Health Plan Weekly

Strategic Business, Financial and Regulatory Analysis of the Health Insurance Industry Health Plan Weekly

Insurers Sound Alarm Over Increasingly Pricey COVID-19 Tests Nov. 25, 2020 With the COVID-19 pandemic getting worse than ever, health insurers are VOLUME 30 | NUMBER 48 facing an uncertain level of exposure to testing costs. That’s because payers and plan sponsors are on the hook for the entire cost of coronavirus tests — which can vary widely — and they could be required to pay for even more testing depending on the Insiders: Biden May 4 strategy that the Biden administration plans to pursue. Revisit Payer Price Transparency Rule The Families First Coronavirus Response Act and the Coronavirus Aid, Relief and Economic Security (CARES) Act require plan sponsors to pay all in- and out- 5 HHS Raises Eyebrows of-network claims for diagnostic and antibody testing services. The CARES Act says With Promises That New those claims must be paid at a listed “cash price,” which essentially allows labs to Rebate Rule Won’t Hike name a price for test processing. Premiums, Spending And costs for out-of-network testing seem to be increasing, according to a survey of claims data prepared by America’s Health Insurance Plans (AHIP). The 6 Chart: Executive Compensation Data for survey, which was conducted in October, found that the average price for out-of- Top Health Insurers in network COVID-19 tests has increased by 10% since July, and that about 23% of 2019 all claims for COVID-19 tests processed by commercial insurers are out-of-network. Of those test claims, 47% had prices that “significantly exceed” $185, the average 8 News Briefs cost for out-of-network tests analyzed in the white paper. continued on p. 4

States Look Beyond Reinsurance to Protect Individual Markets Reinsurance programs can help lower premiums in the individual insurance market, but they’re not enough by themselves — states will need to experiment Don’t miss the valuable benefits with broader measures to impact underlying health care costs, particularly for un- for HPW subscribers at subsidized individual market enrollees, a report from The Commonwealth Fund AISHealth.com — articles, concludes. infographics and more. Log in at However, such programs could be a tough sell as states tighten their budgets AISHealth.com. If you need assistance, email support@ because of the COVID-19 pandemic, says study author Justin Giovannelli, an asso- aishealth.com. ciate research professor and project director at Georgetown University’s Center on Health Insurance Reforms. “Reinsurance has meaningfully lowered premiums for middle-income folks who Managing Editor aren’t eligible for federal premium tax credits,” Giovannelli tells AIS Health. “But Leslie Small it’s no silver bullet — it doesn’t do much for other populations facing affordability [email protected] barriers. States looking to make a broader impact should consider implementing Senior Reporter Peter Johnson other policies in tandem with — or even in lieu of — reinsurance.” Data Reporter The Commonwealth Fund report found that all 12 states that have imple- Jinghong Chen mented a reinsurance program in the individual market have been able to lower Executive Editor premiums. However, the effect on marketplace enrollment is less clear, with some Jill Brown Kettler states showing declines in enrollment and others demonstrating small increases or remaining level.

Published by AIS Health, Washington, DC. An independent publication not affiliated with insurers, vendors, manufacturers or associations. 2 Health Plan Weekly November 25, 2020

