Datapoint: Highmark, AllianceRx Walgreens Prime Team Up on SDOH

May 5, 2021

Highmark Inc. and AllianceRx Walgreens Prime last week said they are partnering on a pilot program that will address Highmark members impacted by social determinants of health. The pilot, which will offer referrals to community services such as connections to behavioral health resources and social workers, will focus initially on Highmark members with multiple sclerosis who get their medications via AllianceRx Walgreens Prime’s specialty pharmacies. Highmark currently serves 3,934,041 members nationwide, with 9.8% enrolled in a public-sector plan offering.

Highmark Inc. and AllianceRx Walgreens Prime last week said they are partnering on a pilot program that will address Highmark members impacted by social determinants of health. The pilot, which will offer referrals to community services such as connections to behavioral health resources and social workers, will focus initially on Highmark members with multiple sclerosis who get their medications via AllianceRx Walgreens Prime’s specialty pharmacies. Highmark currently serves 3,934,041 members nationwide, with 9.8% enrolled in a public-sector plan offering.

Source: AIS’s Directory of Health Plans

Datapoint: SCAN Health Plan Provides In-Home COVID Vaccinations to Seniors

May 4, 2021

Southern California-based Medicare Advantage org SCAN Health Plan last week said it is providing in-home COVID-19 vaccinations to its homebound members and their families in Los Angeles County. The insurer is coordinating this effort via its logistics partner, MedArrive. SCAN, which currently serves 220,223 MA and dual-eligible members in California, says it will expand the program to Orange County next month.

Source: AIS’s Directory of Health Plans

Southern California-based Medicare Advantage org SCAN Health Plan last week said it is providing in-home COVID-19 vaccinations to its homebound members and their families in Los Angeles County. The insurer is coordinating this effort via its logistics partner, MedArrive. SCAN, which currently serves 220,223 MA and dual-eligible members in California, says it will expand the program to Orange County next month.

Source: AIS’s Directory of Health Plans

Datapoint: FDA Approves Zynlonta for DLBCL

May 3, 2021

The FDA on April 23 approved ADC Therapeutics’ Zynlonta for the treatment of diffuse large B-cell lymphoma (DLBCL) in adult patients who have received two previous therapies. Zynlonta is the first single-agent CD19-targeted antibody drug conjugate approved to treat the disease. Other novel therapies approved to treat DLBCL in recent years include Novartis’ Kymriah, which holds covered or better status for 29% of all insured lives under the pharmacy benefit, and Gilead Sciences’ Yescarta, which is covered or better for 30% of all lives.

The FDA on April 23 approved ADC Therapeutics’ Zynlonta for the treatment of diffuse large B-cell lymphoma (DLBCL) in adult patients who have received two previous therapies. Zynlonta is the first single-agent CD19-targeted antibody drug conjugate approved to treat the disease. Other novel therapies approved to treat DLBCL in recent years include Novartis’ Kymriah, which holds covered or better status for 29% of all insured lives under the pharmacy benefit, and Gilead Sciences’ Yescarta, which is covered or better for 30% of all lives.

SOURCE: MMIT Analytics, as of 4/26/21

Analysts Expect Plenty of Insurer M&A but Few Big Deals

April 30, 2021

Industry analysts say they expect the environment for mergers and acquisitions in the health insurance sector to be “favorable” this year, and thus they anticipate “robust M&A activity” among firms that are eager to diversify their assets and modernize their technology.

However, large, transformational deals, such as Cigna Corp.’s purchase of Express Scripts or CVS Health Corp.’s acquisition of Aetna, likely won’t be the norm in 2021, states a Healthcare Quarterly report published by Moody’s Investors Service in April.

Industry analysts say they expect the environment for mergers and acquisitions in the health insurance sector to be “favorable” this year, and thus they anticipate “robust M&A activity” among firms that are eager to diversify their assets and modernize their technology.

However, large, transformational deals, such as Cigna Corp.’s purchase of Express Scripts or CVS Health Corp.’s acquisition of Aetna, likely won’t be the norm in 2021, states a Healthcare Quarterly report published by Moody’s Investors Service in April.

