Preview: Health Plan Weekly

News Briefs

October 22, 2021

UnitedHealth Group will reprocess all of its commercial claims for COVID-19 vaccine administration after a federal investigation found the integrated health care giant paid providers less than 40% of the Medicare reimbursement rate for administering inoculations. Sen. Bob Casey, Jr. (D-Pa.), chair of the special committee on aging, wrote in a letter to UnitedHealth that it must inform the committee of the number of claims it expects to reprocess by Nov. 5. UnitedHealth will owe about $15 million for every 1 million claims it reprocesses, according to press reports.

UnitedHealth Group will reprocess all of its commercial claims for COVID-19 vaccine administration after a federal investigation found the integrated health care giant paid providers less than 40% of the Medicare reimbursement rate for administering inoculations. Sen. Bob Casey, Jr. (D-Pa.), chair of the special committee on aging, wrote in a letter to UnitedHealth that it must inform the committee of the number of claims it expects to reprocess by Nov. 5. UnitedHealth will owe about $15 million for every 1 million claims it reprocesses, according to press reports.

Meanwhile, UnitedHealthcare launched a new prenatal care program in North Carolina with Unified Women’s Healthcare (UWH), an obstetrics and gynecology firm. UWH will introduce new care standards at clinics in Asheville, Hickory, Morehead City and Goldsboro, with the goals of “improv[ing] outcomes and reduc[ing] racial and social disparities among mothers in North Carolina by providing access to quality maternal care,” per a press release.

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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.

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.

A year later, those researchers are still learning about this dramatic change. Their findings will be important to both health systems and payers because virtual care in SUD treatment is here to stay. However, researchers and industry insiders say that the health system has to make intentional, well-informed decisions on what amounts and types of telehealth will work best for patients and clinicians.

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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.

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.

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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