Other policy options may have edges, that will continue to be the found that states’ reinsurance programs a bigger effect, Giovannelli says. For barrier to additional improvements in receive substantial funding from the example, a state coverage subsidy pro- affordability in this market.” federal government, with pass-through gram is more flexible than reinsurance, Giovannelli points out that the dollars available through section 1332 since it can provide assistance broadly Biden administration also could reverse waivers that allow states to test changes or to targeted populations, and it can Trump-era rules on non-ACA-com- to their individual insurance markets. be designed to address premiums and pliant insurance policies: “There are In 10 of the 12 states where programs cost sharing. However, states consider- serious problems with how these prod- have commenced operations, waiver ing any of these options likely will need ucts are marketed. They typically don’t funding covers the majority of program federal support, he says. work for folks with preexisting condi- costs, making the programs viable, the That federal support may not be tions, and they undermine the afford- report said. Two more states — New forthcoming, says Avalere Health con- ability of comprehensive coverage. I Hampshire and Pennsylvania — will sultant Chris Sloan, who notes that the would hope the Biden administration start operating reinsurance programs likely Republican-controlled Senate would restore limits on these products in 2021. would block additional funds for stabi- and close regulatory loopholes that lizing the Affordable Care Act (ACA) allow them to game the markets.” Frankly, many states need a strong and the individual market. That lack Most of the erosion in individual “ reinsurance program to sustain a of dedicated additional funding for viable unsubsidized market, and reinsurance has been one of the largest market enrollment over the last few years has occurred in the unsubsidized could use some additional funding to obstacles since the federal reinsurance improve cost-sharing affordability, population, Sloan says. “Frankly, many program ended in 2016, Sloan tells particularly for lower income states need a strong reinsurance pro- AIS Health. individuals. “While the Biden administration gram to sustain a viable unsubsidized market, and could use some additional will be able to tailor [section] 1332 Eight of the 12 states currently funding to improve cost-sharing af- waiver rules in order to encourage operating a reinsurance program rely fordability, particularly for lower in- states to pursue reinsurance programs at least in part on insurer assessments come individuals.” or public options, it won’t be able to to finance their own obligations, while make funding simply appear,” he says. The funding for reinsurance is five have used general appropriations “Regardless of the tweaks around the key. The Commonwealth Fund report to cover some or all state costs, the report said. “But states have increas- Health Plan Weekly (ISSN: 2576-4365) is published 52 times a year by AIS Health, 2101 L Street, NW, Suite ingly pursued other funding sources,” 300, Washington, D.C. 20037, 800-521-4323, www.AISHealth.com. the authors wrote. “Two states with Copyright © 2020 by Managed Markets Insight & Technology, LLC. All rights reserved. On matters of fair use, individual mandates — New Jersey you may copy or email an excerpt from an article from HPW. But unless you have AIS Health’s permission, it violates federal law to copy or email an entire issue, share your AISHealth.com password, or post content on and Rhode Island — use the penalty any website or network. Please contact [email protected] for more information. dollars they collect to fund reinsurance. Health Plan Weekly is published with the understanding that the publisher is not engaged in rendering legal, Pennsylvania, which recently assumed accounting or other professional services. If legal advice or other expert assistance is required, the services of a responsibility for its ACA marketplace competent professional person should be sought. from the federal government, will

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Senior Reporter, Peter Johnson; Managing Editor, Leslie Small; Executive Editor, Jill Brown Kettler Other states, including Maryland, Colorado and New Jersey, replaced EDITORIAL ADVISORY BOARD: Michael Adelberg, Principal, Faegre Drinker Consulting; Brian Anderson, the expiring federal health insurance Principal, Milliman, Inc.; Pat Dunks, Principal and Consulting Actuary, Milliman, Inc.; Adam J. Fein, Ph.D., tax with state-based taxes on health President, Pembroke Consulting, Inc.; Bruce Merlin Fried, Partner, Dentons; John Gorman, Founder and Chairman, Nightingale Partners LLC insurers with plans to use the money to help fund reinsurance and forthcoming

