Eric Preston

Price Transparency in Indiana for 2 Large Health Systems: IU Health & Parkview Focus is ER visits comparing Anthem PPO and UHC PPO contracted rates benchmarking to Medicare Adjusted Rates CPT 99283 Anthem Range % of Medicare: 366%-520% UHC Range % of Medicare: 410%-1,119% CPT 99284 Anthem Range % of Medicare: 639%-794% UHC Range % of Medicare: 631%-1,011% CPT 99285 Anthem Range % of Medicare: 440%-551% UHC Range % of Medicare: 490%-727% Additional Insight: CPT codes 99285, 99284, and 9923 generated $339,301,095 in billed charges through July 2024 YTD for IU Health System All three CPT codes were in the top 13 of utilization and generated the most in billed charges #employeebenefits #pricetransparency

16

10 Comments

UnitedHealth Group (UNH) reported Q1 2024 results yesterday. Here are 13 key stats and financial metrics: 1/ Medicare Advantage Members -Grew from 7,545,000 to 7,760,000 - YoY (”year-over-year”) -up 2.8% -YoY growth down significantly compared to prior years -Market Leader in MA members 2/ Medicare Supplement Members -Grew from 4,320,000 to 4,325,000 - YoY -Up 0.1% -Market Leader in MS members 3/ Commercial Membership -Grew from 27,350,000 to 29,415,000 - YoY -Up 7.6% -largest YoY growth in recent history 4/ Revenue -Grew from $91.9 billion to $99.8 billion - YoY -up 8.6% 5/ Loss Ratio -increased from 82.2% to 84.3% - YoY -driven by Medicare funding reductions, business mix, and partially due to considerations driven by Change cyberattack (loss ratio = medical costs / premium revenue) 6/ Expenses -decreased from 25.6% to 25.2% of revenue - YoY -includes Operating Costs and Cost of Products Sold -includes $593 million expense associated with responding to cyberattack 7/ Intercompany Revenue Eliminations -Grew from $32.6 billion to $36.6 billion - YoY -up 12% -indicates increase of vertical integration 8/ Total Operating Profit -Declined from $8.09 billion to $7.93 billion -down 1.9% 9/ UHC Operating Profit (Insurance Segment) -Grew from $4.34 billion to $4.395 billion -up 1.2% 10/ Optum Health Profit (Provider Segment) -Grew from $1.78 billion to $1.89 billion -up 6.9% 11/ Optum Insights Profit (Data/Consulting/tech Segment) -Declined from $0.91 billion to $0.49 billion -down 46% 12/ Optum Rx Profit (Prescription Drug Segment) -Grew from $1.06 billion to $1.15 billion -up 8% 13/ Valuation Metrics -Market Cap: $432 billion -Price / Earnings Ratio: 19.64 Interesting Notes & Trends: -MA member growth slowed while commercial increased significantly -Loss Ratio is still up YoY, but has leveled off -Change Healthcare cyberattack rippled throughout the org. resulting in significant expense, business disruption, the need for advanced funding to providers, and also impacted the calculation of IBNR reserves ____ If you're a leader in the Medicare industry give me a follow. I post Medicare Market insights daily! P.S. - > if you like this type of info sign up for my newsletter -> https://lnkd.in/gmv65ipM

