Health Plan Weekly

UnitedHealth, Humana Launch Programs for Chronic Conditions

July 29, 2020

Both UnitedHealthcare and Humana Inc. are rolling out new disease-specific care management programs aimed at providing patients with the tools they need to help control their chronic conditions.

The new initiatives highlight new digital and time-tested interpersonal ways of managing chronic conditions, observers say.

UnitedHealth said it has launched its new digital therapy for people with type 2 diabetes that combines wearable technology and customized personal support. The therapy, called Level2, helps participants gain real-time insights about their condition, using a mobile continuous glucose monitor, activity tracker, app-based alerts and one-on-one clinical coaching.

By Jane Anderson

Both UnitedHealthcare and Humana Inc. are rolling out new disease-specific care management programs aimed at providing patients with the tools they need to help control their chronic conditions.

The new initiatives highlight new digital and time-tested interpersonal ways of managing chronic conditions, observers say.

UnitedHealth said it has launched its new digital therapy for people with type 2 diabetes that combines wearable technology and customized personal support. The therapy, called Level2, helps participants gain real-time insights about their condition, using a mobile continuous glucose monitor, activity tracker, app-based alerts and one-on-one clinical coaching.

Meanwhile, Humana says it has contracted with REACH Kidney Care, an educational nonprofit affiliated with Dialysis Clinic, Inc., to provide kidney disease care coordination services to eligible Medicare Advantage and commercial members in Georgia, North Carolina, South Carolina and Tennessee. The collaboration is focused on early detection of chronic kidney disease, slowing disease progression and improving the patient experience.

Joseph Paduda, principal at Health Strategy Associates, LLC, notes that both programs are designed to reduce severity and therefore the cost of treating patients, identifying patients who are “heading in the wrong direction and likely intervening.” Still, Paduda says, “what’s notable is that both are focused on individual disease states, especially knowing more than a third of adults — and more than half of older adults — have multiple chronic conditions.”

William DeMarco, president of Pendulum HealthCare Development Corp., says that UnitedHealth has an in-house advantage with its Optum subsidiary, which connects the insurer’s data platforms for claims and clinical data. Therefore, more information and measures can be tracked electronically, reducing the need for physician or even nurse intervention except when needed, DeMarco says.

DeMarco says the applicability of digital care management solutions, versus more traditional solutions, depends on the condition — although technology always has a place.

“Diabetes is a data-driven disease,” and therefore particularly well-suited to digital therapy, observes Dan Mendelson, founder of Avalere Health. Other chronic conditions that are particularly data-driven include cardiovascular disease and Crohn’s disease, he says, and “any conditions that require regular medication management are likely to benefit from some kind of digital tools.”

Study Suggests Need for Better Education About Health Savings Accounts

July 28, 2020

In recent years, high-deductible health plans (HDHPs) have faced increasing scrutiny as evidence emerges that they may not actually cause people to be savvier health care consumers. Now, a new study adds another layer to the debate by finding that access to and uptake of health savings accounts (HSAs) is low among people enrolled in HDHPs. “These findings are concerning given that the proportion of employers offering HDHPs has increased dramatically in the past 15 years,” stated a related commentary piece published by JAMA.

By Leslie Small

In recent years, high-deductible health plans (HDHPs) have faced increasing scrutiny as evidence emerges that they may not actually cause people to be savvier health care consumers. Now, a new study adds another layer to the debate by finding that access to and uptake of health savings accounts (HSAs) is low among people enrolled in HDHPs. “These findings are concerning given that the proportion of employers offering HDHPs has increased dramatically in the past 15 years,” stated a related commentary piece published by JAMA.

“For HDHPs to realize the goals of motivating patients to shop around for health care, increasing their price sensitivity and minimizing the chance that they forego necessary care, a high proportion of HDHP enrollees must enroll in an HSA and contribute sufficient funds to meet their out-of-pocket expenses,” wrote Matthew L. Maciejewski, Ph.D., and Anna Hung, Ph.D., Pharm.D., both of Duke University.

The study suggested that one policy option to increase HSA uptake in the individual market could be to “allow more flexibility in what types of HDHPs qualify for linkage to an HSA” or even require exchange plans with high deductibles to be linked to an HSA. Another way would be for employers, health plans and health systems to “target messaging to HDHP enrollees to encourage acquisition of an HSA as a strategy to help manage the high cost-sharing of these plans,” the study said.