Contact [email protected] if you’d like to review our rates for group subscriptions. November 25, 2020 Health Plan Weekly 3 coverage subsidy programs, the report For example, “aggressive antitrust Several states are experimenting said. enforcement and scrutiny of mergers with tactics to improve the individ- At the same time, many individual and acquisitions of all sizes would be ual market risk pool, Anderson says. states are facing severe budget crises an action that the Biden administration For example, Maryland is working to tied to the COVID-19 pandemic, could take without congressional sup- enroll currently uninsured individ- making it unlikely that they could shift port,” Anderson tells AIS Health. “The uals whose subsidy eligibility would money from their general funds to FTC [Federal Trade Commission] has qualify them for a zero-premium plan, subsidize insurance, Sloan says. Section become more aggressive over the past while, California is offering direct 1332 waivers must be budget-neutral 10 years in the clinical organizational subsidies to individuals who earn be- for the federal government, and that space. This would be a continuation of tween 400% and 600% of the federal limits how much money is available, trends.” poverty level. he says. In addition, legislation to curb Giovannelli notes that coverage Still, various states already are surprise medical bills, particularly from subsidy programs likely would be stepping up with coverage expansion pathology, emergency, anesthesiology much easier to implement in states that programs initiated before the pandem- and radiology providers, could help run their own marketplace enrollment ic. These programs include direct sub- to lower the cost of care, which would websites, rather than using the federal sidies and Medicaid buy-ins for people translate into lower premiums, Ander- government’s HealthCare.gov site. who don’t qualify for individual market son says. This would require support subsidies. from the potentially GOP-held Senate, New Mexico Eyes Medicaid Buy-In “Some states are looking at alter- he adds, but there’s been some biparti- New Mexico is investigating the native proposals” to reinsurance, Sloan san support in Congress for action on possibility of offering non-subsidy-el- says. “Things like standardized benefit surprise medical bills. igible individuals a type of Medicaid designs that we see in some state-run buy-in, potentially creating an insur- States Need to Consider Their Goals exchange states, as well as states like ance product that pays clinicians and Colorado or Washington who are look- Meanwhile, if additional states hospitals Medicaid rates instead of ing at public options, are all ways that decide to shore up their individual commercial rates “in order to lower states may try to improve affordability insurance markets via reinsurance, they premiums without wrecking their without allocating substantial addition- first need to determine what they hope subsidized insurance market,” Ander- al funding.” to accomplish with such a program, son says. Anderson explains. If the goal is to re- And “Washington state has an ad- Reinsurance Mainly Offers Stabilization duce variance and residual catastrophic ministrative price-setting, privately run Reinsurance programs have led to expenses in an effort to keep multi- ‘public option’ which pays clinicians substantially lower premiums in states ple insurers in a state’s market, then and hospitals 160% of Medicare in or- that have used them, Sloan says, saving claims-based reinsurance will work, he der to reduce monopoly pricing power unsubsidized enrollees from potential says. If the goal is to remove “predict- in rural counties,” he says. “All of these double-digit percentage increases in able high-cost patients from the mar- options can be done independently premiums. “That said, they are inher- ket, then diagnosis-based reinsurance of reinsurance or in conjunction with ently stabilization mechanisms, often like Alaska and part of the Maine pro- reinsurance if the objective is to lower implemented to avoid drastic premium gram is valuable tool,” he says. gross premiums for people who do not increases in a market or to keep pay- On the other hand, “if the goal is receive subsidies.” ers participating in the market, not to lower gross premiums, other options mechanisms to improve affordability or such as expanding Medicaid for the Read The Commonwealth Fund cost-sharing,” he adds. states that have not expanded Medic- report at https://bit.ly/33cTcX8. Con- David Anderson, a research asso- aid could lower premiums as much or tact Giovannelli at Justin.Giovannelli@ ciate at the Duke-Margolis Center for more so than reinsurance, for roughly georgetown.edu, Sloan at CSloan@ Health Policy, says the Biden adminis- the same fiscal cost to the state while avalere.com and Anderson at da- tration does have some tools it can use also insuring tens of thousands more [email protected]. G to reduce the cost of care more directly. individuals,” Anderson says. by Jane Anderson