260

25 Comments

UnitedHealth Group (UNH) reported Q3 2024 results this morning. Here are 14 key stats and financial metrics: 1/ Medicare Advantage Members -Grew from 7,645,000 to 7,810,000 - YoY (”year-over-year”) -up 2.2% -YoY growth down significantly compared to prior years -Market Leader in MA members 2/ Medicare Supplement Members -Decreased from 4,345,000 to 4,340,000 - YoY -Down 0.1% -Market Leader in MS members 3/ Medicaid Members -Decreased from 8,065,000 to 7,450,000 - YoY -Down 7.6% 4/ Commercial Membership -Grew from 27,250,000 to 29,730,000 - YoY -Up 9.1% -largest YoY growth in recent history 5/ Revenue -Grew from $92.4 billion to $100.8 billion - YoY -up 9.2% 6/ Loss Ratio -increased from 82.3% to 85.2% - YoY (loss ratio = medical costs / premium revenue) 7/ Expenses -decreased from 25.2% to 24.9% of revenue - YoY -includes Operating Costs and Cost of Products Sold 8/ Intercompany Revenue Eliminations -Grew from $34.2 billion to $40.0 billion - YoY -up 10.9% -indicates increase of vertical integration 9/ Total Operating Profit -Grew from $8.53 billion to $8.71 billion -up 2.1% 10/ UHC Operating Profit (Insurance Segment) -Declined from $4.59 billion to $4.21 billion -down 8.3% 11/ Optum Health Profit (Provider Segment) -Grew from $1.57 billion to $2.16 billion -up 37.8% 12/ Optum Insights Profit (Data/Consulting/tech Segment) -Declined from $1.11 billion to $0.79 billion -down 29% 13/ Optum Rx Profit (Prescription Drug Segment) -Grew from $1.26 billion to $1.54 billion -up 23% 14/ Valuation Metrics -Market Cap: $559 billion -Price / Earnings Ratio: 39.99 -(prior to market open) ___ If you're a leader in the Medicare industry give me a follow. I post Medicare Market insights daily! P.S. - > if you like this type of info sign, up for my weekly newsletter "Medicare Market Insights" https://lnkd.in/gmv65ipM

124

12 Comments

Quantum Health deserves credit for initiating the practice of independent actuarial validation. The metrics consistently show Quantum Health’s navigation drives positive health outcomes and associated cost savings — from eliminating ER visits to redirecting members from choosing the wrong specialists and misguided care. Learn more about how we’ve gone #AboveandBeyondfor25Years: https://hubs.ly/Q02DMdjV0 #HealthcareNavigation

10

The U.S. spends more on #healthcare than any other country in the world. Inflationary price growth, along with an aging population creating more demand for medical care, is expected to cause health spending to snowball from 17.6% of the GDP last year to 19.7% by 2032, according to a new CMS report. This is unsustainable. At Caduceus Capital Partners, LLC, we are committed to supporting solutions that will meaningfully decrease costs and increase the quality of care.

12

Alignment Health ("ALHC") - an MA Carrier - reported Q3 2024 results. Here are 6 key stats and financial metrics you should know: 1/ Medicare Advantage Members -Grew from 115,600 to 182,300 - year-over-year ("YoY") -up 57.7% 2/ Total Revenue -Grew from $456.7 million to $692.4 million - YoY -up 52% 3/ Loss Ratio -Increased from 88.4% to 89.6% - YoY (loss ratio = medical cost / premium revenue) 4/ Expenses -Decreased from 18.2% to 13.1% of revenue - YoY -includes Selling, general and administrative expenses 5/ Operating Loss -Improved from $(29.8) million to $(19.5) million - YoY -Operating profit/loss margin improved from -6.5% to -2.8% 6/ Valuation Metrics -Market Cap : $2.24 billion __ Give me a follow, I post Medicare Market insights daily. Then sign up for my free newsletter "Medicare Market Insights". https://lnkd.in/gmv65ipM

79

3 Comments

Alignment Health ("ALHC") - an MA Carrier - reported Q2 2024 results. Here are 6 key stats and financial metrics you should know: 1/ Medicare Advantage Members -Grew from 112,172 to 175,100 - year-over-year ("YoY") -up 56.1% 2/ Total Revenue -Grew from $462.4 million to $681.3 million - YoY -up 47% 3/ Loss Ratio -Decreased from 89.9% to 89.8% - YoY (loss ratio = medical cost / premium revenue) 4/ Expenses -Decreased from 15.2% to 12.9% of revenue - YoY -includes Selling, general and administrative expenses 5/ Operating Loss -Decreased from $(23.7) million to $(18.4) million - YoY -Operating profit/loss margin improved from -5.1% to -2.7% 6/ Valuation Metrics -Market Cap : $1.75 billion ___ Give me a follow, I post Medicare Market insights daily. Then sign up for my free newsletter "Medicare Market Insights". https://lnkd.in/gmv65ipM

