Anthem Raises Profit Forecast for 2022 After Promising 1Q

Anthem, Inc. reported strong first quarter financial results, prompting the insurer to raise its earnings guidance for the year. The company attributed the change largely to a lower-than-expected COVID-19 impact, as the Omicron variant and the long-term effect of delayed care during previous COVID peak periods was less severe than Anthem had originally projected in January.

For the first quarter, Anthem generated $8.25 in adjusted earnings per share (EPS), beating the Wall Street consensus of $7.82. The insurer increased its full-year EPS guidance to greater than $28.40, up from its previous EPS estimate of $28.25.


Insurers Applaud New Medicare Coverage for OTC COVID Tests

Medicare Part B will now cover eight over-the-counter, at-home COVID-19 tests per month with no cost sharing for beneficiaries starting April 4, according to a new Biden administration policy. Medicare Part B and Medicare Advantage beneficiaries will be able to order the tests from a government website or acquire them from participating retailers through the end of the public health emergency.

The new benefit will not require much participation from Medicare Advantage plans, although their members are eligible to receive it. Members can submit purchases for reimbursement or obtain the tests for free from retailers.


Mental Health Care Access Varies Across Demographics, Insurance Coverage

One in four adults reported symptoms of anxiety and/or depression prior to the COVID-pandemic, according to a Kaiser Family Foundation analysis of the National Health Interview Survey in 2019. While the rates of people reporting mental health symptoms across racial and ethnic groups are similar, a much larger share of Black adults with moderate to severe symptoms did not receive treatment. Meanwhile, uninsured people were significantly more likely to not receive mental health care (62%) compared to their insured counterparts (36%). Since the pandemic began, more people suffered from poor mental health, with one-third of adults reporting anxiety and/or depressive disorder in February 2022.

Millions Will Lose Medicaid Coverage After PHE Ends; Only Half of States Have Plans in Place

More than 14 million Medicaid enrollees could lose their coverage within six months when the COVID-19 public health emergency (PHE) ends, a Commonwealth Fund report projected. Meanwhile, Kaiser Family Foundation’s 50-state survey found that many states have not made key decisions on how to promote continuity of coverage. While the PHE is set to expire on April 16, HHS has said it would give at least 60 days’ notice before ending it, suggesting another extension is coming.


News Briefs: Centene Appoints New CEO Amid PBM Overhaul

Centene Corp. has named Sarah London as its new CEO after its longtime chief executive, Michael Neidorff, took a medical leave of absence ahead of his planned retirement. London, who was serving as Centene’s vice chairman, will take the helm immediately. In her previous management role, London was responsible for a “portfolio of companies independent of Centene’s health plans, designing differentiated platform capabilities, and delivering industry-leading products and services to third-party customers,” per a March 22 press release. Before coming to Centene, she worked for UnitedHealth Group’s venture capital arm, Optum Ventures, and its data solutions division, Optum Analytics. London’s appointment comes at a time when Centene is planning an overhaul of its PBM assets, with a request for proposal seeking an external vendor due this summer. The firm in recent months has paid millions of dollars to settle accusations by states that its PBM operations overcharged their Medicaid programs for prescription drugs. During Centene’s Feb. 8 conference call to discuss fourth-quarter and full-year financial results, London told analysts that “the strategy here is to outsource administrative PBM functions to an external partner, thereby allowing us to reduce our three PBM platforms down to one and to focus...[on] clinical member and provider engagement.”

Health Care and Life Sciences Are Facing Headwinds, but Investors Remain Interested in Deals

Health care and life sciences (HCLS) organizations took a tremendous hit from COVID-19 and its secondary effects, including labor shortages, rising wages, supply chain problems and inflation. In addressing the challenge posed by the pandemic, these companies were able to produce impressive progress, not the least of which were the development and delivery of vaccines, therapeutics and tests for COVID. In addition, telehealth evolved quickly, producing new delivery models across multiple parts of the health care system.

But even when faced with multiple headwinds and more uncertainty, investors continue to compete for HCLS acquisitions. According to a recent KPMG LLP report, merger-and-acquisition (M&A) activity across both sectors “bounced back with a vengeance” in 2021: 1,839 deals, not counting joint ventures, minority investments and venture funding. That’s up from 1,618 deals in 2020 and 1,543 deals in 2019.

Payers, Governments Invest in Rural Areas During Pandemic

During the COVID-19 pandemic, payers and federal and local governments are taking steps to improve health outcomes in rural, non-metropolitan communities, where case and mortality rates are significantly higher than in metropolitan areas.

Some of those initiatives include offering grants to health care providers, expanding access to telehealth and hosting events and campaigns to increase vaccinations, according to three speakers who discussed the pandemic and rural health during a Feb. 28 webinar hosted by the National Institute for Health Care Management (NIHCM) Foundation.


Horizon and CINJ Are Piloting Home Infusion Oncology Program

When the COVID-19 pandemic struck, to say the health care system was disrupted is an understatement. Many people undergoing treatment for cancer rightfully were concerned about their potential exposure to the virus and were hesitant to leave their homes for care. In order to continue treating some patients, Horizon Blue Cross Blue Shield of New Jersey partnered with Rutgers Cancer Institute of New Jersey (CINJ) and RWJBarnabas Health to start a pilot to offer home infusion of cancer treatments and telemedicine support for eligible people, the first such program in the state.

In addition to not putting people at risk of acquiring an illness, home infusion means that people don’t have to travel for treatment. It also provides them with one-on-one care, close monitoring during infusions and the ability to schedule treatments around their personal schedule. These benefits are especially important for people with compromised immune systems.

AHIP Will Prioritize Telemedicine, Health Equity Post-Pandemic

On Feb. 23, health insurer trade group AHIP hosted a virtual State of the Industry presentation, reviewing progress made in 2021 and important issues for the health insurance industry as it looks to a world beyond the COVID-19 pandemic.

Matt Eyles, president and CEO of AHIP, opened the conversation with a look at the organization’s 2021 initiatives and hopes for 2022. Eyles stressed the importance of the No Surprises Act, which aims to protect consumers from surprise medical bills. The legislation went into effect on Jan. 1, but it is currently the subject of a number of lawsuits filed by organizations including the American Hospital Association and American Medical Association. “AHIP continues to fight and protect the law,” Eyles said during the presentation.


Big Insurers Change Little About Coverage of At-Home COVID Tests

A little more than a month after the Biden administration directed private health plans to fully cover at-home COVID-19 tests, insurers now have additional clarity from regulators about how to operationalize that mandate. Still, the country’s largest insurers do not appear to have significantly changed their approaches for covering at-home COVID tests since mid-January — with some still requiring members to submit claims for reimbursement rather than setting up more consumer-friendly direct-coverage pathways.

A Jan. 10 guidance document issued by the administration stated that by Jan. 15, all private group and individual health plans had to start covering up to eight over-the-counter, at-home COVID-19 tests per month for each covered member without imposing cost sharing or utilization management requirements. Previously, pandemic relief legislation required insurers to cover only diagnostic tests that were processed by a lab and ordered by a health care professional.