“We’ve already seen several deals this year, and I think those are a good indicator of the kind of deals that you’ll see [going forward],” Dean Ungar, vice president and senior credit officer at Moody’s, tells AIS Health. The Moody’s report highlights UnitedHealth Group’s proposed purchase of analytics firm Change Healthcare, Centene Corp.’s move to buy Magellan Healthcare Inc., Anthem, Inc.’s bid to acquire Puerto Rico Medicare Advantage carrier MMM Holdings Inc., and Cigna’s deal to buy telehealth platform MDLive as examples of transactions in which insurers are aiming to augment their insurance- and non-insurance-related offerings.

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Washington’s Public Option Gets Mixed Results in First Year

April 30, 2021

Washington became the first state in the country to implement a public option on its individual exchange, with plans launching in the 2021 plan year. Experts say that it’s not yet clear whether the plans, which are available through contracts with carriers including UnitedHealthcare, are slowing premium growth.

Washington became the first state in the country to implement a public option on its individual exchange, with plans launching in the 2021 plan year. Experts say that it’s not yet clear whether the plans, which are available through contracts with carriers including UnitedHealthcare, are slowing premium growth.

Washington’s legislature in July 2019 passed a law, S.B. 5526, creating the public option program, called Cascade Care Select. Democratic officials including Gov. Jay Inslee and Insurance Commissioner Mike Kreidler have said that the plans are meant to lower out-of-pocket costs and ensure that there is individual market competition in every county of the state. In 2019, 14 counties had only one option for exchange consumers.

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Centene’s 1Q Features Lots Of Pandemic Upside, Downside

April 30, 2021

Centene Corp.’s two dominant business lines — managed Medicaid and the Affordable Care Act exchanges — both were sources of significant headwinds and tailwinds in the first quarter of 2021, underscoring the often-contradictory impact of the COVID-19 pandemic on the health insurance sector.

On the one hand, Centene acknowledged in its earnings report that it saw higher COVID-19 and traditional utilization in its ACA marketplace business, surprising Jefferies analysts who noted that “those components have tended to move in opposite directions.” Centene also saw its marketplace membership decline year over year by 14%, the analysts noted.

Centene Corp.’s two dominant business lines — managed Medicaid and the Affordable Care Act exchanges — both were sources of significant headwinds and tailwinds in the first quarter of 2021, underscoring the often-contradictory impact of the COVID-19 pandemic on the health insurance sector.

On the one hand, Centene acknowledged in its earnings report that it saw higher COVID-19 and traditional utilization in its ACA marketplace business, surprising Jefferies analysts who noted that “those components have tended to move in opposite directions.” Centene also saw its marketplace membership decline year over year by 14%, the analysts noted.

“We knew [Centene’s] relatively higher pricing would create HIX membership pressure…but thought [the insurer’s] decision not to chase price down would help insulate the MLR [medical loss ratio],” analysts David Windley and David Styblo wrote. “Instead, [Centene] has the double whammy of declining membership and margins.”

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Wall Street Is Bullish on Humana Home Care Deal, 1Q Results

April 30, 2021

Humana Inc. plans to fully acquire home health provider Kindred at Home from private equity firm Welsh, Carson, Anderson & Stowe (WCAS) and TPG Capital, the insurer said on April 27. (WCAS owns a controlling stake in MMIT, AIS Health’s parent company.) The insurer also reported strong financial results, with first-quarter adjusted earnings per share (EPS) of $7.67 beating Wall Street’s projected consensus of $7.07, or $1.04 billion in pretax income.

Humana Inc. plans to fully acquire home health provider Kindred at Home from private equity firm Welsh, Carson, Anderson & Stowe (WCAS) and TPG Capital, the insurer said on April 27. (WCAS owns a controlling stake in MMIT, AIS Health’s parent company.) The insurer also reported strong financial results, with first-quarter adjusted earnings per share (EPS) of $7.67 beating Wall Street’s projected consensus of $7.07, or $1.04 billion in pretax income.

Humana CEO Bruce Broussard said during an April 28 call with investors discussing the firm’s first-quarter results that the Kindred acquisition “will enable us to more closely align incentives to focus on improving patient outcomes, and on reducing the total cost of care.”

