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Employers Focus on Affordability, Access in 2023 Benefit Design, Mercer Reports

Over 70% of employers with 500 or more employees are planning to enhance their benefit programs in 2023, with increasing emphasis on health care affordability, work and life balance and women’s reproductive health, according to Mercer’s “Health & Benefit Strategies for 2023 Report.” The report, which is based on surveys of 708 organizations with a focus on the 451 large employers, also found that health benefit strategies are becoming less about reducing health care costs but more about supporting the emotional, physical, social and financial well-being of employees.

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New Drug Benefit Design Report Shows Increasing Emphasis on Member Experience

In 2022, the majority of plan sponsors used a drug benefit consultant while designing their drug benefit programs, according to Pharmaceutical Strategies Group’s 2022 “Trends in Drug Benefit Design Report,” sponsored by Rx Savings Solutions. The report, which is based on surveys of 153 individuals representing employers, union/Taft-Hartley plans and health plans that covered an estimated 35.1 million lives, also revealed an increasing focus on member satisfaction.

ACA Plans Deny 18% of Claims in 2020; Enrollees Rarely Appeal

About 18.3% of in-network claims were denied by non-group qualified health plans (QHPs) offered on HealthCare.gov in 2020, according to a recent Kaiser Family Foundation analysis. Among the 144 issuers in HealthCare.gov states with complete data on claims received and denied, 52 of them had a denial rate between 10% and 19%. In 2020, the majority of denials (72%) were classified as “all other reasons,” while one in five of the roughly 765,000 medical necessity denials involved behavioral health services. In addition, of the more than 42 million denied claims in 2020, marketplace enrollees appealed fewer than 61,000 claims — a 0.1% appeal rate — and insurers upheld 63% of denials that were appealed.

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MCO Stock Performance, June 2022

Here’s how major health insurers’ stock performed in June 2022. UnitedHealth Group had the highest closing stock price among major commercial insurers as of June 30, 2022, at $513.63. Molina Healthcare, Inc. had the highest closing stock price among major Medicaid insurers at $279.61.

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Fewer Abortion Facilities Accept Health Insurance, While Patients Face Higher Out-of-Pocket Expenses for Abortion

The proportion of open abortion facilities that accept any type of health insurance declined from 89% in 2017 to 80% in 2019 and 2020, while median patient self-pay charges for abortion are going up, according to a study published in Health Affairs in April. The South has the lowest percentage of health insurance acceptance, yet the Midwest saw the largest decrease over the four years, from 88% in 2017 to 75% in 2020.

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More Than 250,000 People Gain Yearlong Postpartum Care

CMS recently approved Maine, Minnesota, New Mexico and Washington, D.C., to offer 12 months of postpartum coverage through Medicaid and Children’s Health Insurance Program (CHIP) extensions, adding an additional 15,000 enrollees annually with extended coverage from 60 days to 12 months after pregnancy. In total, nearly 253,000 people in 14 states and D.C. have gained such access as a result of the American Rescue Plan Act (ARPA).

Starting on April 1, states were able to apply “to extend Medicaid postpartum coverage to 12 months via a state plan amendment,” according to the Kaiser Family Foundation. So far, Connecticut, Indiana, Kansas, Maryland, Massachusetts, North Carolina, Pennsylvania, Washington and West Virginia have also submitted the extension proposals.

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How Will Interstate Telehealth Licensure Waivers’ Expiration Impact Medicare Beneficiaries?

During the pandemic, all 50 states and Washington, D.C., issued licensure waivers that allowed out-of-state clinicians to perform telehealth with patients across state lines. By analyzing telehealth usage by Medicare beneficiaries from 2017 to 2020, researchers found that out-of-state telehealth made up only a small percentage of all outpatient visits during the first year of the pandemic, though the percentage varied by state, according to a recent study published in Health Affairs.

The number of out-of-state telehealth services jumped from 17,286 in the first quarter to 171,754 in the second quarter of 2020, and then slightly declined. Before 2020, less than 1% of out-of-state new patient visits occurred via telehealth nationwide, while in 2020, the number jumped to 6%.

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MCO Stock Performance, May 2022

Here’s how major health insurers’ stock performed in May 2022. Anthem, Inc. had the highest closing stock price among major commercial insurers as of May 31, 2022, at $509.61. Molina Healthcare, Inc. had the highest closing stock price among major Medicaid insurers at $290.22.

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CMS Spends Billions on Drugs Granted FDA Accelerated Approval With Unproven Clinical Benefits

Through 2020, CMS spent $68 billion on 38 drugs that were granted accelerated approval from the FDA between 2012 and 2017, with spending after conversion to standard approval accounting for 75% of overall spending, according to a JAMA Health Forum study. However, only 34% of these drugs had a confirmatory trial evaluating a clinical outcome as a primary end point and more than $40 billion was spent for drugs evaluated using surrogate end points. Clinical trials for one drug that converted to standard approval (pembrolizumab) and three that remained unconverted (atezolizumab, durvalumab and olaratumab) for their original indications failed to confirm benefit for primary efficacy end points, while these drugs cost CMS $14 billion in total through 2020. The researchers concluded that “persistent evidentiary gaps should prompt payers to limit spending on promising drugs with unproven benefits.

Key Financial Data for Leading Health Plans — First Quarter 2022

Here’s how major U.S. health insurers performed financially in the first quarter of 2022. Health Plan Weekly subscribers can access more health plan financial data — including year-over-year comparisons of leading health plans’ net income, premium revenue, medical loss ratios and net margins. Just email support@aishealth.com to request spreadsheets for current and past quarters.

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