September

JPMorgan’s Health Care Reboot Ditches Disruption for Insiders

September 24, 2021

JPMorgan Chase Co. has revamped its troubled effort to become a major player in health care by taking an insider approach and staffing its new venture, Morgan Health, with career health care executives — a move that comes after the firm initially positioned itself as a disruptor with its flashy Haven joint venture alongside Amazon and Berkshire Hathaway. Morgan Health will instead focus on a familiar goal — “improving employer-sponsored healthcare,” per its website — through an emphasis on primary care and capitated reimbursement, while building on JPMorgan’s existing relationships with Cigna Corp. and CVS Health Corp.’s Aetna.

Beyond the goal of reducing JPMorgan’s health care costs, Morgan Health will eventually sell analytics, benefit design and care coordination insights and a capitated reimbursement model to other employer plan sponsors. In contrast with Haven, Morgan Health is directed solely by JPMorgan. Morgan Health also controls a $250 million venture fund, of which $50 million was spent in August to invest in primary care provider Vera Whole Health, where Morgan Health now holds a board seat. Vera’s primary care practice is funded solely by risk-based, capitated reimbursement.

To access this post, you must purchase a subscription plan. Click Here to purchase.

Already a member? Click Here to login.

Surveys Highlight What Members Want From Health Plans

September 24, 2021

In recent weeks, rankings and survey results have emerged that seek to answer a timeless question for health insurers: How can plans better serve and engage their members?

While the methodology of these reports varies considerably, as do the results, all of their findings offer insights into best practices for an ever-changing industry.

One such survey comes from a company called Zipari, which sells consumer engagement platforms to payers. For the first of what the company hopes will be a yearly report — titled “Members Weigh-In on Consumer Experience, With Some Surprises for Payers” — Zipari sent an online survey to health plan members and representatives across the country.

To access this post, you must purchase a subscription plan. Click Here to purchase.

Already a member? Click Here to login.

How Can Feds, MCOs Make Medicaid Telehealth Use Last?

September 24, 2021

More and more health care is making a permanent move to the internet following the pandemic-driven virtual care boom — which is a big reason why Medicaid MCOs are doing more to bring telehealth and even broadband internet access to their members. That’s according to a Sept. 23 panel of federal officials and an insurance executive at the AHIP National Conference on Medicare, Medicaid and Dual Eligibles.

“Over the last 18 months, we saw a huge uptake of telehealth in the [U.S.] — it’s like nothing we’ve seen before,” said Joanne Jee, policy director and congressional liaison at the Medicaid and CHIP Payment and Access Commission (MACPAC). “All the states turned on a dime to expand their Medicaid coverage in very meaningful ways. Prior to the pandemic, nearly all states covered some form of telehealth. But what we saw in the pandemic is that all states are covering telehealth in a more expansive way.”

To access this post, you must purchase a subscription plan. Click Here to purchase.

Already a member? Click Here to login.

Key Financial Data for Leading Health Plans – Second Quarter 2021

September 24, 2021

Click here for a pdf of the full issue

To access this post, you must purchase a subscription plan. Click Here to purchase.

Already a member? Click Here to login.

News Briefs

September 24, 2021

Cigna Corp. on Sept. 23 unveiled several shifts in its top executives’ roles. Eric Palmer will become the president and CEO of the company’s Evernorth health services division, and Paul Sanford will occupy the newly created role of executive vice president of operations, the company said. In addition, Noelle Eder, the company’s executive vice president and global chief information officer, will expand her role to oversee “global data, analytics and automation,” while Everett Neville will take on an expanded leadership role as executive vice president of strategy, corporate development and solutions. Meanwhile, current Evernorth CEO Tim Wentworth, Cigna President of Government and Solutions Matt Manders, and Cigna Chief Clinical Officer Steve Miller, M.D., will retire.

HHS and the Treasury Dept. on Sept. 17 issued a final rule cementing the administration’s plans to lengthen the Affordable Care Act open enrollment period and add a new special enrollment period (SEP), among other provisions. The annual enrollment period will now have an extra 30 days — spanning from Nov. 1, 2021, to Jan. 15, 2022 — and the SEP will be available monthly for certain low-income individuals, HHS said. Both changes were opposed by health insurers, which submitted comments to the administration expressing concerns about potential adverse selection. The final rule also reversed select Trump-era policies, including those that allowed states to transition away from HealthCare.gov and required insurers to send consumers a separate bill for abortion services.

To access this post, you must purchase a subscription plan. Click Here to purchase.

Already a member? Click Here to login.

Cigna Corp. on Sept. 23 unveiled several shifts in its top executives’ roles. Eric Palmer will become the president and CEO of the company’s Evernorth health services division, and Paul Sanford will occupy the newly created role of executive vice president of operations, the company said. In addition, Noelle Eder, the company’s executive vice president and global chief information officer, will expand her role to oversee “global data, analytics and automation,” while Everett Neville will take on an expanded leadership role as executive vice president of strategy, corporate development and solutions. Meanwhile, current Evernorth CEO Tim Wentworth, Cigna President of Government and Solutions Matt Manders, and Cigna Chief Clinical Officer Steve Miller, M.D., will retire. ✦ HHS and the Treasury Dept. on Sept. 17 issued a final rule cementing the administration’s plans to lengthen the Affordable Care Act open enrollment period and add a new special enrollment period (SEP), among other provisions. The annual enrollment period will now have an extra 30 days — spanning from Nov. 1, 2021, to Jan. 15, 2022 — and the SEP will be available monthly for certain low-income individuals, HHS said. Both changes were opposed by health insurers, which submitted comments to the administration expressing concerns about potential adverse selection. The final rule also reversed select Trump-era policies, including those that allowed states to transition away from HealthCare.gov and required insurers to send consumers a separate bill for abortion services.
To access this post, you must purchase a subscription plan. Click Here to purchase.

Already a member? Click Here to login.

Experts: EU Will Continue to Beat US on Biosimilar Adoption

September 23, 2021

As biologics research and development becomes more granular, biosimilars may wind up both less useful and profitable than boosters of the drug category once thought. According to experts, the first wave of biologic patent expiry is almost over — and a new set of expirations starting in 2024 will determine whether biosimilars will have as big an impact in the U.S. as they have in the European Union.

There has been a large number of biosimilar approvals in recent years, according to business intelligence firm GlobalData. The EU “experienced this biosimilar wave ahead of regions such as the US and Asia-Pacific because the EU created the first biosimilar-specific approval pathway,” according to Quentin Horgan, GlobalData’s senior drugs database analyst. Approvals of biosimilars have slowed down in recent years.

Partially due to that fact, a June 2021 report from the IQVIA Institute observed that “in the short-term (2021-2023) the European market provides a relatively low opportunity for biosimilars with only a small number of brands losing exclusivity. However, this will change dramatically between 2024 and 2029 as approximately 100 biologic medicines will lose exclusivity.”

To access this post, you must purchase a subscription plan. Click Here to purchase.

Already a member? Click Here to login.