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Insiders: Biden May Revisit “I think — as far as the presi- which in turn raises the amount of tax Payer Price Transparency Rule dent-elect’s vision of price transparency credits that the Treasury would have — he’ll share the goals of that final to pay out. [The new administration] While President-elect Joe Biden’s rule, especially on the insurer side. could say, ‘We don’t mind the effort, administration will likely move for- [But] I don’t think he will share the but this is the wrong way to do it.’” ward with some type of health insurer [same] approach that was taken.” Contact Bagel via Dan Lemle price transparency regulation, industry Bagel agrees with Mendelson that at [email protected], Barkett via Ed insiders say the new policy will likely the new administration will likely at- Emerman at eemerman@eaglepr. differ from the rule the Trump ad- tempt to issue more detailed guidance com and Mendelson via Liz Moore at ministration recently finalized(HPW that will make the process of putting [email protected]. G 11/6/20, p. 1). prices in front of consumers more by Peter Johnson “I think that the [new] adminis- explicit. Still, Bagel cautions that any tration will take a step back and think changes to the rule are unlikely to hap- Insurers Fret Over Testing Costs carefully about what makes the most pen quickly, due to the pressing need continued from p. 1 sense,” Avalere Health Founder Dan to handle the COVID-19 pandemic. “We had started to hear stories Mendelson tells AIS Health. Mendel- “I don’t think it will be something from plans around some really egre- son doubts that the Trump administra- they address in the first 100 days or six gious testing charges over the summer, tion rule will actually have an impact months,” he adds. as testing started to ramp up,” AHIP at the consumer level. Under the rule, Biden’s Regulatory Strategy Is Unclear Senior Vice President Jeanette Thorn- by January 2023 health plans must On a similar note, John Barkett, ton tells AIS Health. offer members online shopping tools senior director of policy affairs at Wil- Citing a similar survey published that allow them to see the negotiated lis Towers Watson, cautions that the rate between their provider and their in August, Thornton says AHIP was new administration has not yet had a particularly struck by the fact that plan, as well as a personalized estimate chance to demonstrate what its regula- of their out-of-pocket cost for 500 of “the number of COVID tests being tory strategy will look like, and won’t delivered out-of-network significantly the most shoppable items and services. do so until it has established itself. Effective one year later, those shopping increased,” along with average testing “We have no precedent yet for prices. tools will have to show the costs for all how President Biden and his admin- Thornton says the CARES Act remaining items and services. istration will look at Trump rules,” provision that prevents plans from Barkett tells AIS Health. “One got Quality Should Be Part of Equation charging members cost sharing for the sense President Trump looked at “The most meaningful type of testing has meant that typical utiliza- President Obama’s rules and laws and tion management practices don’t really price transparency is where the con- went about changing them or reversing sumer can actually see what she is them regardless of whether or not they apply to testing. going to pay for Intervention A versus could have found something that they “Under the CARES Act, for the Intervention B, and what the quality liked in them. I don’t know if President consumer, the person that’s getting is for that intervention,” Mendelson Biden would do the same thing yet.” the test, it’s really agnostic whether it’s explains. “That’s what we need to move Barkett explains that some amount in or out of network because the cost towards, not necessarily disclosure of research and modeling, which could sharing has to be waived,” Thornton of every contract that a health plan take time, will likely determine the explains. “There’s less of an ability to has with a hospital, which ultimately insurer price transparency rule’s fate. steer members to higher quality or doesn’t serve systemwide objectives.” “In the rule itself, the [Trump] lower cost test sites because it’s free to Michael Bagel, the director of administration’s budget experts and the person.” public policy at the Alliance of Com- economists and actuaries calculated Joe Paduda, founder of health care munity Health Plans, tells AIS Health that this would raise prices in the consultancy Health Strategy Associates, that Biden will likely revisit the insurer Obamacare markets,” Barkett explains. tells AIS Health via email that “plans price transparency policy. “It would raise premiums for people, have little to no control over out-of-

Access searchable Health Plan Weekly archives at https://aishealth.com. November 25, 2020 Health Plan Weekly 5 network entities,” and adds that “plans that represents self-funded plan spon- the time, the charge is between two should be actively and assertively ed- sors, says that his membership has or three hundred dollars,” Gelfand ucating members about the issue” to experienced a similar dynamic. tells AIS Health. Gelfand says that his keep testing costs down. “I have member companies who members are irritated that they are James Gelfand, senior vice presi- have sent me their ranges of what they being charged that much, but have dent for policy for the ERISA Industry have been asked to pay for these tests, paid up. Committee (ERIC), a lobbying group the out-of-network ones, and most of continued on p. 7

