Member: Health Plan Weekly

Telehealth SUD Treatment Needs More Research, Oversight

October 15, 2021

A growing amount of treatment for substance use disorders (SUDs) has moved to telehealth providers due to the COVID-19 pandemic. This trend likely increased patients’ access to treatment, among other benefits, but researchers and plan sponsors say that the efficacy and value of virtual care modalities in SUD settings is still an open question.

Last year, during the first wave of the pandemic, the entire health care system had to make internet and telephone care available in a short time. SUD treatment was no different. A good deal of SUD treatment traditionally takes place in person, especially in peer support groups and inpatient drug detox. Researchers were already investigating whether remote SUD care is useful before the pandemic, but their work became urgent last spring and summer as providers rushed to meet social distancing requirements.

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UnitedHealth Reports Solid 3Q Despite Rising COVID Costs

October 15, 2021

UnitedHealth Group’s third-quarter 2021 financial results impressed Wall Street, with equities analysts describing the company’s performance as “solid across the board” and “generally positive” even though the company did see health care costs related to COVID-19 rise during the quarter.

The diversified health care giant and parent company of the country’s largest health insurer reported an adjusted earnings per share (EPS) of $4.52 for the third quarter, beating the Wall Street consensus of $4.41. The firm’s revenues increased 11% year over year to $72.3 billion, which it attributed to “balanced, double-digit growth at both Optum and UnitedHealthcare.” And the company’s medical loss ratio for the quarter was 83%, slightly beating the consensus estimate of 83.4% but representing an increase compared to last year’s 81.9%, which UnitedHealth said was due to the repeal of the health insurance tax.

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Air Ambulance Prices Grew Fast — and Will Likely Stay High

October 15, 2021

Air ambulances have been villainized in recent years for charging patients with surprise bills at eye-popping amounts. Comprehensive new research by FAIR Health confirms that air ambulance costs went up very fast — and experts say that even though surprise billing has been banned, high prices are here to stay.

“From 2017 to 2020, average charges, estimated allowed amounts and Medicare reimbursements all increased for both fixed-wing and rotary-wing air ambulance transport,” the Sept. 28 white paper says. The white paper is the most authoritative study of air ambulance charges in the commercial market to date: Most previous research into air ambulance studies focused on Medicare reimbursement. The paper also found that:

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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.

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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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