Webinar

Regional Payers Mirrored National Insurers in COVID Enrollment Trends

June 9, 2021

MMIT’s recent Meet the Expert webinar, Predicting Enrollment Changes in the COVID Era, examined how enrollment among health insurers was affected by the COVID-19 pandemic, using MMIT’s proprietary Payer Landscape enrollment data.

As the industry standard in market access and enrollment data, MMIT created Payer Landscape to support the needs of organizations who are looking for a granular view of payer and employer enrollment information by benefit type, down to the local level. 

After looking at broad trends, the webinar zeroed in on case studies of three national insurers. We didn’t have time to get to all the great questions sparked by the webinar, so we wanted to take the opportunity to answer a question regarding the enrollment impact MMIT is seeing on regional and local payers. Here’s the answer:

MMIT’s recent Meet the Expert webinar, Predicting Enrollment Changes in the COVID Era, examined how enrollment among health insurers was affected by the COVID-19 pandemic, using MMIT’s proprietary Payer Landscape enrollment data.

As the industry standard in market access and enrollment data, MMIT created Payer Landscape to support the needs of organizations who are looking for a granular view of payer and employer enrollment information by benefit type, down to the local level. 

After looking at broad trends, the webinar zeroed in on case studies of three national insurers. We didn’t have time to get to all the great questions sparked by the webinar, so we wanted to take the opportunity to answer a question regarding the enrollment impact MMIT is seeing on regional and local payers. Here’s the answer:

An analysis of the payers that had between 1 million and 3 million lives at the start of the pandemic — the 25 plans that sit below the nation’s top 10 insurers — shows similar trends to the overall industry. These payers include 16 regional and single-state Blue Cross Blue Shield plans, as well as Medicaid and Medicare-focused insurers like CareSource and Healthfirst and regional carriers like HealthPartners and UPMC Health Plan.

Average enrollment among these payers fell from 2.038 million in the first quarter of 2020 to 1.957 million in the third quarter of last year before recovering to 2.047 million in the second quarter of 2021.

Across the health insurance industry, we see that commercial enrollment fell 8% between the first and the third quarter of 2020 and then remained roughly steady from the fourth quarter of 2020 to today. Meanwhile, managed Medicaid enrollment showed slow growth between January and July 2020 before increasing more rapidly over the several months.

Regional insurers illustrate this trend. Medical Mutual of Ohio and Harvard Pilgrim Healthcare, Inc., two payers that primarily have commercial enrollment, showed significant drops over the first several months of 2020. Harvard Pilgrim lost 105,000 members between the first and the third quarter of 2020, dropping from 1,019,902 to 914,611. The New England insurer held steady, reporting 914,872 at the second quarter of 2021. Similarly, Medical Mutual lost 50,000 enrollees between the first and the third quarter of 2020, dropping from 1,439,563 to 1,389,036. By the second quarter of 2021 it stood at 1,376,301.

Meanwhile, L.A. Care Health Plan’s enrollment remained about flat over 2020, increasing only from 1,895,069 in the first quarter of last year to 1,898,545 in the fourth quarter. But it has gained 107,000 members in 2021 to stand at 2,005,735 at the second quarter of 2021.

Click here to listen to the webinar recording. And to learn more about MMIT’s Payer Landscape solution, email marketing@mmitnetwork.com.

Predicting Enrollment Changes in the COVID Era

May 20, 2021

When the COVID-19 pandemic reached the U.S. last year, the closures and disruptions that the virus brought to nearly every facet of life sparked considerable concern about the impact on market access. For example, would there be major shifts in medical and pharmacy coverage, with millions of lives moving from commercial coverage to the ranks of the uninsured and thus losing access to life-saving treatments?

The pandemic and the ensuing legislative, policy and economic response have made it more difficult than ever to predict enrollment across payers, geographies and channels, as Jill Brown Kettler discussed at a recent MMIT Meet the Expert webinar. As the leading provider of market access data, analytics and insights, MMIT’s expert teams of clinicians, data specialists and market researchers provide clarity and confidence on the “what and why” of market access, so that our clients can make better decisions.

When the COVID-19 pandemic reached the U.S. last year, the closures and disruptions that the virus brought to nearly every facet of life sparked considerable concern about the impact on market access. For example, would there be major shifts in medical and pharmacy coverage, with millions of lives moving from commercial coverage to the ranks of the uninsured and thus losing access to life-saving treatments?

The pandemic and the ensuing legislative, policy and economic response have made it more difficult than ever to predict enrollment across payers, geographies and channels, as Jill Brown Kettler discussed at a recent MMIT Meet the Expert webinar. As the leading provider of market access data, analytics and insights, MMIT’s expert teams of clinicians, data specialists and market researchers provide clarity and confidence on the “what and why” of market access, so that our clients can make better decisions.

(1) Commercial Enrollment: According to MMIT’s proprietary Payer Landscape enrollment data, the commercial sector was hardest hit by the pandemic, with commercial enrollment dropping by 8% or 13 million lives between January 2020 and April 2021. Most of the losses occurred between January and July 2020, and enrollment has held roughly steady since then.

The decline wasn’t as steep as some had feared, because of factors including the easier-than-expected transition to remote work and the Payroll Protection Program, which helped some employers maintain head counts and health insurance coverage. Of more concern is the fact that the travel, tourism and hospitality industries, which arguably suffered the most in the pandemic, already were less likely to offer health insurance to their workforces. And with layoffs and closures concentrated in industries with historically lower health insurance offer rates, there was less of an impact on overall commercial enrollment.

