest-ranked plans saw member satisfaction scores decrease by 8 points. J.D. Power said the largest differences in customer satisfaction among the high-performing and low-performing plans were in plans’ ability to help members save time and money, help them obtain health services, and gain members’ trust. 

CDPHP and the Lifetime Healthcare Cos. have agreed to an affiliation in which Lifetime would become the parent company of CDPHP, according to a May 22 press release. The companies’ boards of directors have unanimously approved the deal, which still must be approved by state and federal regulators. Lifetime is the parent company of Excellus BCBS and Univera Healthcare, which like CDPHP are nonprofit health plans based in New York. If approved, the insurers would maintain their brands.  

CMS on May 9 extended through June 2025 waivers meant to help states and Medicaid managed care organizations navigate the unwinding of COVID-19 pandemic-related eligibility rules. The waivers, which include provisions allowing MCOs to reach out to members about redeterminations and help members complete eligibility paperwork, were originally set to expire in January 2025.

The extension of the waivers — specifically, 1902 (e)(14) waivers — could help MCOs leave behind the upheaval caused by the return of eligibility redeterminations, which resumed in spring 2023 after a multiyear pause tied to the COVID-19 public health emergency. The crush load of eligibility checks has been difficult for states to manage. Many states disenrolled eligible Medicaid beneficiaries for administrative reasons, typically because the beneficiary made an error in their eligibility check or didn’t return paperwork in time to meet a redetermination deadline. The chaos, which was the subject of mutual recrimination between states and CMS, has caused no shortage of headaches for MCOs.