103

12 Comments

Employers, stay competitive in the actuarial job market! The DW Simpson Salary Survey offers invaluable insights into current compensation trends. Ensure your salary packages attract and retain top actuarial talent. 👉 Access the full survey results: https://nsl.ink/dRkA #ActuarialSearch #AnalyticsRecruiting #ActuarialSalarySurvey

3

Ever heard of 'step therapy' in healthcare? It's when your insurance requires you to try cheaper meds before expensive ones. Think Metformin before Ozempic for diabetes. Cost-saver or barrier to care? Illinois just banned it for fully insured health plans beginning in 2025. Share your thoughts! https://lnkd.in/g_xfccMw #HealthcarePolicy #StepTherapy #InsuranceChanges

2

Alignment Health ("ALHC") - an MA Carrier - reported Q1 2024 results. Here are 6 key stats and financial metrics you should know: 1/ Medicare Advantage Members -Grew from 109,700 to 165,100 - year-over-year ("YoY") -up 50.5% 2/ Total Revenue -Grew from $439 million to $629 million - YoY -up 43% 3/ Loss Ratio -Grew from 91.1% to 92.2% - YoY (loss ratio = medical cost / premium revenue) 4/ Expenses -decreased from 16.0% to 14.4% of revenue - YoY -includes Selling, general and administrative expenses 5/ Operating Loss -Increased from $(32.5) million to $(41.1) million - YoY -Operating profit/loss margin improved from -7.4% to -6.5% 6/ Valuation Metrics -Market Cap : $1.3 billion ____ Give me a follow, I post Medicare Market insights daily. Then sign up for my free newsletter "Medicare Market Insights". Link in Bio.

61

1 Comment

Million-dollar claims have risen 50% in four years, with cardiovascular disease ranking #2 in stop-loss reimbursement spending at over $360M. These insights can help self-funded employers manage risk and costs: https://bit.ly/3XMW3CV #HealthAccess #HighCostClaims #EmployeeWellness #SunLifeUS

16

UnitedHealth Group ("UNH") is the giant in the Medicare space. But, they didn't become that over night. This week's Medicare Market Insights Deep Dive looks at their Q1 2024 results compared to the prior 6 years. -How has membership growth changed? -How has Revenue generation changed? -How has Operating Income ("profit") changed? We also take a look at the Medical Loss Ratio over time. Click here for the free Deep Dive -> https://lnkd.in/gXubE5Qy Question, what other companies would you like a deep dive like this for? __ P.S. -> don't forget to subscribe!

69

We just published the 2024 Milliman Medical Index (MMI), our annual analysis of the cost of healthcare for folks with employer-sponsored coverage. The MMI is the estimate of the overall annual cost of healthcare, including both the employee and employer (i.e., total cost of care). The 2024 MMI estimates that -- Individual healthcare costs at $7,151 -- Our hypothetical family of four costs $32,066, gross of Rx rebate dollars -- The family MMI is $30,486 net of Rx rebates -- The largest contributor to year-over-year changes are trends in pharmacy costs, specifically the the surge in GLP-1 utilization/cost We also have a handy calculator that uses real data to estimate your family healthcare costs, including the amount for premium, costs by service type, and the employer share. My family MMI is $27,058 for the four of us. Full report and calculator: https://bit.ly/4dQL4yw

98

2 Comments

As healthcare provider networks have broadened, PPOs no longer provide employers with the same value. Our latest #USIExecutiveSeries article discusses how USI helps organizations review and implement alternative cost-saving solutions: https://usi.info/3yEHQy2

10

1 Comment

#ICYMI: Video Replay: During our recent Industry Webinar: Opioid Utilization – Looking Into the Future, NCCI’s Raji Chadarevian, Executive Director of Actuarial Research, uncovered important insights into #opioid prescribing patterns and the evolving landscape of pain management. Find the full video @ https://lnkd.in/ecwPCXdd

6