Since Oregon placed a payment cap on hospitals for its state employee health plans, beneficiaries have seen a reduction in out-of-pocket spending and an increase in utilization, according to a recent JAMA Health Forum study. Roslyn Murray, Ph.D., the lead author, tells AIS Health that “there’s an appetite” from other states to implement similar price regulations, although they have faced pushback from providers.

The Oregon State Legislature passed a law in 2017 limiting in-network facility prices at 24 urban hospitals to 200% of Medicare prices and out-of-network hospital facility prices to 185% of Medicare prices. The legislation applied to members of the state employee plans, which provide benefits for two groups: educators in school districts and community colleges (known as the Oregon Educators Benefit Board) and employees of state agencies and universities (known as Public Employees Benefit Board).

Health Care Service Corp. (HCSC), which owns Blue Cross Blue Shield plans in Illinois, Montana, New Mexico, Oklahoma and Texas, recently rolled out an “alternative health plan” that combines what essentially is a tiered provider network, price transparency and streamlined medical billing.

Industry experts who spoke to AIS Health, a division of MMIT, say HCSC’s new benefit design has a variety of intriguing elements that could prove attractive to employers. Indeed, UnitedHealthcare has in recent earnings calls been touting the rising popularity of a similar offering.

The Biden administration on Sept. 9 finalized a sweeping set of regulations that aim to ensure health plans are covering behavioral health treatment as comprehensively as they cover medical care. The move was met by rapid criticism from a coalition of trade groups representing health insurers and large employers, which argued the new regulations “will not address the inadequate supply of mental health providers.”

But other groups, such as a mental health advocacy organization tied to the Kennedy family, welcomed the rules as a necessary step forward to ensure compliance with the Mental Health Parity and Addiction Equity Act (MHPAEA). And one health policy expert tells AIS Health, a division of MMIT, that there are reasons to be skeptical of some criticisms lobbed at the new regulations by plan sponsors and insurers.

Elevance Health, Inc. has agreed to acquire Indiana University Health Plans, according to a Sept. 10 press release. IU Health Plans, a subsidiary of Indiana University Health, has 19,000 Medicare Advantage members and 12,000 fully insured commercial beneficiaries. It will become a part of Anthem Blue Cross and Blue Shield in Indiana, which is Elevance’s insurance affiliate in the state. The deal is subject to customary closing conditions and is expected to close by the end of the year.

Here’s how major U.S. health insurers performed financially in the second quarter of 2024. 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.

In the first quarter of 2024, annual growth in health care spending exceeded the levels seen before the COVID-19 pandemic. Yet hospital inpatient admissions, on a per capita basis, remained lower than pre-pandemic levels, reflecting a shift to outpatient centers, according to a recent Peterson-KFF Health System Tracker analysis.

As many elective hospitalizations were canceled or delayed at the beginning of the pandemic, health care spending dipped in late 2019 and early 2020. Shortly after that, year-over-year growth in health services spending rebounded to pre-pandemic levels and remained high, with double-digit growth since early 2023. Nursing and residential care facilities spending saw year-over-year growth ranging from 10.0% to 13.4% since the beginning of 2023.

CareFirst BlueCross BlueShield, one of the largest insurers in the mid-Atlantic region, recently announced its involvement in a program for early stage technology companies looking to develop artificial intelligence (AI) products for the health care sector. A CareFirst executive tells AIS Health that the payer hopes to learn more about what is happening in the AI space for potential use within the company. One expert, however, says insurers for the most part are still contemplating how to implement AI in their workflows while also being cognizant of its potential flaws.

CareFirst is partnering with Johns Hopkins University for the TechStars AI Health accelerator that will take place in March 2025 in Baltimore. TechStars is a company that invests in and provides guidance and money to startup companies in several industries. The firm hosts numerous so-called accelerators, which are months-long programs where founders of young companies meet with experienced industry leaders and investors. TechStars invests $120,000 in the companies it chooses for the accelerators in exchange for a 6% to 9% equity stake. Most accelerators receive hundreds of applicants, of which TechStars usually selects 20 or fewer to participate.

David Cordani, CEO of The Cigna Group, made it clear during a Sept. 5 presentation at the Morgan Stanley Healthcare Conference that the firm doesn’t view the elevated medical costs facing health insurers this year as a threat to its diversified portfolio.

Cigna Healthcare, the firm’s health insurance business, in the “recent timeframe” has been able to deliver “good, predictable” medical loss ratios (MLRs), Cordani said, referring to a closely watched metric that shows the percentage of premiums spent on medical claims.

During the Wells Fargo Healthcare Conference on Sept. 4, executives from Centene Corp. and Humana Inc. shared new details about how the headwinds facing their Medicaid and Medicare businesses are expected to play out. And within those updates, there was both good and bad news.

Centene Chief Financial Officer Drew Asher said during his presentation that the firm is “continuing to get Medicaid pressure,” largely due to the resumption of routine eligibility checks that restarted last spring after a multiyear pause during the COVID-19 pandemic. Centene discussed the issue at length during its second-quarter earnings call in July, “and so you might ask, all right, what’s changed in the last month and a half?” Asher said. 

Elevance Health, Inc. will offer Affordable Care Act exchange plans in three new states next year. The insurer’s Wellpoint-branded plans will expand into Florida, Maryland and Texas — all states where it has a managed Medicaid presence. According to AIS’s Directory of Health Plans, Elevance Health has approximately 1 million members enrolled in ACA exchange plans, making it the insurer’s smallest market segment. As of 2024, the insurer offered exchange plans in 10 states, with California, Virginia and New York representing its three largest markets.

The value of Affordable Care Act marketplace plans decreased from 2014 to 2023, according to a Paragon Health Institute report published on Sept. 3. The authors — actuaries Daniel Cruz and Greg Fann — noted that just 11% of exchange customers were enrolled in plans with broad provider networks in 2023, down from 36% in 2014. During that same period, gross premiums in the individual marketplace increased 50% more than premiums for people enrolled in employer plans. The authors argued that “the ACA insurance rules caused premiums to increase and led insurers to offer narrower and more restrictive networks over time” and that “the design of the ACA premium tax credits has also incentivized enrollees to select lower-quality plans.”