Data & Analytics

MMIT Reality Check on Multiple Sclerosis (1Q2023)

A review of market access for multiple sclerosis treatments shows that under the pharmacy benefit, about 62% of the lives under commercial formularies are covered with utilization management restrictions. Around 47% of the lives under Medicare formularies are not covered for at least one of the drugs.

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Medicaid Beneficiaries Are Unequally Served by Non-Emergency Medical Transportation

Medicaid beneficiaries of different races and ethnic backgrounds may not have equal access to non-emergency medical transportation (NEMT), suggests a new study from the Medical Transportation Access Coalition (MTAC). While only a small number of Medicaid beneficiaries use NEMT, it is more common among beneficiaries with complex, costly medical needs. When breaking down NEMT utilization by race and ethnicity, MTAC (staffed by Faegre Drinker Consulting, in partnership with the National Opinion Research Center) found that the number of riders was not proportionate to overall enrollment distribution, which “indicates that NEMT is not serving beneficiaries of different races and ethnicities equally and may suggest a need for focused education about NEMT to certain groups.” Researchers and policymakers should focus on finding and addressing the root causes of these differences, the authors asserted. American Indian and Alaska Native beneficiaries had the highest utilization rates, followed by Black enrollees, then white enrollees.

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MMIT Reality Check on Macular Edema (1Q2023)

A review of market access for macular edema treatments shows that under the pharmacy benefit, about 30% of the lives under commercial formularies are covered with utilization management restrictions. Around 58% of the lives under Medicare formularies are not covered for at least one of the drugs.

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Elevance-BCBS of Louisiana Deal, by the Numbers

Elevance Health has signed a deal to acquire Blue Cross and Blue Shield of Louisiana, the companies said on Jan. 23. With 1,049,194 members, BCBS of Louisiana is currently the second-largest health insurer in the state, according to AIS’s Directory of Health Plans. Combined, the two insurers will surpass the current market leader, UnitedHealthcare, with over 1.4 million enrollees in the state.

The acquisition builds on an existing joint ownership of Healthy Blue, which offers Medicaid and Medicare dual eligible coverage. The deal would expand Elevance’s presence in the state by 281%. If the deal closes, Elevance, the largest Blue Cross and Blue Shield affiliate with almost 37.6 million enrollees, will operate as a Blues licensee in 15 states.

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Elevance’s Louisiana Purchase Could Portend More Blue Cross Blue Shield Consolidation

Elevance Health, Inc. on Jan. 23 announced a deal to acquire Blue Cross and Blue Shield of Louisiana, breaking what one analyst called a nearly two-decade “ice age” in which no major consolidation among Blues took place. Experts say it’s unclear whether the tie-up is a harbinger of a flurry of similar dealmaking, but they suggest that the time may be right to see additional mergers and acquisitions (M&A) among Blues affiliates.

“It has been a long drought” since Blues plans conducted major M&A, observes Ashraf Shehata, national sector lead for health care and life sciences at KPMG. And during that time, the country’s largest health plans have gotten larger and more diversified. “So I think…it’s probably time for the industry, especially on the Blue side, to consolidate a bit more,” Shehata tells AIS Health, a division of MMIT.

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MMIT Reality Check on Epilepsy (1Q2023)

A review of market access for epilepsy treatments shows that under the pharmacy benefit, about 35% of the lives under commercial formularies are covered with utilization management restrictions. Around 11% of the lives under Medicare formularies are not covered for at least one of the drugs.

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Report Offers Ways to Fix ‘Hot Mess’ of Health Plan Price Transparency Data

Although health plans have started to comply with a federal transparency rule that requires them to publicly post reams of information about provider payments, “multiple problems have rendered the published data largely inaccessible and unusable,” according to a new report.

The report, produced by Georgetown University’s Center on Health Insurance Reforms (CHIR), is the product of a recent collaboration between a slew of prominent health policy and economics researchers who were convened by CHIR Director Sabrina Corlette. The idea was to develop recommendations that would make the “Transparency in Coverage” regulation more effective in its quest to shine a light on health care cost information.

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Talk of Flu Season, OptumInsight Colors UnitedHealth 4Q Earnings Call

During the company’s recent conference call to discuss fourth-quarter and full-year 2022 financial results, UnitedHealth Group executives touched on subjects ranging from the historically bad flu season to the future of the company’s data analytics division. All in all, equities analysts declared the health care giant to be on strong footing as 2023 gets underway — a positive sign, they say, for a managed care sector that tends to follow where UnitedHealth leads.

“Within MCOs, there is little fundamental concern,” Jefferies analysts advised investors on Jan. 17, with each MCO’s earnings per share (EPS) likely to see a compound annual growth rate of about 12% through 2024. And while UnitedHealth shares are priced at a “nearly unprecedented 35% premium” relative to its peers, the analysts suggested that the diversified firm’s OptumInsight and OptumHealth divisions “make a case for the widening spread.”

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Executive Compensation Data for Presidents and/or CEOs of Blue Cross and Blue Shield Affiliates, 2021

See a full list of director compensation for Presidents and/or CEOs of Blue Cross and Blue Shield Affiliates at https://bit.ly/3GPOdyK, compiled by AIS Health.

N/A = Not Available.

Compensation data for Jared Short includes payments allocated to Regence insurance operations in Washington state, Oregon and Utah but not Idaho.

SOURCE/METHODOLOGY: All data is compiled from individual health insurance companies, state insurance department documents and U.S. Securities and Exchange Commission filings.

Health plans selected based on commercial medical risk enrollment as of the beginning of 2022, per AIS’s Directory of Health Plans.

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Seniors Make the Switch to Medicare Advantage in Increasing Numbers

The number of seniors who switched from traditional Medicare to Medicare Advantage increased annually from 2016 to 2020, according to new research published in JAMA Health Forum. The switch rate from traditional Medicare to MA grew to 6.8% in 2020 — more than three times higher than the switch rate from MA to traditional Medicare. This trend was noticed across populations with a variety of traits, including age, race and mortality status, and was particularly strong among Medicare-Medicaid dual eligibles. Switch rates from MA to traditional Medicare, meanwhile, are largely on the decline, but still more common among duals than non-duals. The study’s authors suggested this movement was a contributor to overall MA growth, noting that MA’s share of Medicare enrollment is projected to exceed 50% this year. They also observed that switching accounted for a growing share of new MA enrollment growth, rising from 49% in 2016 to 67% in 2020.

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