Looking ahead, we expect commercial enrollment to remain steady, with perhaps a slight drop-off in the fall. That’s partly the result of COVID relief legislation that will provide some protection for workers who lost job-based insurance. The American Rescue Plan, signed into law March 11, expands eligibility for premium subsidies for Affordable Care Act exchange plans and creates new temporary premium subsidies to cover the cost of COBRA continuation coverage.

(2) Managed Medicaid: The biggest enrollment gains over the past six quarters have been in the managed Medicaid segment, which saw an increase of about 8 million lives, almost a 17% uptick, while state Medicaid lives remained about flat between January 2020 and April 2021. After slow growth between January and July 2020, managed Medicaid has been adding roughly 2 million lives every quarter. We expect Medicaid enrollment to keep increasing because of national policy changes. States are receiving extra funding for Medicaid programs, but must comply with a maintenance of effort requirement that bars them from disenrolling most Medicaid recipients who no longer qualify.

(3) Health Insurance Exchanges: Meanwhile, health insurance exchange enrollment rose 15% or about 1.5 million lives to reach 11.7 million in April 2021. It could rise still further, with the Biden executive order that created a new special enrollment period for exchanges that runs through Aug. 15. This means that anyone can sign up for exchange coverage even without a qualifying life event. In addition, the executive order created more funding for navigators, who are tasked with helping people enroll in any eligible coverage — including Medicaid, possibly creating a lift in that program’s enrollment as well.

Click here to listen to the webinar. And to learn more about MMIT’s Landscape solution, email marketing@mmitnetwork.com.

3 Barriers Faced by Patients Needing Innovative Technologies — and How Pharma Can Help: MMIT Meet the Expert Webinar Recap on Access Trends for Innovative Technology

May 5, 2021

On April 27, MMIT held the next installment of its ongoing Meet the Expert webinar series. This session was focused on trends surrounding patient access to innovative technologies like cell and gene therapies, genetic testing and telemedicine. All three of these technologies have seen huge advances in development and availability — and patient access to them is rapidly changing as well, said MMIT’s Fiza Bari, a senior manager of custom market research.

She described a patient named Rose, who has a Diffuse Large B-Cell Lymphoma. Rose is eligible for chimeric antigen receptor (CAR) T-cell gene therapy that will take her own DNA and create a personal treatment that will target her cancer cells. Her family may also wish to pursue genetic testing, while Rose has been taking advantage of telemedicine this past year due to the pandemic. What access challenges does she face?

On April 27, MMIT held the next installment of its ongoing Meet the Expert webinar series. This session was focused on trends surrounding patient access to innovative technologies like cell and gene therapies, genetic testing and telemedicine. All three of these technologies have seen huge advances in development and availability — and patient access to them is rapidly changing as well, said MMIT’s Fiza Bari, a senior manager of custom market research.

She described a patient named Rose, who has a Diffuse Large B-Cell Lymphoma. Rose is eligible for chimeric antigen receptor (CAR) T-cell gene therapy that will take her own DNA and create a personal treatment that will target her cancer cells. Her family may also wish to pursue genetic testing, while Rose has been taking advantage of telemedicine this past year due to the pandemic. What access challenges does she face?

(1) Cell and gene therapies: Cost is a major barrier to accessing these innovative agents, according to MMIT’s quarterly surveys of payers, providers and practice managers, which capture key insights about major trends impacting access. CAR-T therapy is “high cost,” said one large national carrier with 11.9 million lives. It’s less expensive for the “employer and carrier to continue with maintenance drugs given the lack of stability in employment/carrier.” A regional plan cited “accountability for providers, hospitals, and pharma.” It added, “What if the drug doesn’t work?” Those challenges have led payers to establish complex prior authorization requirements, which in turn impacts oncology practices — and leads to a high administrative burden.

Pharma companies can help by negotiating outcomes-based contracts to help mitigate some of the risk for payers, ultimately making the therapies more easily accessible for patients. These companies also can help ease the administrative burden faced by oncologists and practice managers by providing more support and information on the therapies.

(2) Genetic testing: Rose’s family may want to access genetic testing since B-cell lymphoma can be hereditary. However, many payers require prior authorization for these genetic tests because of a lack of perceived utility. One national plan with 3.9 million lives lamented the “lack of documentation [and] off-label use,” while a pharmacy benefit manager (PBM) with 11.1 million lives said the “standard of care [is] not well established and testing centers [are] not easily accessible, expensive.”

How can pharma companies help ease these barriers? MMIT’s research showed that for payers that cover over 90% of lives, positive outcomes data and inclusion of the need for the genetic test in the therapy label are the most influential factors in deciding to cover testing. So by providing payers with information around labelling and outcomes, pharma can help reduce the administrative burden for oncologists and thus improve access for patients.

(3) Telemedicine has become much more widespread as a means of reducing the risk of COVID-19. According to MMIT’s research, all payers reimburse for telemedicine, and most payers will cover these services for all disease states, not just for COVID-19. But while this access likely will continue for conditions such as behavioral health and dermatology in the post-COVID era, payers see less value in providing access to telemedicine related to oncology services. This can impact patients like Rose, who have seen the benefits of fewer physician visits with telemedicine. Manufacturers can help by providing physicians and payers with educational materials and support in order to encourage the use of telemedicine.

For more information about how MMIT’s market research can help you understand payer and provider perceptions, contact us today at busdev@mmitnetwork.com.

To watch a replay of this webinar, visit www.mmitnetwork.com/meet-the-expert-innovative-technology-webinar.

And check out our webinar lineup here. The next session on May 18 is about Predicting Enrollment Changes in the COVID Era.