health care utilization

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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Demand for Medication Abortion May Rise if Roe Falls

The use of medication abortion — which involves two drugs, mifepristone and misoprostol — has grown significantly since its approval and now accounts for 54% of all pregnancy terminations before nine weeks of gestation in the U.S. If the Supreme Court overturns Roe v. Wade, medication abortion usage is likely to increase as patients in states that ban the procedure are likely to attempt to obtain courses of medication abortion from states that allow it. Only 18 states and the District of Columbia allow both advanced practice clinicians and medical doctors to dispense abortion pills. Six states have passed laws banning any use of telehealth for medication abortion, according to a recent Kaiser Family Foundation analysis. Insurance coverage for both surgical and medical abortion is heavily regulated across the nation. A 2019 study from the Government Accountability Office found that 14 states’ Medicaid programs do not cover mifepristone even in the cases of rape, incest and life endangerment.

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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Medicare Advantage’s Two-Sided Risk Model Associated With Reduced Acute Care Use

Value-based payment models can significantly lower acute care usage among Medicare beneficiaries, suggested a study of nearly 500,000 Medicare Advantage members published last month in JAMA Network Open. The study, which analyzed data collected between December 2017 and January 2019, was led and reviewed by the Humana Healthcare Research Human Subject Protection Office. (Humana is the second-largest MA insurer in the U.S). MA beneficiaries participating in two-sided risk models had lower rates of hospitalizations, observation stays and emergency department visits compared with fee-for-service (FFS) Medicare enrollees. This effect was particularly striking in avoidable acute care use — the two-sided risk model was associated with a 15.6% reduction in avoidable hospitalizations. Researchers noted a lack of significant differences between FFS and upside-only risk models, which “suggests that downside financial risk may play a key role in effective value-based payment arrangements.”

Research Shows Various Ways Racial Disparities in Health Care Persist

While the Affordable Care Act improved health coverage across racial and ethnic groups, nonelderly American Indian and Alaskan Native (AIAN), Hispanic, Native Hawaiian and Other Pacific Islander (NHOPI), and Black populations remain much less likely than white individuals to have health insurance, according to a Kaiser Family Foundation study. In addition, the overall rate of cancer screening is lower among people of color compared to their white counterparts, though overall cancer incidence rates declined for all groups between 2013 and 2018. Meanwhile, as of late November 2021, Black and Hispanic people were more than 2.5 times as likely as white people to be hospitalized for COVID-19, accroding to data from the Centers for Disease Control and Prevention. Finally, a recent Commonwealth Fund report shows that closing the Medicaid coverage gap and extending enhanced marketplace premium subsidies under the Build Back Better Act would significantly improve racial equity in coverage rates, with people of color making up half of those slated to gain coverage.

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Specialty Pharma Is Top of Mind for PBM Execs in Earnings Calls

While the cost-saving potential of biosimilars was an overarching theme as the major PBMs’ parent companies discussed second-quarter 2021 earnings, “specialty” was the buzzword during the most recent round of conference calls regarding fourth-quarter and full-year 2021 financial results.

“I would definitely say that the specialty [pharmacy] and home delivery business are contributing to earnings and our margin,” said Heather Cianfrocco, CEO of UnitedHealth Group-owned PBM OptumRx, during a Jan. 19 call with analysts.

News Briefs: ACA Enrollment Tally Reaches 14.5M

With the open enrollment period for 2022 Affordable Care Act exchange plans now over in most states, the Biden administration announced a record-breaking number of signups. A total of 14.5 million people enrolled in ACA marketplace coverage from Nov. 1, 2021, through Jan. 15, 2022, including 10.3 million people who live in states served by HealthCare.gov and 4.2 million in states with their own marketplace, CMS said. Enrollment remains open in the District of Columbia and five states — California, Kentucky, New Jersey, New York and Rhode Island — through Jan. 31.

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UnitedHealth Downplays Cost of Omicron, At-Home Tests

For health insurers, the new year has ushered in a mandate to cover at-home COVID-19 tests and a highly transmissible coronavirus variant that is making it clear the pandemic is far from over. During its recent conference call to discuss fourth-quarter 2021 financial results, UnitedHealth Group explained how its massive, integrated health care enterprise is responding to both challenges.

The Biden administration on Jan. 10 unveiled new guidance specifying that all group and individual health plans must reimburse members for eight free over-the-counter COVID tests per month without cost sharing. The administration also said it would allow insurers to cap test costs at $12 each if insurers set up in-network agreements with pharmacies/retail stores that allow members to access free tests directly, without filing for reimbursement.

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As Omicron Surges, U.S. Struggles With Booster Rate

On Jan. 10, the U.S. reported 1.35 million new coronavirus cases as the highly contagious Omicron variant swept across the nation, breaking the previous daily record of 1.03 million. While a COVID-19 vaccine booster could increase immune response, the Centers for Disease Control and Prevention’s data show that only 36.7% of fully vaccinated people have received a booster dose nationwide, as of Jan. 11, 2022. Doubling the pace of booster vaccinations per day could prevent more than 41,000 deaths and 400,000 hospitalizations by the end of April, according to a recent analysis by The Commonwealth Fund.