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2020 is a Mixed Bag for Health Insurers – Surging Revenue but Low Grades

Imagine that you are the CEO of a large, midwest-based, health insurance company and have just learned the results of a national survey where employers gave your company a mid-level grade on the ability to direct employees to high-quality health care. Somewhat discouraging news, don’t you think?

But there’s also good news. Net income for your organization is up almost 100 percent during the recent quarter and you have personally received over $52 million in total pay for 2019.  In fact, your total realized compensation increased 143 percent from the $21.5 million you took home in 2018.

Such is the life of this non-fictional CEO, whose compensation is comprised of salary, stocks, contributions to pension and many other wonderful perks.

Steady Revenue for Insurers – Reduced Claims

Due to the widespread deferral of elective and routine care during the COVID-19 pandemic in the second quarter, health insurance companies have benefited from plummeting medical costs while still collecting predetermined health premiums from their customers. This fortuitous ‘perfect storm’ has resulted in insurers obtaining skyrocketing net income compared to the same period a year ago.

How this will continue to play out when the pandemic recedes, however, will not be known for some time.

Both small and large insurance organizations experienced miraculous financial returns from the second quarter of 2020. UnitedHealth Group reported a net income of $6.7 billion – a 97.8 percent increase. Anthem Blue Cross and Blue Shield reported an increase of 99.8 percent, while Cigna Corp. reported a net income increase of almost 25 percent during this same period.

Many executives promise to correct this financial imbalance by eventually returning excess funds to customers and health providers.

CEO Compensation Growth

Meanwhile, according to a BDO USA survey released earlier this year, health insurer CEOs are doing quite well financially.  I don’t begrudge their success, I really don’t. I do believe, however, in responsible capitalism. Making millions upon millions of dollars just to be an administrator is both excessive and unconscionable. The ‘value’ provided by health insurers within our dysfunctional health system raises some concern. The question of ‘how much is too much’ is a subjective gymnastic exercise, however.

The 2019 compensation for the aforementioned CEO was 348 times more than the median pay earned by an employee at his organization ($54,322). This example is merely illustrative of the health insurance industry.

Lack of Price Transparency

Both insurance companies and hospitals are resisting the tidal wave that is moving toward healthcare price transparency, which should call into question the commitment insurers have to their premium-paying clients. For example, are insurers in business to serve medical providers or their employer clients? Perhaps insurers serve both parties? If so, are employers at a disadvantage by not having specific knowledge of the prices negotiated between insurers and providers? I believe they are.

Without transparency in prices and patient outcomes, how do employers know they are receiving commensurate value for the premiums they pay – which also includes administrative costs charged by insurers? Frankly, it is very subjective.

According to 2019 data from the Kaiser Family Foundation, over 156 million non-elderly Americans – or almost half of the country’s total population – receive employer-sponsored health insurance. By sheer numbers, employers are entitled to know what negotiated arrangements are made between the insurers they use and the medical provider community.

But now comes a newly-released survey. This one addresses whether employers are satisfied with their insurers.

Employers’ View on Insurers is Lukewarm

In July, The Leapfrog Group released very interesting survey results regarding an online survey of employer executives that administer and fund benefits for employees and their dependents. Leapfrog, an independent national healthcare watchdog organization on healthcare issues for employers around the country, desired to “gain employer perspectives on health plan effectiveness in achieving health care quality, safety and value.”

Survey respondents, a total of 174 employers* – small, midsize and large – cited their experiences with health plans that included, Aetna, Cigna, UnitedHealthcare, and over a dozen Blue Cross and Blue Shield plans around the country. Four key issues were rated by employers:

  1. Responsiveness of the health plan to employer concerns;
  2. Transparency in helping employers and employees choose the best (health) providers;
  3. Payment reform initiatives that incentivize excellence in the market; and
  4. Value strategies driven by health plans.

The responses by employers on each issue is quite revealing on just how they perceive the value provided by insurers on high-cost healthcare. These perceptions, by the way, are not flattering to health insurers, especially the views coming from larger employers.

According to the summary of results, Leapfrog indicated that “Most employer respondents appeared to have reservations about whether their health plan puts their needs above the preferences of contracted providers. About a third of Cigna and Aetna clients believed their plan put them first, while only 14 percent of UnitedHealthcare employers were similarly satisfied.

Overall, when asked to grade their health plans, from A to F, employer respondents gave their plans a C-plus (2.57 GPA) on their ability to direct their employees to high-quality healthcare. UnitedHealthcare received the poorest grade, with a 2.29 GPA.

Having accountability in healthcare delivery, payment and outcomes is extremely important to payers. But – at least with the Leapfrog survey – insurers have a long way to go in making their value commensurate with how insurers earn their profits in a poorly-run health system.

Insurance company CEOs should take a hard look at themselves in their mirrors to really see what their reflection candidly reveals.

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*I would’ve like to have seen a bit larger number of respondents, but this is, nonetheless, a very good survey.

CVS and Aetna – A New (and Improved) Healthcare Giant?