HHS Raises Eyebrows With Promises That New Rebate Rule Won’t Hike Premiums, Spending On Nov. 20, as part of a health though, the new rebate rule will not premiums for all seniors by 25%, care regulatory blitz taking place apply to Medicaid MCOs and will give drug makers another $100 in the waning days of the Trump be effective starting in 2022 rather billion bailout, and have taxpayers administration, HHS finalized a than 2020. foot the bill for higher costs.” once-tabled regulation that would In accordance with Trump’s “It is inconceivable that the Ad- revamp the Medicare prescription executive order, HHS Secretary Alex ministration would now do a com- drug rebate system. This time Azar issued a letter alongside the plete about face and violate its own around, HHS is promising that final rule asserting why he believes it Executive Order by asserting that the so-called rebate rule won’t raise won’t raise premiums, out-of-pocket the rule would not increase federal costs for Medicare beneficiaries or costs or federal spending. But some spending, beneficiary premiums, or the federal government, but some industry analysts appear skeptical of patients’ total out-of-pocket costs,” experts remain skeptical. his reasoning. AHIP President and CEO Matt The rebate rule first appeared According to Citi analyst Eyles wrote in a Nov. 20 statement. in January 2019 in a notice of pro- Ralph Giacobbe, HHS appears Larry Kocot, the leader of KP- posed rulemaking (NPRM), which to be “assuming that Part D plans MG’s Center for Healthcare Regula- aimed to remove safe-harbor pro- will choose to cover more generics, tory Insight, observed that the final tections under the federal anti-kick- improve negotiation with drug rebate rule “does not appear to be back statute for rebates that drug companies, and reduce overhead much different, substantively, from manufacturers provide to Medicare the NPRM,” and the CBO and Part D plans, PBMs and Medicaid costs in order to hold premiums CMS’s actuary both estimated that managed care organizations. But the constant.” However, “given prior would raise Part D premiums and administration pulled the proposed analysis by CBO that the rule would spending. “Secretary Azar has stated rule in July 2019 amid estimates increase premiums and spending, that federal spending, patient out of from the Congressional Budget and considering what we already pocket costs and premiums for Part Office (CBO) and CMS’s Office of know about rebate pass-through in D beneficiaries would not rise under the Actuary that it would increase bidding, it is difficult to see how the the federal rule, but he has offered federal spending and Medicare argument of assumed behavior and little more than his opinion, based beneficiary premiums. reliance on wide interpretation/se- upon his experience, for this asser- Undeterred, President Donald mantics would circumvent the hard tion,” Kocot tells AIS Health. Trump directed HHS to revive the numbers provided by CBO,” he regulation in an executive order wrote in a Nov. 23 note to investors. Access the final rule at https:// issued this summer, and the depart- America’s Health Insurance bit.ly/2JbP3eT and Azar’s letter at ment complied by releasing a final Plans (AHIP) also pointed to such https://bit.ly/39aDVtV. Contact rebate rule on Nov. 20 that bears a analyses, noting that “as the Admin- Kocot via Bill Borden at wborden@ strong resemblance to the original istration’s own actuaries found, the kpmg.com. version. Unlike the first iteration, rebate rule will increase Medicare by Leslie Small

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Executive Compensation Data for Top Health Insurers in 2019