Jason Karcher, a Milliman, Inc. actuary, says that for plan sponsors, failing to educate consumers about how to get the most benefit out of an HDHP with an HSA is “tempting fate.” That’s because if consumers end up deferring needed care because they’re concerned about upfront costs, “it can compound and result in higher plan costs down the road.”

E. Craig Keohan, chief revenue officer of HealthSavings Administrators — one of the largest HSA providers — says his firm has had success with engaging consumers by tailoring outreach to people in different circumstances. The company developed six different “personas,” and asks new HSA enrollees to pick one, then “we craft all education and communication on them based on that,” Keohan tells AIS Health.

Despite Coronavirus Surge, UnitedHealth Expects Care Utilization to Rebound This Year

July 23, 2020

With COVID-19 cases and deaths surging in some U.S. states, it has become clear that the nation won’t be back to normal anytime soon. Still, the country’s largest health insurer is betting that health care utilization, and the costs associated with it, will return to something close to typical levels in the second half of the year.

At its lowest point in April, inpatient care volume — including care for COVID-19 patients — was about three quarters less than normal, UnitedHealth Group Chief Financial Officer John Rex said during a July 15 conference call to discuss the company’s second-quarter earnings. At that same low point, utilization of outpatient and physician services fell to roughly 60% of normal levels.

By Leslie Small

With COVID-19 cases and deaths surging in some U.S. states, it has become clear that the nation won’t be back to normal anytime soon. Still, the country’s largest health insurer is betting that health care utilization, and the costs associated with it, will return to something close to typical levels in the second half of the year.

At its lowest point in April, inpatient care volume — including care for COVID-19 patients — was about three quarters less than normal, UnitedHealth Group Chief Financial Officer John Rex said during a July 15 conference call to discuss the company’s second-quarter earnings. At that same low point, utilization of outpatient and physician services fell to roughly 60% of normal levels. But in June, UnitedHealth saw inpatient volume recover to nearly 95% of baseline, and as June turned to July, outpatient and physician services were “tracking above 90%,” Rex said. “These national trends have continued thus far in July, even as certain states are seeing short-term deferral of services where there are elevated levels of infection and hospitalization,” he added.

Indeed, the company predicts that overall, “utilization’s going to come back during the second half of the year,” UnitedHealthcare CEO Dirk McMahon said.

In a note to investors, Citi analyst Ralph Giacobbe observed that the executives’ comments about health care utilization returning to normal were “surprising to us.”

“Ultimately we believe healthcare cost trends will remain muted, and as we look out over the next 12+ months we see those trends driving upside, and lower headline risk post-election driving multiples higher,” Giacobbe added.

In the second quarter, UnitedHealth’s adjusted earnings per share of $7.12 easily beat the consensus estimate of $5.28, and the firm nearly doubled its adjusted EPS compared with the second quarter of 2019. UnitedHealth also maintained its 2020 EPS outlook of $15.45 to $15.75 ($16.25 to $16.55 on an adjusted basis).

Meanwhile, job losses tied to the COVID-19 pandemic and ensuing recession led to a decline in revenue and enrollment for UnitedHealth’s commercial insurance business. But revenue rose on the government business side as Medicare and Medicaid enrollment grew “by nearly 600,000 additional people served year to date,” per the company’s earnings release.

Insurers Take Varied Approaches to Better Serve LGBTQ+ Members

July 22, 2020

In June, when the Supreme Court ruled in Bostock v. Clayton County, Georgia that transgender people are protected by the Civil Rights Act of 1964 in matters of employment, it was just the latest of a decade-long wave of legal and political victories for the LGBTQ+ movement.

Those changes in the law have only begun to play out in the health care industry, which has a fraught history with LGBTQ+ patients. Experts say health plans must address a legacy of discrimination in collaboration with LGBTQ+ community groups in order to better serve this population.

By Peter Johnson

In June, when the Supreme Court ruled in Bostock v. Clayton County, Georgia that transgender people are protected by the Civil Rights Act of 1964 in matters of employment, it was just the latest of a decade-long wave of legal and political victories for the LGBTQ+ movement.

Those changes in the law have only begun to play out in the health care industry, which has a fraught history with LGBTQ+ patients. Experts say health plans must address a legacy of discrimination in collaboration with LGBTQ+ community groups in order to better serve this population.

