Health Insurance Carrier Earnings Calls: Learn Their TRUE Strategy
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- čas přidán 11. 09. 2021
- The Q2 2021 Investor Earnings Calls of UnitedHealth Group, CVS Health, Cigna and Anthem All Discuss the SAME 2 Drivers of Their Growth:
1) Government Programs (i.e. Medicare Advantage and Medicaid Managed Care)
2) Increase Script Count for Their PBM Businesses... More Prescriptions = More Money.
Employer Health Plans are NOT Mentioned on Any of these Investor Calls as a Source of Growth for Health Insurance Companies.
Contrast that Lack of Priority with the $14B in Digital Health Venture Capital and Private Equity Investment for Many Companies That Are Creating Innovative Solutions for Employer Health Plans.
Why the Disconnect?
Answer:
Health Insurance Carriers are 'Fast-Followers' of Healthcare Innovation for Employers Because They Need Their Services for Employers to be 'Just Good Enough' to Retain them as Clients.
The Insurance Carriers Then Use These Employer Plans to Negotiate 'Not So Hot' PPO Discounts from Hospital Systems in Exchanged for Much Lower HMO Allowed Amounts.
The Insurance Carriers Then Run Their Medicare Advantage and Medicaid Managed Care Members Through Those Much Better HMO Contracts to Monetize Their Growing Government Business.
Sources:
Health Insurance Carriers WANT Medicare for All Video: • Insurance Carriers Wan...
UHG Earnings Call: www.fool.com/earnings/call-tr...
CVS Health Earnings Call: news.alphastreet.com/cvs-heal...
Cigna Earnings Call: www.fool.com/earnings/call-tr...
Anthem Earnings Call: www.fool.com/earnings/call-tr...
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Nailed it!
Thank you for watching and for your feedback.
Appreciate your videos. Question: Is there an easy way to triangulate total MA lives covered segmented by payer? Info on the smaller companies (i.e. - individual Blues) is tough to find and I really am only finding enrollment data (not total)
Great question. Unfortunately, I do not know the answer.
@@ahealthcarez no worries thanks for the reply!
Can you give some suggestions or made a video on how to negotiate allowable rates with insurance companies. Do small private practice groups have wiggle room or is it take it or leave it basically since "small fish in big pond?" I've seen less that 50% of Medicare rates....
You are doing God's work
You are kind. I’m just keeping my head down. 😉
Another great video. Question: Why are Medicare advantage members twice as profitable than a commercial payer?
Federal Government pays larger premiums to insurance companies for Medicare Advantage members and the insurance companies are able to keep costs down with HMO plans that require referrals/prior-authorizations.
The insurance company then keeps the difference as profit.
Many commercial plans are self-funded, so the insurance company can only charge an administrative fee that is much less money than charging the full premium.
Argument actually concludes that UHC, etc. are pretty smart for improving margin and going where the money is.
Acting rationally given their incentives. However, this approach is not how they portray themselves to their employer customers.
Thank you for watching and for your comment.
Quiero que alguien me diga si el plan 348 de unión y seguros todavía existe
I think their commercial HMO reimbursements are technically different than their MA HMO reimbursements. Do you know if that is true?
Great question. It is not.
Managed care market seems to be going down after Q2 (investors don’t believe will grow) with COVID costs, delta worries, and Biden opening up the prescription negotiation process. Interesting to see what will happen if they lower the Medicare age.
Thank you for watching and for your comment!
Nah it’s going to get bigger as it saves Medicare a lot of money in the long and incentives primary care rather then fee for service specialty/surgery care.
Thank you for weighing in, Bryan.