Increase 2019 Other 2019 Total (Decrease) Company President/CEO 2019 salary 2019 Bonus Compensation Compensation from 2018 Centene Corp. Michael F. Neidorff $1,500,000 - $493,078 $26,438,425 1.21% Cigna Corp. David M. Cordani $1,500,000 - $228,070 $19,303,032 1.89% UnitedHealth Group Inc David S. Wichmann $1,384,615 - $201,993 $18,886,989 4.31% Molina Healthcare Inc Joseph M. Zubretsky $1,300,000 $20,024 $18,025,074 18.43% Humana, Inc. Bruce D. Broussard $1,335,069 - $485,804 $16,726,455 2.54% Anthem, Inc. Gail K. Boudreaux $1,400,000 - $228,093 $15,473,139 9.09% Blue Cross Blue Shield of Michigan Daniel J. Loepp $1,537,661 $9,056,823 $1,510,499 $12,104,983 -37.03% Mutual Insurance Company Blue Cross Blue Shield of Florida Patrick J. Geraghty $1,296,154 $4,800,000 $5,867,066 $11,963,220 6.92% Health Care Service Corporation David Lesar $5,527,560 - $510,551 $6,038,111 N/A Independence Hospital Indemnity Plan, Daniel J. Hilferty $1,250,000 $4,431,750 $36,276 $5,718,026 -30.80% Inc. Cambia Health Solutions, Inc. (operates Regence companies in Idaho, Oregon, Mark B. Ganz $1,076,501 $3,845,186 $205,494 $5,127,181 21.07% Utah and Washington state)* Wellmark, Inc. John D. Forsyth $769,231 $3,401,520 $75,001 $4,245,752 10.56% Triple-S Management Corp. Roberto Garcia-Rodriguez $825,000 $600 $9,100 $4,193,701 29.07% Blue Cross and Blue Shield of Andrew Dreyfus $1,150,001 $2,930,777 $72,052 $4,152,830 5.35% Massachusetts, Inc. Premera Blue Cross Jeffrey Edward Roe $1,118,988 $2,714,846 $203,359 $4,037,193 -0.02% BlueCross BlueShield of Tennessee, Inc. Jason David Hickey $805,201 $2,384,270 $181,556 $3,371,027 22.55% Blue Cross and Blue Shield of North Gerald A. Petkau $703,716 $2,161,594 $279,000 $3,144,310 21.87% Carolina Highmark Inc. Deborah Lynn Rice-Johnson $729,236 $1,957,308 $401,030 $3,087,574 16.74% Blue Cross Blue Shield of Arizona, Inc. Pam Kehaly $928,566 $1,627,978 $124,725 $2,681,269 144.47% CareFirst, Inc. Brian David Pieninck $872,558 $1,588,650 $170,176 $2,631,384 67.45% CareSource Erhardt Preitauer $770,428 $734,590 $599,235 $2,325,470 234.57% Tufts Associated Health Maintenance Thomas Croswell $1,113,102 $1,162,696 - $2,275,798 20.01% Organization, Inc. Blue Cross and Blue Shield of South David Stephen Pankau $367,792 $1,733,264 $70,372 $2,171,428 3.91% Carolina Harvard Pilgrim Health Care, Inc. Michael Carson $934,333 $992,213 $85,181 $2,011,727 119.82% Medica Health Plans John W. Naylor $878,846 $911,378 $192,509 $1,982,733 14.31% Blue Cross and Blue Shield of Nebraska Steve Grandfield $772,500 $903,893 $35,338 $1,711,731 -0.87% Hawaii Medical Service Association Michael B. Stollar $824,699 $863,855 $6,000 $1,694,554 51.97% Blue Cross Blue Shield of Minnesota Craig Samitt $1,058,564 $500,000 $52,091 $1,610,655 38.09% CareFirst, Inc. Brian David Pieninck $720,192 $754,800 $96,419 $1,571,412 50.19% Blue Cross and Blue Shield of Kansas Erin Stucky $726,308 $795,993 $28,546 $1,550,847 -11.21% City Medical Mutual of Ohio Richard A. Chiricosta $310,393 $913,957 $7,861 $1,232,211 12.63%

