Health Plan Weekly

Private Plans in Michigan Stall Under CPC+ Model

A primary care reform model in Michigan failed to deliver intended cost savings and quality improvements among two private payers, casting doubt on whether current value-based model designs in the primary care space have the muscle to exert real benefits.

A study published in the September issue of Health Affairs analyzed the spending and quality results of two large insurers in Michigan that offered a payment reform model designed after the federal Comprehensive Primary Care Plus (CPC+) program. The results were muted: Among the private payers involved, the CPC+ model failed to reduce total spending; the results indicate that, when accounting for care management fees, spending actually rose under the CPC+ program. On the quality side, performance remained unchanged between CPC+ and non-CPC+ participants.

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Walmart, UnitedHealth Strike Latest Insurer-Retail Clinic Deal

Walmart Inc. and UnitedHealth Group will launch a co-branded Medicare Advantage plan in Georgia, license Optum-branded analytic and decision-making tools to existing Walmart Health clinics in 15 Florida and Georgia locations, and use Optum software to enable those Walmart clinics to enter value-based network agreements with MA plans.

One health care insider tells AIS Health that the move is further evidence of patients’ frustration with traditional, standalone clinics — and evidence that managed care firms are placing heavy bets on new types of providers to capitalize on that dissatisfaction.

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News Briefs: Home Depot Appeals Settlement With BCBSA

The Home Depot, Inc. and two other employers — Topographic and Employee Services Inc. — have appealed a $2.67 billion settlement reached in connection with a class-action lawsuit against the Blue Cross Blue Shield Association (BCBSA). The litigation, which has been ongoing since 2012, challenges Blues plans’ agreement to divide the country among the association’s 36 members and to restrict members’ ability to offer non-Blues products, alleging that constitutes anticompetitive behavior. The decision to appeal the settlement could delay the disbursement of funds as well as the changes expected to come about from the settlement, which could give Blues plans more freedom to collaborate and consolidate, experts told AIS Health in 2020. A federal judge signed off on the settlement in August.

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Public Coverage Is Up, Private Coverage Is Down — Yet Likely Not for Long

The uninsured rate dipped slightly between 2020 and 2021, and while private insurance continued to be the most common type of coverage, it decreased in prevalence while government coverage increased, according to new data from the U.S. Census Bureau. One Wall Street analyst suggests that the findings are unsurprising given the current policy and demographic landscape, but he notes that trends are poised to change considerably when millions cease to qualify for Medicaid.

The Census Bureau’s survey, conducted between February and April, asked individuals whether they had any type of health coverage in the past calendar year. In 2021, 8.3% of the U.S. population lacked health insurance, compared to 8.6% in 2020. Put another way, 27.2 million Americans did not have coverage last year, down from 28.3 million the year prior. The 2021 uninsured rate of 8.3% represented a small uptick compared to 2019, however, when it reached a low of 8.0%.

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Armed With Transparency Data, Purchaser Groups Focus on Rising Prices

Amid growing medical cost trend and broad fears of inflation, two major purchaser groups have unveiled initiatives to coordinate plan sponsors in an effort to lower health care prices. Managed care experts tell AIS Health, a division of MMIT, that purchasers’ frustration with high prices are valid, but they don’t expect prices to come down any time soon with inflation and other macroeconomic trends set to wash over the health care sector.

The National Alliance of Healthcare Purchaser Coalitions (NAHPC) recently released a “playbook” white paper for regional purchaser groups and employers seeking to rein in price increases. The term purchaser coalition refers to a number of regional nonprofits across the country that are composed of the region’s largest employers; those groups comprise NAHPC’s membership. NAHPC’s largest member, the Purchaser Business Group on Health (PBGH), also rolled out a new plan to manage costs.

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Key Financial Data for Leading Health Plans — Second Quarter 2022

Here’s how major U.S. health insurers performed financially in the second quarter of 2022. Health Plan Weekly subscribers can access more health plan financial data — including year-over-year comparisons of leading health plans’ net income, premium revenue, medical loss ratios and net margins. Just email support@aishealth.com to request spreadsheets for current and past quarters.

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AHIP Cheers Ruling in Dialysis Payment Case, but Congress Could Step In

Recently, health insurance trade group AHIP highlighted an under-the-radar Supreme Court ruling that centered on who should pay the bulk of the costs associated with treating some of the sickest patients: those with end-stage renal disease (ESRD). However, industry experts tell AIS Health, a division of MMIT, that what seems to be a victory for employer-based plans may be short-lived if Congress weighs in on the issue.

The case, Marietta Memorial Hospital Employee Health Benefit Plan v. DaVita Inc., concerned whether an employer-based health plan violated the Medicare Secondary Payer Statute (MSPS) by offering limited outpatient dialysis benefits to its enrollees. Specifically, the health plan in question had no in-network dialysis providers, capped reimbursement at 87.5% of the Medicare rate, and “imposed utilization management restrictions, such as claims audits and reviews,” health law attorney and Georgetown University research professor Katie Keith noted in a June article for Health Affairs.

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News Briefs: UnitedHealth, Walmart Ink Medicare Advantage Deal

UnitedHealth Group on Sept. 7 unveiled a “10-year, wide-ranging collaboration” with Walmart Inc., which will start in 2023 with 15 Walmart Health locations in Florida and Georgia. UnitedHealth’s Optum division will provide Walmart Health clinicians with “analytics and decision support tools” to help them improve outcomes for Medicare beneficiaries, and the two firms will offer a co-branded Medicare Advantage plan starting in January called UnitedHealthcare Medicare Advantage Walmart Flex (HMO-POS). Commercial health plan members with UnitedHealthcare’s Choice Plus PPO plan will also have in-network access to Walmart Health Virtual Care, effective in January. “Eventually, the collaboration aims to serve even more people, including those across commercial and Medicaid plans, by providing access to fresh food and enhancing current initiatives to address social determinants of health, over-the-counter and prescription medications, and dental and vision services,” stated a UnitedHealth press release.

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Three Major Insurers Will Expand ACA Exchange Footprints in 2023

Galvanized by a growing, stable Affordable Care Act exchange market and a looming dropoff in Medicaid membership, some of the country’s largest health insurers in 2023 are once again expanding their ACA marketplace footprints. At the same time, two startup insurers are pulling out of select markets — although one policy expert tells AIS Health that those moves mainly reflect how difficult it is to compete against companies with dominant market shares.

Katherine Hempstead, senior policy adviser at the Robert Wood Johnson Foundation, says significant enrollment growth in Southern states appears to be driving some insurers’ expansion moves this year.

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MCO Stock Performance, August 2022

Here’s how major health insurers’ stock performed in August 2022. UnitedHealth Group had the highest closing stock price among major commercial insurers as of August 31, 2022, at $519.33. Humana Inc. had the highest closing stock price among major Medicare insurers at $481.78.

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