For health insurance companies, this year looks very similar to last year: elderly patients Continue to postpone careThe cost of COVID-19 is a burden, and record profits are the end result.
Reality does not match expectations. Health insurance companies predict that in the first year of the pandemic, a large number of patients who have become ill due to delayed care will rush back.The assumption that medical costs will rise is included Higher premiums This year. But the insurance company guessed wrong, and the utilization rate is still sluggish.
Online, this works well for insurance companies. Lower-than-expected costs often translate into higher profits, despite the Affordable Care Act Medical loss rate rebate Limit the extent to which insurance companies can benefit financially when their premiums are overrun.
Adam Block, a professor of public health at the New York School of Medicine and founder of Charm Economics, said that health insurance companies have seen their windfall gains as a means for new initiatives.
“The health plan is studying these [claims] Reduce and switch to telemedicine-a cheaper platform-and consider how to invest savings in improving the health of the population,” Bullock said.
Insurance companies are particularly focused on taking care of the lucrative and growing Medicare Advantage population. Elderly giving up care makes it harder for insurance companies to predict their current and future medical needs. Incomplete information may lead to inaccurate risk scores, which may affect medical insurance reimbursement under the risk adjustment plan.
Although patients did not postpone care at the levels reported at this time last year, the surge in COVID-19 and vaccine hesitation has caused a large number of patients to occupy expensive hospital beds. Rick Kes, senior policy analyst for RSM healthcare, said that staff shortages also make it difficult for individuals to schedule medical appointments, causing older people to continue to abandon healthcare.
Kes said that proper modeling of the health and utilization of these members is the biggest business risk faced by the three major medical insurance advantage operators of UnitedHealth Group’s UnitedHealthcare, Humana, and CVS Health’s Aetna. He said that this risk is driving their investments in 2022 and beyond.
“In 2020, many health plans have seen very favorable results, and I think some people are worried,’We will see incredible returns on claims, and we will see such a large utilization rate in 21 years,” Kay Said. “I don’t think we saw the watershed moment when everyone returned to the medical office.”
Humana, UnitedHealthcare and Aetna declined to allow executives to be interviewed. Humana and UnitedHealthcare mentioned Modern Healthcare in their recent earnings conference call, and Aetna declined to comment.
In Humana’s third quarter ended September 30, the company reported that the utilization of Medicare Advantage unrelated to COVID-19 had fallen by 7.7% compared to pre-pandemic levels. At the same time, the hospital care of elderly people with coronavirus is higher than expected. The end result was a 1% drop in the utilization rate of its Medicare Advantage enrollees.
Humana has been focusing on collecting risk scores and collected information on 92% of policyholders that the company believes may affect revenue next year. Unlike competitors that rely on virtual first visits to collect this data, Humana relies on home visits and patient visits to its senior care center to obtain members’ diagnoses.
“wonder if it is or not [telehealth] Will be an alternative, or if we want to motivate highly long-term members to engage in virtual priority interactions from a nursing perspective and our ability to formulate appropriate care plans for a variety of reasons,” Humana CEO Bruce Broussard in the company’s earnings conference call Tell the analyst.
In the past quarter, Humana has made seven acquisitions, giving it the ownership of 21 other high-end clinics.By the end of this year, the company is expected to operate 200 CenterWell and Conviva offices Nationwide. The insurance company plans to open another 30 clinics focusing on the elderly next year. Humana also recently paid an undisclosed amount to acquire onehome and announced plans to acquire Kindred At Home to strengthen its home care business.
Brad Ellis, senior director of North American Insurance Ratings at Fitch Ratings, said that from a high level, Humana’s savings due to fewer selective visits claims were offset by COVID-19 costs. But because the difference was not as large as Humana expected, the insurance company lowered its earnings forecast for this year, but maintained its forecast for 2022.
“We are surprised at how delayed care affects the medical loss rate of these companies,” Ellis said. “When you see a surge in acute COVID-19 cases in the news, people start to postpone care and stop seeing a doctor or going to the hospital.”
UnitedHealth Group’s Chief Financial Officer John Rex stated on the company’s earnings conference call in October that UnitedHealth Group has seen commercial policyholders continue to arrange for selective consultations, while Medicare and Medicaid enrollees are less likely to postpone care. There is an increase. The push-pull effect between these two factors caused the company to raise its profit forecast for the third time this year.
After the surge in visits to the coronavirus in September, United Healthcare believes COVID-19 is the worst endedAt the same time, insurance companies focus on obtaining patient risk scores through face-to-face and virtual interviews.
Rex said UnitedHealthcare included its highest-risk Medicare Advantage and Medicaid members into an intervention plan in which the nursing team monitors patients’ daily vital signs at home to reduce hospital admissions and mortality.
“During these door-to-door visits, our registered nurses will conduct environmental scans, drug reviews and preventive tests on the home,” Rex said. “Last year, we visited more than 1.7 million people, including more than 200,000 people living in rural areas, and we will complete more than 2 million by 2021.”
Optum, the healthcare services arm of the UnitedHealth Group, is conducting virtual visits to all its patients with their primary care physicians and behavioral clinicians, a method that combines traditional and digital care.
This strategy reflects Aetna’s focus on combining CVS Pharmacy’s 10,000 stores with digital care sites as a way to reduce costs while making patients accessible.
“They are cheering up,’What will happen to the risk score in 2022?’ Because we will still have a pandemic in 2021,” said Deana Bell, Milliman’s chief actuary. “The same problem may exist—especially in different local hotspots—if people are too scared to get normal health care services and record these diagnostic codes in their claims, how do you manage it? It is difficult to manage it for Your income next year.”