Health Plans

MCO Stock Performance, September 2021

October 15, 2021

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Consolidation in Payer, Provider Markets Continues to Rise

October 15, 2021

About 73% of health insurance markets in the metropolitan statistical areas were highly concentrated in 2020, while in 46% of those markets, a single insurer’s market share reached at least 50%, according to the 2021 edition of an annual report from the American Medical Association. The consolidation trend is also pronounced with providers, a trend that is likely to be accelerated due to revenue shortfalls caused by the pandemic. A Health Affairs study found that the share of primary care physicians affiliated with vertically integrated health systems increased from 38% in 2016 to 49% in 2018, while more than half of physicians and 72% of hospitals were affiliated with one of 637 health systems in 2018. Yet several studies suggested that there is no clear evidence that provider consolidation leads to higher quality of care.

About 73% of health insurance markets in the metropolitan statistical areas were highly concentrated in 2020, while in 46% of those markets, a single insurer’s market share reached at least 50%, according to the 2021 edition of an annual report from the American Medical Association. The consolidation trend is also pronounced with providers, a trend that is likely to be accelerated due to revenue shortfalls caused by the pandemic. A Health Affairs study found that the share of primary care physicians affiliated with vertically integrated health systems increased from 38% in 2016 to 49% in 2018, while more than half of physicians and 72% of hospitals were affiliated with one of 637 health systems in 2018. Yet several studies suggested that there is no clear evidence that provider consolidation leads to higher quality of care.

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News Briefs

October 15, 2021

CMS for the first time on Oct. 12 approved a state’s request to provide gender-affirming care as an essential health benefit (EHB) in the individual and small-group health insurance markets. Colorado’s new EHB-benchmark plan will offer transgender individuals access to a wider range of services than what is currently covered by their health plans, such as eye and lid modifications, face tightening, facial bone remodeling for facial feminization, breast/chest construction and reductions, and laser hair removal. Effective Jan. 1, 2023, Colorado is also adding EHBs in its benchmark plan to include mental wellness exams and expanded coverage for 14 prescription drug classes.

CMS for the first time on Oct. 12 approved a state’s request to provide gender-affirming care as an essential health benefit (EHB) in the individual and small-group health insurance markets. Colorado’s new EHB-benchmark plan will offer transgender individuals access to a wider range of services than what is currently covered by their health plans, such as eye and lid modifications, face tightening, facial bone remodeling for facial feminization, breast/chest construction and reductions, and laser hair removal. Effective Jan. 1, 2023, Colorado is also adding EHBs in its benchmark plan to include mental wellness exams and expanded coverage for 14 prescription drug classes.

Humana Inc. is expanding its use of Cohere Health’s digital prior authorization platform for musculoskeletal services, the Boston-based digital health company said on Oct. 13. As part of its initial implementation of Cohere Health’s platform, Humana in January 2021 had rolled out the digital solution to 12 states and has since “made significant progress toward achieving its vision to reimagine and modernize processes for prior authorization by reducing approval times, increasing provider satisfaction, and improving delivery of care, all while preserving important benefits such as safety, predictability, and reducing waste,” according to a press release.

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Datapoint: Ochsner to Launch MA Org in Louisiana

October 14, 2021

New Orleans-based health system Ochsner Health is launching a Medicare Advantage organization, with enrollment beginning in the 2022 plan year. The plans will offer $0 premiums and copays, plus localized wellness benefits. Humana Inc. is the current market leader in Louisiana, serving 51.0% of Medicare lives with 214,277 members.

New Orleans-based health system Ochsner Health is launching a Medicare Advantage organization, with enrollment beginning in the 2022 plan year. The plans will offer $0 premiums and copays, plus localized wellness benefits. Humana Inc. is the current market leader in Louisiana, serving 51.0% of Medicare lives with 214,277 members.

Source: AIS’s Directory of Health Plans

Datapoint: Three States to Launch New Exchange Marketplaces

October 13, 2021

Kentucky, Maine and New Mexico are moving away from Healthcare.gov for the 2022 plan year, launching new state-based marketplaces or, in Kentucky’s case, rebooting a former exchange. In Kentucky, 85,344 people currently receive coverage via the federal exchanges, compared to Maine’s 54,900 and New Mexico’s 40,896.

Kentucky, Maine and New Mexico are moving away from Healthcare.gov for the 2022 plan year, launching new state-based marketplaces or, in Kentucky’s case, rebooting a former exchange. In Kentucky, 85,344 people currently receive coverage via the federal exchanges, compared to Maine’s 54,900 and New Mexico’s 40,896.

Source: AIS’s Directory of Health Plans

Datapoint: Centene Takes on Major Medicare Expansion for 2022

October 12, 2021

Centene Corp. on Oct. 4 said it will expand its Medicare Advantage market’s geographic footprint by 26% in 2021, offering products in 1,575 counties across 36 states. Centene currently serves 1,208,486 MA members across its AllWell, Fidelis, Health Net and WellCare brands. In September, the company announced it is consolidating all of its MA products under the WellCare brand.

Centene Corp. on Oct. 4 said it will expand its Medicare Advantage market’s geographic footprint by 26% in 2021, offering products in 1,575 counties across 36 states. Centene currently serves 1,208,486 MA members across its AllWell, Fidelis, Health Net and WellCare brands. In September, the company announced it is consolidating all of its MA products under the WellCare brand.

Source: AIS’s Directory of Health Plans