Health Plan Weekly

Humana Inc. on Oct. 11 revealed that Bruce Broussard, who has been its CEO since 2013, will step down next year and be replaced by Jim Rechtin, the current CEO of private equity-owned physician staffing company Envision Healthcare Corp.  

On the surface, choosing Rechtin to succeed Broussard could raise some eyebrows, since Envision just announced a deal that will allow the firm to emerge from Chapter 11 bankruptcy. And in recent years, major staffing firms like Envision have been at odds with insurers — in fact, Envision in May was awarded $91 million by an arbitration panel in a dispute with UnitedHealthcare over alleged underpayment for medical care.  

PHILADELPHIA — Lina Khan, chair of the Federal Trade Commission, told attendees at the American College of Emergency Physicians (ACEP) Scientific Assembly on Oct. 11 that the FTC is paying close attention to so-called vertical integration in the health care industry.  

“The FTC for decades, before I even arrived, had really been focused on what are known as horizontal mergers, between hospitals in particular,” she said. “But we’ve seen over the last decade that the tactics are changing. We are increasingly seeing not just the merger of alike, but also the merger of different entities within the same supply chain, what’s known as vertical integration.” 

States are struggling to complete Medicaid redeterminations: CMS has said that there are potentially millions of Medicaid and Children’s Health Insurance Program members who were improperly disenrolled due to administrative problems. Some in the managed care industry believe that text messaging could drastically reduce the amount of procedural disenrollments, but a managed care trade group says that regulatory and operational struggles stand in the way of texting’s full potential. 

State-led verification of Medicaid eligibility restarted earlier this year after being paused for several years as part of the federal response to the COVID-19 pandemic. According to KFF, “at least” 7.87 million people have been disenrolled through Oct. 2 — a figure that is almost certainly an “undercount” due to reporting lags of state data. KFF also found that 73% of people disenrolled from Medicaid lost coverage for “procedural reasons.” 

J.D. Power & Co., in the latest edition of its annual survey of consumer satisfaction with telehealth brands, gave UnitedHealthcare, the managed care arm of UnitedHealth Group, the highest marks of any insurer. The company beat out second place Kaiser Permanente and third place Humana Inc. for the top spot.   

Insurers have invested heavily in telehealth since the beginning of the COVID-19 pandemic. Starting in 2020, due to pandemic lockdown orders, telehealth became a key care modality in a way that it never had been before. UnitedHealthcare, according to a press release touting the J.D. Power results, offers telehealth products such as 24-hour virtual urgent care without cost sharing and virtual primary care. The health care giant in June made 24-hour virtual care available to 5 million of its fully insured members without cost sharing.  

Private insurers paid providers a similar amount for both evaluation and management and mental health therapy services regardless of whether the care was delivered in person or via telehealth in 2021, according to KFF-Peterson Health System Tracker. The analysis noted that while private insurers and employers were paying about the same amounts for in-person and telehealth in 2020, it was initially unclear whether they would continue to do so in 2021.

Telehealth use for mental health therapy surged with the COVID-19 pandemic: In 2021, more than half of mental health services were delivered via telemedicine, compared to only 1% in 2019. Common mental health therapy claims were paid at similar rates for in-person and telehealth care.