Health Plan Weekly

In his first shareholder meeting since returning to the helm of an embattled UnitedHealth Group, CEO Stephen Hemsley aimed to reassure shareholders that the diversified health care company can get its business back on track. But some industry experts suggest that UnitedHealth’s turnaround ought to involve reevaluating its philosophy in addition to shoring up its margins.

“UNH’s intense — and to date, very profitable — focus on ‘coding to the metric’ doesn’t bode well for a shift to a more patient-oriented culture,” says Joseph Paduda, principal of the consulting firm Health Strategy Associates. “Staff have long been evaluated based on quarterly earnings and other easily measured metrics (coding, pricing, enrollment); Helmsley’s desire to ‘help people experience more years of good health and less time navigating health care’ will cause whiplash in a giant organization ill-equipped to make patient experience a central value,” Paduda adds, referring to Hemsley’s remarks during UnitedHealth’s June 2 meeting with shareholders.

In J.D. Power’s 2025 U.S. Commercial Member Health Plan Study, the company highlighted a widening gap between the highest and lowest performing health plans, which lays bare some increasingly meaningful differences in how members perceive the service, communication and value they’re receiving. According to J.D. Power, part of what may be driving that trend is a virtuous — rather than vicious — cycle.

“Plans that have kind of ‘gotten religion’ have leaned into that,” says Caitlin Moling, senior director of global healthcare intelligence at J.D. Power. “They’re seeing, oh you know, if we give better communications or offer tailored approaches, we don’t have to spend as much on call centers.” On the other end of the spectrum, “there are plans that have not simply leaned into member satisfaction and are still hoping that square peg will fit in the round hole, efficiency wise,” Moling continues. “That widening gap is showing that satisfaction is no longer [just] the ‘nice to have’ factor.”

Elevance Health, Inc. saw increased health care utilization among its Affordable Care Act exchange members in April, according to CEO Gail Boudreaux, who spoke on May 28 during the Bernstein Strategic Decisions Conference. However, Elevance in a Securities and Exchange Commission filing on the same day reaffirmed its financial guidance for 2025.

Boudreaux attributed the higher ACA exchange utilization to a different member mix from a year ago and a higher risk population, which was particularly true for people who received large premium subsidies to offset the cost of their plans. She added that exchange beneficiaries used more behavioral health services than Elevance anticipated.

As Medicare Advantage and Part D organizations submitted their bids for plan year 2026, the impact of the Inflation Reduction Act (IRA) created continued uncertainty around the direct subsidy that covers a portion of plans’ Part D costs. At the same time, there remained heightened concern around maintaining and improving margin, as large publicly traded firms struggled with pricing last year that didn’t match utilization, and sponsors were forced to take a deeper look at their service areas and benefits to maintain margin stability.

And that’s just scratching the surface of the many considerations that went into bids this year, according to actuaries who spoke with AIS Health, a division of MMIT, after helping MA and Part D clients prepare their bids by the June 2 deadline.  

The Congressional Budget Office on June 3 estimated that 10.9 million people enrolled in the individual market and Medicaid would lose health insurance coverage through 2034 if the version of the “One Big Beautiful Bill Act” advanced by the House becomes law. The CBO also projects the bill would increase the federal deficit by nearly $2.4 trillion over the next decade. AHIP noted in a June 4 statement that CBO also estimates 4.2 million people in Affordable Care Act exchange plans would lose coverage if the enhanced premium tax credits are allowed to expire at the end of the year. “This combination will destabilize the individual insurance market, resulting in diminished competition, fewer choices and higher premiums — all at a time when millions of people no longer covered by Medicaid will need affordable sources of stable coverage,” AHIP said.