Infographics

Hospitals Charged Private Health Plans 2.5 Times Medicare Rates in 2022

Employers and private insurers, on average, paid 254% of what Medicare did for the same inpatient and outpatient services at the same facilities in 2022, according to a new RAND Corp. study.

The report examined data from more than 4,000 hospitals across all U.S. states except Maryland and found that average relative prices paid by private insurers increased from 241% of Medicare rates in 2020 to 254% in 2022, which was largely driven by growth in inpatient relative prices.

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© 2024 MMIT

Specialty Drug Benefits Survey Spotlights Gene Therapy, Biosimilar Strategies

While over 90% of health plans receive specialty medication rebates under the pharmacy benefit, the receipt of medical-benefit rebates has risen in the past one to two years, according to the 2024 Trends in Specialty Drug Benefits Report, published by Pharmaceutical Strategies Group, an EPIC company. The report also covered topics like the management strategies of Humira biosimilars and the financial risk associated with cell and gene therapy.

The report is based on responses from 185 benefits leaders from employers, unions/Taft-Hartley plans and health plans representing plan sponsors of approximately 86.6 million covered lives, conducted from Sept. 18, 2023, through Oct. 13, 2023.

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© 2024 MMIT

Amount of Medicaid Funds Flowing to MCOs Is Poised to Rise, KFF Predicts

Taking a look at the overall state of Medicaid managed care, KFF earlier this month compiled data from prior years of its surveys and analyses to identify notable trends. About 75% of all Medicaid beneficiaries are enrolled in risk-based managed care — with that percentage set to grow as Oklahoma transitions away from fee-for-service (FFS) Medicaid — and most states spend at least 40% of total Medicaid dollars on payments to MCOs. KFF noted that spending could increase as states shift higher-cost, higher-need beneficiaries, such as disabled individuals and adults aged 65 and older, into managed care. Moreover, most states (32 states including Washington, D.C.) with managed care carve in their pharmacy benefits to MCO contracts, observed KFF.

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© 2024 MMIT

CMS Minority Health Report Suggests Similar Patient Experiences, Varied Outcomes

As CMS continues efforts to advance health equity, the agency on May 2 released its annual report on disparities in the Medicare Advantage program based on race, ethnicity and sex. Racial and ethnic minorities are consistently more likely to enroll in Medicare Advantage versus the traditional, fee-for-service Medicare program. The 2024 report, released by the CMS Office of Minority Health in partnership with The RAND Corp., examined patient experience measures based on responses to the 2023 Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey, as well as clinical care measures based on the Healthcare Effectiveness Data and Information Set (HEDIS) that is collected from administrative data and patients’ medical records, reflecting care received in 2022.

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© 2024 MMIT

MCO Stock Performance, April 2024

Here’s how major health insurers’ stock performed in April 2024. Elevance Health, Inc. had the highest closing stock price among major commercial insurers as of April 30, 2024, at $528.58. Humana Inc. had the highest closing stock price among major Medicare insurers at $302.09.

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HSA-Eligible Plans Have Mixed Impact on Health Care Use, No Impact on Spending

People with health savings account-eligible high-deductible health plans (HDHPs) use less outpatient services and fill fewer prescription medications than people with PPOs, but HSA plan enrollment appears to have no impact on total health care spending, according to a recent study published by the Employee Benefit Research Institute (EBRI).

As of 2022, 57.9% of employees were enrolled in an HSA-eligible health plan, while 32.3% of them were in an HDHP that was not associated with an HSA.

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© 2024 MMIT

Specialty Drug Benefits Survey Spotlights Gene Therapy, Biosimilar Strategies

While over 90% of health plans receive specialty medication rebates under the pharmacy benefit, the receipt of medical-benefit rebates has risen in the past one to two years, according to the 2024 Trends in Specialty Drug Benefits Report, published by Pharmaceutical Strategies Group, an EPIC company. The report also covered topics like the management strategies of Humira biosimilars and the financial risk associated with cell and gene therapy.

The report is based on responses from 185 benefits leaders from employers, unions/Taft-Hartley plans and health plans representing plan sponsors of approximately 86.6 million covered lives, conducted from Sept. 18, 2023, through Oct. 13, 2023.

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© 2024 MMIT

Racial Health Care Disparities Persist in All States, With Significant Divides in Premature Deaths

Substantial racial and ethnic disparities in health and health care are pervasive across all states in the U.S., according to The Commonwealth Fund 2024 State Health Disparities Report.

The report evaluated 25 health indicators of health system performance for Black, white, Hispanic, American Indian and Alaska Native (AIAN), and Asian American, Native Hawaiian, and Pacific Islander (AANHPI) populations. It found that racial health disparities are a bigger problem in some states than in others. Massachusetts, Rhode Island and Connecticut saw relatively high performance for all racial and ethnic groups, while Oklahoma, West Virginia and Mississippi performed poorly for all groups.

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© 2024 MMIT

Analysis Tallies Premium Impact of Provider Markups on Specialty Drugs

If providers charged the same price as specialty pharmacies for specialty medications, $13.1 billion in spending on health insurance premiums and premium equivalents could have been avoided in 2024, according to a new analysis from the consulting firm Oliver Wyman, commissioned by AHIP.

Provider-administered drugs can be delivered directly to clinicians from specialty pharmacies — known as white bagging — or providers can purchase the drugs directly and store the drugs until they are needed for patient care, which is called “buy and bill.” When the “buy and bill” method is utilized, the providers can charge a markup for the drug that is passed through to the patient’s bill.

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© 2024 MMIT

Centene Wins Big in Latest Round of Medicaid Contract Awards

For Medicaid-focused insurers facing the headwinds of the post-pandemic disenrollment backlog, a contract win can cause a major sigh of relief. That’s particularly true for Centene Corp., the largest managed Medicaid insurer in the U.S., which held onto three state contracts in Michigan, New Hampshire and Florida in recent months. Shares of Centene were up 3.5% following its April 12 win in Florida, where it currently serves 1.46 million members, according to AIS’s Directory of Health Plans (DHP).

Awards from Kansas and Georgia — where Centene is an incumbent — are expected to be announced in the coming weeks. Texas, meanwhile, is in the middle of a procurement process that could mean a plan switch for about 1.8 million beneficiaries. And it could spell the end of Centene’s winning streak. CEO Sarah London at the Barclays Global Healthcare Conference, held in March, said the company was “disappointed” in the scoring of its most recent Texas proposal, and planned to protest any contract loss. “I would say the biggest concern for the program overall is the idea that the results are going to force 1.8 million Medicaid members in Texas, which is a state that has a very high choice rate, to choose a different place,” London continued.

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© 2024 MMIT