Health Plan Weekly

Change Healthcare is the target of an ongoing cyberattack that is causing significant disruption for providers and pharmacists that rely on the UnitedHealth Group subsidiary to process claims, payments and authorizations.  

While two prominent credit-rating firms say the incident likely won’t affect the credit worthiness or earnings outlook of UnitedHealth’s overall enterprise, one industry expert says the Change cyberattack does still pose risks for the company — and puts similarly diversified health insurers on notice. 

“There’s just no guarantee that anybody’s going to be entirely safe from cyberattacks,” says Dean Ungar, a vice president and senior analyst at Moody’s Investors Service. “I think this does serve as a wake-up call or reminder to everyone in the industry…Even those [firms] that weren’t hit probably took this opportunity to take another look at what they’re doing and make sure that they’re protected — to the extent that you can be.” 

Part of a long-running lawsuit filed by Elevance Health, Inc. against The Cigna Group, over what Elevance considers inappropriate contract practices by Cigna's Express Scripts PBM, entered mediation mandated by the Second Circuit Court of Appeals, according to court documents and Elevance’s latest 10-K filing with the Securities and Exchange Commission (SEC). Elevance was seeking to recover $14.8 billion in damages and is now appealing a district court judge’s dismissal of its remaining claim. 

David Kaufman, an attorney at Laurus Law Group LLC, says that the mediation mandated by the Second Circuit is unlikely to do much to satisfy Elevance.  

“Perhaps the parties could reach an agreement through mediation that will be supervised by the court,” Kaufman says. “I don’t know how likely that is considering the magnitude of the money that they’re seeking.” 

More than half — 52% — of adults covered by commercial insurance deal with social risk factors that can raise health care costs, according to a Feb. 20 white paper from UnitedHealth Group and the Health Action Council (HAC). UnitedHealth and HAC executives say that the report’s findings can help health plans and plan sponsors be more proactive in addressing social determinants of health (SDOH)-related needs in commercial populations. 

Some SDOH challenges faced by the commercially insured population include social isolation and problems with finances, food, and housing, per the report. Twenty-six percent of the studied group faced one SDOH risk, 16% faced two SDOH risks and 10% faced three or more. 

With respective increases of 10.8% and 10.7% in 2023, health care spending on prescription drugs and home health care rose the fastest out of seven health care categories analyzed in a recent Altarum report.

Total national health care expenditures grew by 6.2% last year, while gross domestic product (GDP) increased by 6.3% year over year. In December 2023, health care spending accounted for 17.2% of GDP and has remained below 17.5% since January 2022. About 84% of health spending was attributed to personal health care, half of which was spent on hospital care and physician and clinical services.

Since the Supreme Court overturned Roe v. Wade last year, 8% of large firms offering health insurance to their employees reduced or expanded their coverage for abortion. That’s according to an analysis of KFF’s Employer Health Benefits Survey, which found that 3% of firms whose largest plan does not cover abortion or covers it under limited circumstances reduced or eliminated coverage for abortion. Meanwhile, 12% of firms whose largest plan covers abortion in most or all circumstances added or expanded abortion coverage. KFF defined large employers as those with at least 200 workers.  

U.S. health insurance companies’ capitalization levels are expected to increase this year but at a lower rate than last year, according to an AM Best report released on Feb. 29. The credit rating firm noted that the growth should slow because many insurers are seeing less profitability in their Medicare Advantage and managed Medicaid books of businesses. The report found the growth in net premiums written by health insurers increased 10% in 2022 and 7.6% through the first three quarters of last year.