Contact [email protected] if you’d like to review our rates for group subscriptions. November 25, 2020 Health Plan Weekly 7 continued from p. 5 is observable, and blames policymakers ers will be able to plan ahead for what “It’s a healthy profit for the pro- for allowing it to happen. some of what this cost might be.” vider,” Gelfand says. “If the test costs “This should be capped. [Typi- However, Adler cautions that $25 or $50, and they’re getting that cal] lab tests are paid pretty much on testing will not be the same in 2021. much, I don’t care how much time a par with Medicare [rates], or actually He points out that the Biden admin- tech spends administering it — that’s a slightly less than Medicare, often, by istration is much more committed good profit. But it’s also small enough commercial plans,” Adler tells AIS to expanding access to testing than that we can kind of live with it. Maybe Health. He says that policymakers in the Trump administration, which has not if we have to pay for 20 million the CARES Act “could have pretty intermittently tried to block efforts tests, but if we’re paying for people easily chopped off the worst abuses” by to scale up both testing access and who are symptomatic or high-risk, pegging COVID-19 testing prices to capacity. you can live with that number. But the Medicare rates for normal lab testing. Adler and other insiders say there array of outliers is pretty jaw-dropping. Adler is uncertain about how high is a chance that the Biden administra- The persistence of charges that are in out-of-network testing charges will tion could revisit Trump administra- the $800, $1,000, $2,000 range is a impact premiums going forward, partly tion guidance that requires carriers and lot. It’s not just a blip on the radar.” because plans haven’t had to deal with plan sponsors to only pay for “medical- Loren Adler, associate director of this problem before. ly necessary” testing — which doesn’t the USC-Brookings Schaeffer Initiative “Their premiums were already include tests done for public health for Health Policy, agrees that the issue baked in when the year started,” Adler surveillance or back-to-work purposes of overcharging for COVID-19 testing says. “For next year, presumably, insur- (HPW 6/29/20, p. 1).

Executive Compensation Data for Top Health Insurers in 2019, continued

Increase 2019 Other 2019 Total (Decrease) Company President/CEO 2019 salary 2019 Bonus Compensation Compensation from 2018 SelectHealth, Inc. Patricia R. Richards $588,310 $421,253 $25,310 $1,034,873 -19.64% Priority Health Joan Budden $556,981 $294,664 $70,147 $921,792 -22.57% Providence Health Plan Michael L Cotton $512,815 $270,499 $121,024 $904,338 26.54% USAble Mutual Insurance Company Curtis E. Barnett $807,815 $36,755 $34,761 $879,331 -35.28% Geisinger Health Plan Steven R. Youso $666,855 - $190,326 $857,181 -37.32% Presbyterian Health Plan, Inc. Brandon Fryar $593,355 $178,095 - $771,450 20.78%

CareSource Erhardt Preitauer $439,569 - $34,267 $695,053 N/A

UPMC Health Plan, Inc. Diane Holder $249,997 $337,608 - $587,604 138.20% Health Partners, Inc. Andrea Walsh $527,095 - - $527,095 32.98% Capital Blue Cross Gary St. Hilaire $96,146 $235,943 $1,905 $333,994 12.44%

See a full list of director compensation for top health insurers at https://bit.ly/3l1F2OR, compiled by AIS Health. N/A = Not Available Compensation data for Mark Ganz includes payments allocated to Regence insurance operations in Washington state, Oregon and Utah but not Idaho. SOURCE/METHODOLOGY: All data is compiled from individual health insurance companies, state insurance department documents and U.S. Securities and Exhange Commission filings. Health plans selected based on commercial medical risk enrollment as of the beginning of 2020, per AIS’s Directory of Health Plans. NOTE: Alabama, Louisiana, Idaho and South Dakota do not disclose compensation data for specific executives at health insurance companies. California and New York do not collect compensation data. David Lesar was named president and CEO of Health Care Service Corp. in May 2020, effective June 1, 2020. Gerald A. Petkau was appointed interim CEO of Blue Cross and Blue Shield of North Carolina after Patrick Conway resigned on Sept. 25, 2019. Petkau was the chief operating officer of the insurer. Brian David Pieninck was named president and CEO of CareFirst, Inc. in May 2018, effective July 1, 2018. Erhardt Preitauer was named CEO of CareSource in May 2018. His sign-on payments was $221,217. Michael Carson became the president and CEO of Harvard Pilgrim Health Care, Inc. in 2018. Steve Grandfield was appointed CEO of Blue Cross and Blue Shield of Nebraska in March 2018. Craig Samitt became CEO of Blue Cross Blue Shield of Minnesota in July 2018. His sign-on payment was $750,000. Brian David Pieninck was promoted to president and CEO of CareFirst, Inc., effective July 1, 2018. Danette K. Wilson retired from Blue Cross and Blue Shield of Kansas City in May 2019. Erin Stucky, formerly EVP for Market Innovation and Business Development, succeeded Wilson effective June 1, 2019. Erhardt Preitauer joined CareSource in May 2018. His sign-on payment was $221,217.