Just announced this past Sunday, pharmacy chain giant CVS Health agreed to purchase Aetna, a large, national health insurance company, for about 70 percent of Jeff Bezos (Amazon) net worth – or $69 billion.

CVS is one of the largest providers of pharmacy services in the country, with almost 10,000 retail pharmacy locations and about 1,100 MinuteClinic walk-in clinics, while Aetna is the third-largest U.S. health insurer. By combining, their total annual revenue would be $240 billion. In a joint statement, CVS and Aetna claim this deal will “redefine access to high-quality care in lower cost, local settings – whether in the community, at home, or through digital tools.” Further, according to the CVS Health President and CEO, Larry Merlo, “…With the analytics of Aetna and CVS Health’s human touch, we will create a healthcare platform around individuals.”

Both organizations jointly claim the combined company will “dramatically further empower consumers,” and “better understand our members’ health goals, guide them through the healthcare system and help them achieve their best health.” By having a broader use of data and analytics, the new organization hopes to benefit the entire healthcare system and be able to address the cost of treating patients with chronic diseases. The combined synergy of both organizations lay out a vision to reshape healthcare into a new approach.

This large ‘deal’ has the makings of being a great thing – for both organizations (CVS and Aetna), their shareholders and those covered through their products.

But will it?

Quite often, the American culture is fixated on the belief that “bigger is better,” or that “new and improved” will always serve us best. Perhaps it will. But as I mentioned in my blog, “The Illusion of Getting ‘Bigger‘” – when Aetna was attempting to purchase Humana (a deal that was subsequently blocked by a judge in early 2017 for antitrust purposes) – such deals are not a slam-dunk to fix an ailing and complex $3+ trillion healthcare system. In fact, in some cases, larger integrated delivery networks may make the coordination efforts to serve patients more cumbersome and inefficient.

The twists and turns of organizations finding new approaches and seizing opportunities to make healthcare more affordable, safer and much more efficient is clearly a laudable goal. But, to be so, the patient must always be at the center of these initiatives. The profit and incentive motives are important, but getting it right for the patient should be the primary driver of any meaningful change.

Let’s hope the hype is matched by results.

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The Value of Employee Benefits…
It’s a Passing Parade

Portland Grand Floral Parade 2016

Portland Grand Floral Parade 2016

On the eve of receiving our new 2016 Iowa Employer Benefits Study survey results, I once again have a great deal of anticipation about what this data may reveal. At this point, I only know that 1,014 randomly-selected employers responded to this survey which continues to exceed our annual goal of 1,000. A big ‘thank you’ to all organizations that took the time to participate in this annual work!

Offering workplace employee benefits has been happening for decades. From the employee perspective, receiving various workplace perks is a staple expectation when being interviewed and ultimately hired by most employers. In fact, recent research conducted by staffing and HR service company, Randstad US, shows that jobseekers most value salary, employee benefits, long-term job stability and a pleasant work environment.

Employers, for their part, offer employees and jobseekers a cadre of benefits they believe to be highly-valued by their mainstream targeted ‘audience.’ But it is extremely important for employers to dissect their intended audience by gender, age groups (e.g. generation), location, race and other factors that will help clarify the benefit ‘value’ employees desire. By not doing so, a disconnect will eventually occur, resulting in a large chasm of a wasted investment that is costly, both in terms of money and desired human capital.

Conducting biannual employee engagement surveys may eliminate much of the guesswork that employers have when trying to predict which future strategies to embrace. I suspect that a healthy chunk of employers put their human investment strategies on cruise control assuming that the desires of employees five or ten years ago will still apply in today’s world. Most often, they do not.

Much like a New Year’s Day or Fourth of July parade, a perpetual flow of people (and floats) coming and going will not be replicated again. In a similar fashion, so does the employment pool that organizations continue to encounter.

One example on how employers respond to the ‘new parade’ of employees can be found through three employers: Aetna, Fidelity and PricewaterhouseCoopers. All three have launched their own student loan matching programs for employees who are pursuing undergraduate and/or graduate-level degrees.

Beginning in 2017, Aetna’s full-time employees will qualify for matching loan payments of up to $2,000 per year, totaling $10,000 per student. Part-timers will receive half of this amount by pursuing undergraduate or graduate degrees from accredited institutions.

According to the Society of Human Resource Management (SHRM), about 3% to 4% of all U.S. companies contribute to employees’ student debt payments to help soften the financial burden they increasingly face. About 71% of college graduates carry student loan debt, totaling $1.3 trillion of student debt in this country. A need clearly exists to help alleviate financial hardships and new approaches must be pursued.

Our annual study’s purpose is to survey employers about the key benefits they offer at this particular point in time. It allows employers to compare their benefits with the mainstream. However, the juxtaposition of organization culture and employee attributes can allow any organization to stake a claim on having a competitive advantage when attracting and retaining their most prized asset – the employee. To do this, the organization will need to account for what is most important and valued by their employee population.

So enjoy this year’s parade, but be ready for upcoming attractions that may appear in the next one.

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