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ACA Exchange Enrollment Was Up Even Before Pandemic SEP

April 30, 2021

Over 12 million people selected or were automatically reenrolled in health plans during the 2021 open enrollment period for Affordable Care Act exchange plans — which ended Dec. 15. — representing a 5% increase from 11.4 million sign-ups for the 2020 plan year, according to CMS. Texas, Hawaii, Mississippi, Georgia and Florida saw more than 10% increases. In addition, as of March 31 more than 528,000 people signed up for health insurance during the current special enrollment period related to the pandemic, which lasts through Aug. 15.

Over 12 million people selected or were automatically reenrolled in health plans during the 2021 open enrollment period for Affordable Care Act exchange plans — which ended Dec. 15. — representing a 5% increase from 11.4 million sign-ups for the 2020 plan year, according to CMS. Texas, Hawaii, Mississippi, Georgia and Florida saw more than 10% increases. In addition, as of March 31 more than 528,000 people signed up for health insurance during the current special enrollment period related to the pandemic, which lasts through Aug. 15.

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News Briefs

April 30, 2021

CMS on April 30 released the second half of the 2022 Notice of Benefit and Payment Parameters for the Affordable Care Act exchanges, which caps consumers’ out-of-pocket costs at $400 annually. The Trump administration finalized the first phase of the omnibus rule that sets parameters for ACA exchange plans just days before President Joe Biden’s inauguration. The second phase of the rule also “includes several provisions to help consumers more easily distinguish between plan options and increase opportunities to qualify for future special enrollment periods,” according to the Biden administration. Read more at https://go.cms.gov/3eMwudB.

CMS on April 30 released the second half of the 2022 Notice of Benefit and Payment Parameters for the Affordable Care Act exchanges, which cuts consumers’ out-of-pocket costs by $400 annually. The Trump administration finalized the first phase of the omnibus rule that sets parameters for ACA exchange plans just days before President Joe Biden’s inauguration. The second phase of the rule also “includes several provisions to help consumers more easily distinguish between plan options and increase opportunities to qualify for future special enrollment periods,” according to the Biden administration. Read more at https://go.cms.gov/3eMwudB.

Included in President Joe Biden’s $1.8 trillion antipoverty package, the American Families Plan, is a proposal to make the expanded Affordable Care Act exchange subsidies permanent. The administration’s COVID-19 relief legislation enacted in March increased premium tax credits for people who already qualify for financial help and made subsidies available to people who previously didn’t qualify — but the expanded subsidies were set to expire after 2022. In his address to Congress on April 28, Biden called for health care reforms such as allowing the government to negotiate drug prices and reducing deductibles for ACA marketplace plans, but those are not included in his new legislative proposal. Visit https://bit.ly/3aPQjzm.

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Anthem 1Q Results Tout Gov’t Plan Growth, 85.6% MLR

April 29, 2021

Anthem, Inc. reported strong membership growth in its Medicare and Medicaid segments along with a lower-than-expected medical loss ratio (MLR) of 85.6% in its 2021 first-quarter earnings report. The MLR results, which handily beat analysts’ expectations of an 87.7% MLR, reflected lower utilization of non-COVID-19-related medical services, the company said.

Anthem, Inc. reported strong membership growth in its Medicare and Medicaid segments along with a lower-than-expected medical loss ratio (MLR) of 85.6% in its 2021 first-quarter earnings report. The MLR results, which handily beat analysts’ expectations of an 87.7% MLR, reflected lower utilization of non-COVID-19-related medical services, the company said.

The insurer isn’t necessarily expecting utilization to jump as the pandemic winds down, Chief Financial Officer John Gallina said April 21 during the company’s earnings conference call. “We continue to closely monitor our markets as vaccination rates increase,” Gallina said. “The senior population has been vaccinated sooner, and so we are seeing a significant decline in COVID inpatient [costs] associated with seniors, which means that the non-COVID [utilization] can rebound a bit faster. We believe that we’ve totally factored that in.” Members who needed care in 2020 mostly were able to obtain it, Gallina said, and so there likely isn’t “a giant backlog.” But Anthem did see some increased costs associated with COVID-19 testing and vaccine administration in the first quarter, he said.

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