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40 payer execs on 2025 outlook + more · Becker’s Payer Issues Podcast

• 0:00
  This is Jacob Emerson with the Becker's Payer
• 0:02
  Issues podcast.
• 0:04
  Here's your biweekly industry news briefing for January
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  6th.
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  The majority of health plan executives say they're
• 0:12
  focused on growth and have a favorable outlook
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  for 2025.
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  That's according to a new survey from Deloitte.
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  Between August September of last year, Deloitte surveyed
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  40 c suite executives from large health plans
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  and large health systems nationwide
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  with revenues greater than $500,000,000.
• 0:31
  Do you identify the top trends expected to
• 0:33
  affect business strategies
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  this year? Among those respondents, 65% said developing
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  growth strategies
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  is
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  their top priority for the year, and 59%
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  have a favorable outlook for the year ahead.
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  A rise in revenues is expected by 69%
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  of respondents, and a rise in profitability
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  is expected by 71%.
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  Overall, large health care companies should be focused
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  on consumer acquisition and retention, meeting the needs
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  of those customers, investing in digital platforms, strengthening
• 1:03
  cybersecurity,
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  and prioritizing health equity. Insurers specifically should also
• 1:08
  be prioritizing working more closely with employers on
• 1:11
  certain health products,
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  expanding alternative and virtual care sites and consumer
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  facing digital tech, and enhancing operational efficiencies.
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  60% of insurance executives expect the adoption of
• 1:23
  digital technology to accelerate in 2025,
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  while 53%
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  expect that generative AI and other tech like
• 1:30
  unlimited reality and digital twins
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  will impact organizational strategies.
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  Executives were asked to list the emerging trends
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  they are tracking most heavily,
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  and 58% identified AI and automation first.
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  Many health plans are already using generative AI
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  for claims processing, underwriting, personalized treatment plans, fraud
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  detection, and document extraction.
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  Also among the health plan respondents, 58%
• 1:55
  expect that recent and upcoming regulatory changes
• 1:58
  will influence their organization's strategies this year, and
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  63% are already prioritizing
• 2:04
  compliance strategies
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  to address those challenges.
• 2:08
  The UnitedHealth Group has been named the world's
• 2:11
  largest insurer by net premiums written for the
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  10th year in a row. That's according to
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  AM Best annual ranking published this January.
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  The top 10 insurers in the world by
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  2023
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  net premiums written. Number 1 is UnitedHealth Group.
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  2nd, Centene, and it's Elavance Health. 4th is
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  Kaiser Permanente. 5th is China Life Insurance Company.
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  6th is Humana, then State Farm, then Alliance
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  SE. Number 9 is Berkshire Hathaway. And number
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  10 is AXA SA out of France.
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  Well, Elavance Health has completed its acquisition of
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  Indianapolis based Indiana University Health's insurance business.
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  With the closure of the deal that was
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  first announced back in September, IU Health Plans
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  will now operate as part of Anthem BCBS
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  of Indiana.
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  IU Health Plans serves 19,000 Medicare Advantage members
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  across 36 counties
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  and just under 10,000 fully insured commercial group
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  members through employers.
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  The acquisition of IU's health plans is one
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  of several that Elavance has announced or completed
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  in 2024.
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  The company said back in April that it
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  plans to acquire Center's plan for Healthy Living,
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  a New York based Medicaid long term care
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  plan.
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  The company also closed on its acquisition of
• 3:24
  infusion center and specialty pharmacy operator, Paragon Healthcare.
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  And in October, the company said it intends
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  to purchase Nashville based CareBridge,
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  which is a value based home and community
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  based care provider for patients with chronic and
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  complex needs.
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  Florida Blue is the latest insurer to sue
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  CMS over its Medicare Advantage star ratings for
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  2025.
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  In that lawsuit filed in December in a
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  federal district court in Washington, attorneys for Florida
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  Blue argued that CMS did not account for
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  the effects of natural disasters when it calculated
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  the insurer's Medicare Advantage star ratings.
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  Severe flooding in Broward County in April 2023
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  caused a significant drop in rates of office
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  visits and prescription refills
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  for Florida Blues MA plan members according to
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  the insurer.
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  Though Florida governor Ron DeSantis and president Joe
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  Biden declared a state of emergency in areas
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  affected by the flooding, CMS did not grant
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  an 1135
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  waiter, designating a public health emergency for the
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  flooding.
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  In 2019, CMS adopted an extreme circumstances rule
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  to account for the impact of natural disasters
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  and other uncontrollable
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  circumstances
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  that might affect star ratings.
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  If the flooding in Broward had been granted
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  public emergency status, Florida Blue's HMO MA plan
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  would have received a 4 and a half
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  star rating rather than a 3 and a
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  half stars for plan year 2025.
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  According to the payer,
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  its Medicare Part D plan would have received
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  a 3 star rather than a 2 and
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  a half star rating. Florida Blue said it
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  will lose out on tens of 1,000,000 of
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  dollars in bonus payments as a result of
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  those lower ratings, and it is asking the
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  courts to require CMS to recalculate
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  those ratings.
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  Several other insurers have challenged those 2025 ratings
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  in courts, though on different grounds. In December,
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  CMS increased the ratings for several UnitedHealth and
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  Centene plans,
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  and Humana and Elavance have also filed similar
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  challenges.
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  The new California law that went into effect
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  January 1st will prohibit payers from making coverage
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  decisions based solely on artificial intelligence
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  algorithms.
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  Under that new law, any denial, delay, or
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  modification of care based on medical necessity
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  must be reviewed and decided by a licensed
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  physician or qualified health care provider with expertise
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  in the specific clinical issues at hand.
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  California senator Josh Becker, the bill's sponsor, said
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  that AI has immense potential to enhance health
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  care delivery, but it should never replace the
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  expertise and judgment of physicians.
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  An algorithm cannot fully understand a patient's unique
• 5:55
  medical history or needs, and its misuse can
• 5:58
  lead to devastating consequences.
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  And finally, a former chief human resources officer
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  at Elevance Health, Troy Hennigan,
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  has filed a lawsuit against the company in
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  a georgia federal court alleging age
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  discrimination after his termination
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  in June of last year. The lawsuit claims
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  that mister Hannigan, who is 62,
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  was unlawfully replaced as the CHRO at Carillon
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  by a younger individual, and he alleges that
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  his termination violated the age discrimination in employment
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  act. Elevance denied those allegations in an October
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  legal response,
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  asserting that mister Hennigan's termination was based on
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  legitimate business decisions unrelated to his age. Mister
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  Hennigan had been with elevance since 2019. According
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  to the September complaint, his supervisor informed him
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  in February of 2024
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  that the company wanted to go in another
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  direction and hire a younger person for his
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  role, describing the decision as a win win
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  because people assumed he wanted to retire.
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  Mister Hennigan resisted this alleged narrative, proposing to
• 7:00
  remain through the end of the year, though
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  that proposal was rejected.
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  He claims that his departure was falsely framed
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  as a retirement in company communications,
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  and this position was ultimately filled by someone
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  under the age of 43.
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  In its response, elevance denied any discriminatory statements
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  attributed to mister Hennigan's supervisor, such as his
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  desire to hire a younger person. And the
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  company is arguing that he agreed to describe
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  his his departure as a retirement and asserts
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  that it acted in good faith to comply
• 7:29
  with anti discrimination laws.
• 7:31
  If you like the latest health insurance industry
• 7:33
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• 7:36
  subscribe to the Becker's payer issues enewsletter on
• 7:38
  our website at beckerspayer
• 7:40
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