“Plans can employ a variety of approaches, but most importantly all efforts must have strong Board and management backing to be perceived as real and not window-dressing,” Joe Paduda, a principal at Health Strategy Associates, tells AIS Health via email. “Involving the LGBTQ+ community in communicating the plan’s commitment, demonstrating that thru supporting LGBTQ+ issues and causes, welcoming LGBTQ+ individuals into management in leadership positions, and ensuring diversity efforts address this community are all table stakes.”

Ani Koch, senior program manager at Blue Cross and Blue Shield of Minnesota (BCBSMN) for community health and health equity in the LGBTQ+ community, says trans people are well aware of the mistreatment that ignorance can cause. Koch, who is trans and led a community-based trans health group before joining BCBSMN, says that trans people rely on informal networks to locate respectful providers.

Koch adds that BCBSMN is making a proactive effort to make that grassroots knowledge part of network design, so that the plan’s trans members have less work and risk to deal with when seeking care.

“They have access to the community that we seek to serve. So rather than us trying to form something new, we tried to call them in and work with them,” Koch says. “I can say from my experience, both personally and professionally, that it really does tend to be a word-of-mouth situation.”

Guillaume Bagal, head of diversity and inclusion at Blue Cross Blue Shield of Rhode Island, says that BCBSRI has taken a similar approach with its LGBTQ Safe Zone program. The Safe Zone program identifies providers who have a good relationship with LGBTQ Rhode Islanders and make an intentional effort to serve them well.

Trump Admin’s COVID-19 Testing Payment Guidance Stirs Debate

July 21, 2020

Weeks after the Trump administration released guidance saying private health insurers don’t have to pay for COVID-19 testing conducted for the purposes of workplace safety or public health surveillance, questions and controversy are still simmering about the implications of that edict.

“With COVID-19 cases skyrocketing and our testing capacity nowhere near where it needs to be, it is unacceptable that this Administration’s priority seems to be giving insurance companies loopholes instead of getting people the free testing they need,” wrote Frank Pallone Jr. (D-N.Y.), Bobby Scott (D-Va.), Richard Neal (D-Mass.), Patty Murray (D-Wash.) and Ron Wyden (D-Ore.) in a recent letter to HHS, the Dept. of Labor and the Treasury Dept.

By Leslie Small

Weeks after the Trump administration released guidance saying private health insurers don’t have to pay for COVID-19 testing conducted for the purposes of workplace safety or public health surveillance, questions and controversy are still simmering about the implications of that edict.

“With COVID-19 cases skyrocketing and our testing capacity nowhere near where it needs to be, it is unacceptable that this Administration’s priority seems to be giving insurance companies loopholes instead of getting people the free testing they need,” wrote Frank Pallone Jr. (D-N.Y.), Bobby Scott (D-Va.), Richard Neal (D-Mass.), Patty Murray (D-Wash.) and Ron Wyden (D-Ore.) in a recent letter to HHS, the Dept. of Labor and the Treasury Dept.

James Gelfand, senior vice president of health policy at the ERISA Industry Committee (ERIC), tells AIS Health that he’s fielded concerns that since insurers aren’t paying for back-to-work testing, workers might have to. But in reality, many of the large, self-insured businesses that ERIC represents “are starting to reopen and relaunch back up to full capacity, but most of them are not using a robust testing regime to do so.” The reason, he says, is that diagnostic tests “are essentially taking a snapshot of a moment in time with sometimes a 10-day lag time,” so they’re not very helpful to employees who need to know right away if they’re safe to go back to work.

Steve Wojcik, vice president of public policy at the Business Group on Health, says he sees the logic behind not forcing health insurers to pay for back-to-work testing.

“If there is a medical reason…to get tested, and a doctor is recommending it, then the health plan would cover it, but if testing is part of return to work, some employers may be incorporating testing [costs] into their return-to-work plans,” he points out.

According to Christen Linke Young, a fellow at the USC-Brookings Schaeffer Initiative for Health Policy, a separate problem is the fact that private insurers are required to pay for out-of-network COVID-19 testing at whatever cash price that a lab or provider lists on a public website. Because those prices aren’t necessarily constrained by prevailing market rates, that can “put a lot of upward pressure on insurance reimbursement for tests,” she says.