Health Plan Weekly

Medicaid Plans Get Ready for Yearlong Postpartum Care

State Medicaid programs now have the option of applying to CMS to expand postpartum coverage for parents who have just given birth to 12 months, up from the default 60 days of coverage. Medicaid MCOs in states that have opted into the expanded coverage tell AIS Health, a division of MMIT, that they are taking steps to get ready for the new coverage and anticipate better outcomes for both new parents and new children as a result of the program.

Maternal mortality rates in the United States are disturbingly high compared to other developed countries — in 2018, 17 women per 100,000 live births died, compared to three in the Netherlands, Norway and New Zealand, per the Commonwealth Fund — and the U.S. is the only developed country to see that rate increase in recent years. Most of those deaths were preventable.

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© 2024 MMIT

Cigna Eases Investor Fears With Better Medical Cost, Membership

Cigna Corp. pleased Wall Street with its first-quarter 2022 financial results, touting a solid increase in commercial self-funded membership and a better-than-projected medical loss ratio (MLR) of 81.5%.

The insurer posted first-quarter 2022 net income of $1.18 billion ($3.68 per share) on revenue of $44.0 billion, up from net income of $1.16 billion ($3.30 per share) on revenue of $40.1 billion for the same period in 2021.

Cigna’s self-funded commercial membership rose 9% to 12.5 million through March 31, while insured commercial membership rose 2% to 2.2 million. In all, Cigna had 17.8 million medical members on March 31, 2022, up about 700,000 or 4% from Dec. 31, 2021, when it stood at 16.7 million.

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Study: 25% of Medicaid Docs Provide At Least 75% of Care

About a quarter of the practitioners in Medicaid managed care organization networks provide more than three-quarters of the services used by members, according to an article published by researchers affiliated with Yale and Cornell Universities in the journal Health Affairs this month. Experts say that this concentration of care likely limits access to care for members, and health plans need to do more to make sure their networks aren’t made up of so-called “ghost providers.”

The article, which analyzed claims and enrollment data from Kansas, Louisiana, Michigan and Tennessee during 2015-17, found that care delivery is highly concentrated in both primary care and specialists. However, the authors caution that their study of the states “might not generalize nationally” and only studied four specialties.

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© 2024 MMIT

News Briefs: Oscar Leaves Arkansas, Colorado

Oscar Health, Inc. will cease operations in Arkansas and Colorado at the end of this plan year. Chief Financial Officer Scott Blackley defended the decision by saying “they’re really small” markets for the firm in response to a question from Goldman Sachs analyst Nathan Rich during the startup insurer’s latest earnings call, according to the Motley Fool. He added that “they don’t have a significant or even close to material effect [on profits.] There is a benefit though from just reducing…compliance work.” The firm has yet to post a profit, prompting criticism from managed care insiders.

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© 2024 MMIT

Some Insurers May Not Be Ready for Price Transparency Mandates

Insurer price transparency rules are finally starting to come into effect after years of litigation and administrative delays, but it’s not clear whether insurers will be compliant when deadlines arrive. Health care insiders tell AIS Health, a division of MMIT, that larger carriers have an advantage in implementation and smaller insurers may have a more difficult time keeping up.

Federal enforcement of payer price transparency rules by HHS and the departments of Labor and Treasury will begin on July 1 of this year. That deadline, during which plans will need to “make public machine-readable files disclosing in-network rates and out-of-network allowed amounts and billed charges,” per a government document, is the first of many health plan transparency requirements that will come into effect over the next two years.

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© 2024 MMIT

AHIP: States Should ‘Carefully Consider’ Basic Health Program

With millions of people at risk of losing Medicaid coverage once the COVID-19 public health emergency ends, two states are setting up insurance programs designed to scoop up people who make too much for Medicaid and find Affordable Care Act exchange coverage unaffordable.

If Oregon and Kentucky follow through on their plans to set up Basic Health Programs (BHPs), they’ll join just two other states — New York and Minnesota — that have taken advantage of an often-overlooked provision of the ACA, Section 1331. However, there is some evidence that health insurers are wary of BHPs gaining traction.

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© 2024 MMIT

Aetna Is Star of the Show in CVS First-Quarter Financial Results

CVS Health Corp. posted robust financial results in the first quarter of this year, with revenues increasing by 11.2% to $76.8 billion. Wall Street praised the firm — particularly its Aetna health insurance division — for delivering strong results, and predicted the Caremark PBM would overcome disappointing results for the first quarter.

The integrated health care company’s quarterly adjusted operating income was $4.48 billion, increasing nearly 7% year-over-year from the first quarter of 2021.

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© 2024 MMIT

MCO Stock Performance, April 2022

Here’s how major health insurers’ stock performed in April 2022. UnitedHealth Group had the highest closing stock price among major commercial insurers as of April 29, 2022, at $508.55. Molina Healthcare, Inc. had the highest closing stock price among major Medicaid insurers at $313.45.

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© 2024 MMIT

Telehealth Usage Expands by Over 7,000% During the Pandemic

Driven by the COVID-19 pandemic, telehealth utilization increased 7,060% from 2019 to 2020, while utilization dropped 38% in ambulatory surgery centers, 30% in emergency rooms, 16% in urgent care centers and 4% in retail clinics, according to a new FAIR Health white paper. The FH Medical Price Index tracks the weighted average growth in median procedure charges and median allowed amounts. Among the six procedure categories it studied, hospital evaluation and management saw the largest percent increase in both the charge amount index and allowed amount index.

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© 2024 MMIT

News Briefs: Centene Will Sell Off Two PBM Assets

As part of its PBM restructuring efforts, Centene Corp. will sell two pharmacy benefits subsidiaries, Magellan Rx and PANTHERx, for approximately $2.8 billion in separate deals. Magellan Rx will be sold to Blue Cross and Blue Shield affiliate-owned PBM Prime Therapeutics for $1.35 billion, while specialty pharmacy PANTHERx will be sold to a group of private equity firms that includes The Vistria Group, General Atlantic and Nautic Partners for $1.45 billion. Both prices are preliminary and the deals must undergo antitrust review. The PANTHERx sale “is expected to close in the next two to four months,” according to a Centene press release, while Magellan Rx “is expected to close in the fourth quarter of 2022.” Centene executives have sought to sell the firm’s PBM assets for some time; new CEO Sarah London said in February that the firm planned to “reduce our three PBM platforms down to one and to focus...[on] clinical member and provider engagement.” After the deals, Centene will retain PBM Envolve Health, presumably to fulfill those functions. Meanwhile, Centene has spent millions to settle claims by state Medicaid programs that it overcharged them for prescription drugs.

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© 2024 MMIT