Infographics

UnitedHealth Dominates While Startups Make Gains in 2022 Medicare Open Enrollment Period

Medicare Advantage enrollment grew by about 232,000 lives during the 2022 Open Enrollment Period (OEP), according to CMS’s May data release and AIS’s Directory of Health Plans. As in the Annual Election Period (AEP), UnitedHealthcare dominated, holding 45.1% of the overall OEP gains, followed by CVS Health Corp.’s Aetna at 16.9% and Centene Corp at 13.5%. Among other large, publicly traded insurers, Cigna Corp. and Humana Inc. both flopped in the OEP, losing 12,600 and 4,200 members, respectively. Meanwhile, insurance startups Bright Health and Clover Health both made the top 20 despite recent financial challenges and questioned viability. See the top 25 OEP performers, plus their AEP results and current enrollment, in the chart below.

The Vast Majority of Physicians Accept New Medicare and Private Insurance Patients

Most non-pediatric office-based physicians accepted new patients, with similar shares accepting new Medicare (89%) and privately insured patients (91%), according to a Kaiser Family Foundation analysis based on the 2019 National Electronic Health Records Survey. A smaller share of primary care physicians accepted new patients with Medicare or private insurance than physicians in other medical or surgical specialties. Across the nation, the share of physicians accepting new Medicare patients ranged from 95% in Iowa, Minnesota and Pennsylvania to 76% in the District of Columbia, similar to the range across states for privately insured patients. As of March 2022, only 1% of non-pediatric physicians formally opted out of the Medicare program, with psychiatrists accounting for 42% of these physicians opting out.

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$35 Monthly Insulin Cap Could Save Part D Enrollees 29% Per Prescription

The House in March passed a bill that caps the out-of-pocket cost of insulin at $35 per month for Medicare Part D beneficiaries and for certain privately insured enrollees. A recent Kaiser Family Foundation analysis found that total out-of-pocket spending by Part D enrollees on insulin quadrupled between 2007 and 2019, reaching nearly $1 billion. If a $35 copay cap had been in place in 2019, Part D enrollees without low-income subsidies would have saved $14 per insulin prescription on average. Meanwhile, another study found that over one in four individual and small group enrollees paid more than an average of $35 per month out of pocket for insulin products in 2018. With a $35 cap, median monthly savings could reach $27 in the individual market and $19 in the small and large group markets.

Study: With High Prices, Rebate Revenue Is Growing for PBMs

New research published in JAMA Health Forum found that rebate revenue for PBMs grew between 2015 and 2019 — but that growing rebate revenue was not passed on to patients.

The research letter’s authors measured both prerebate and postrebate drug costs taken from medical loss ratio (MLR) filings made by plans to CMS. The research sample includes commercial insurance filings from small group, individual and large group health plans across “approximately 2,200 unique health plans” covering 70 million lives.

Medicaid Rolls Soar to Nearly 89 Million Beneficiaries as Redeterminations Loom

Nationwide Medicaid enrollment has grown more than 22% since the outset of the COVID-19 pandemic, topping 88.7 million lives, according to the latest update to AIS’s Directory of Health Plans. But the end of the Public Health Emergency (PHE) — which at press time was likely to be extended beyond mid-July — could leave between 5.3 million and 14.2 million people without coverage when redeterminations resume, asserted a May 10 analysis from the Kaiser Family Foundation. A separate study from the Georgetown University Heath Policy Institute found that 6.7 million children stand to lose CHIP coverage at the end of the PHE. See a state-by-state overview of three years of pandemic-fueled Medicaid enrollment changes in the chart below.

A Look at Third-Party Oncology Clinical Pathways

In order to improve patient outcomes and reduce variations in oncology care, more and more payers and providers are adopting oncology clinical pathways (OCPs) — treatment protocols that aim to provide the optimal cancer care to patients at the lowest cost, according to a recent MMIT webinar. The share of oncologists exposed to third-party oncology pathways increased from 20% in 2015 to 52% in 2021, with one third of oncologists choosing a provider-focused pathway as of the fourth quarter of 2021. Breast cancer, multiple myeloma and non-small cell lung cancer are among the top therapeutic areas managed by third-party pathways.

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.

MCO Stock Performance, April 2022

Here’s how major health insurers’ stock performed in April 2022. UnitedHealth Group had the highest closing stock price among major commercial insurers as of April 29, 2022, at $508.55. Molina Healthcare, Inc. had the highest closing stock price among major Medicaid insurers at $313.45.

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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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A Look at Third-Party Oncology Clinical Pathways

In order to improve patient outcomes and reduce variations in oncology care, more and more payers and providers are adopting oncology clinical pathways (OCPs) — treatment protocols that aim to provide the optimal cancer care to patients at the lowest cost, according to a recent MMIT webinar. The share of oncologists exposed to third-party oncology pathways increased from 20% in 2015 to 52% in 2021, with one third of oncologists choosing a provider-focused pathway as of the fourth quarter of 2021. Breast cancer, multiple myeloma and non-small cell lung cancer are among the top therapeutic areas managed by third-party pathways.