Access searchable Health Plan Weekly archives at https://aishealth.com. 8 Health Plan Weekly November 25, 2020

“I think that’s something they presumably it goes down the more “What we’re trying to figure out would change,” Adler says. “That’s a people get vaccinated.” is, is there an actual way to have a test, day one, strike of the pen sort of thing. Gelfand says cost is just one reason you do it, and you get the results [right That’s a beginning of the administra- that his members are looking to move away]?” Gelfand says. For employers tion, simple fix that you could do to away from lab-dependent testing to rap- screening employees at the workplace, make testing free at the point of care.” id, self-administered tests — lab testing tests are only useful if “you don’t have to send it somewhere else and wait for Adler observes that the new administra- is expensive even if it is not overcharged. the time in transit. If you can eliminate tion is “coming in and saying, ‘Look, we He also adds that lab tests are practically worthless for workplace screening. that step, there’s definitely interest. If want all testing and all vaccine coverage you can do that, you’ve taken away to be 100% free to the patient.’” Comprehensive testing for on-site employees, Gelfand notes, “is what we all the complaints about scheduling Adler says that the imminent were supposed to do, according to pub- [scarce testing appointments] and lag vaccine rollout is another factor that lic health experts. But then reality set time.” makes projecting testing spend diffi- in. The testing’s not really that useful. Contact Adler at ladler@brook- cult. “By January 20, our vaccine roll- There’s no way to know if you get tested ings.edu, Gelfand via Kelly Broadway out will be partway out,” Adler says. on day X that you’ll get results by day Y.” at [email protected], Paduda at “There’s not all that much time left Gelfand says his members are ex- [email protected] and in the shelf life of COVID-19 testing, tremely interested in some sort of rapid Thornton via David Allen at dallen@ hopefully. Depending on the vaccine, test that can be administered with ahip.org. G you have six more months of it. But minimal training. by Peter Johnson

News Briefs ✦ Americans’ satisfaction with their another 61 insurers are expanding Integrated Health Care Report, 56% health insurance has dipped to its within states where they already of the 300 firms surveyed “are now lowest point since 2016, according operated, according to a new actively integrating their medical, to American Customer Satisfaction analysis from the Kaiser Family pharmacy and ancillary benefits” Index (ASCI) Finance, Insurance, Foundation. Next year there will be under their health and wellness pro- and Health Care Report for 2019- an average of 5.0 insurers per state grams — a 10% increase from when 2020. The sector’s score weakened in the exchanges, which is still below Anthem conducted its last survey in 7.2% year over year for an ASCI the high of 6.0 insurers in 2015 but 2018. Another 40% are “considering score of 72 out of 100, and Huma- far improved from the low of 3.5 in or potentially considering” integrat- na Inc. remained in the lead with 2018. In 2021, 78% of enrollees will ing benefits. Among employers who a 75 — though its score declined have a choice of three or more in- are actively integrating their benefits, 5%. The Blue Cross and Blue Shield surers, up from 67% of enrollees in the integration of pharmacy, vision Association scored an industry-aver- 2020 and 58% of enrollees in 2019. and dental all saw increases of at least age 72 but bucked the declining-sat- Meanwhile, only 10% of counties 6% compared with the 2018 survey isfaction-score trend by seeing a 1% have only a single insurer offering in findings. “It’s encouraging that em- uptick. And “at the bottom of the 2021, down from 52% of counties ployers are realizing employee health industry, CVS Health’s Aetna plum- in 2018. Visit https://bit.ly/3nUCY- and benefits can impact their com- mets 7% to 71,” according to a press da to learn more. pany beyond the associated health release summing up the report. Read ✦ care costs, and can really speak to the more at https://bit.ly/3pZN7qL. Employers are increasingly seeing the value in integrating their em- bottom line,” said Jeff Spahr, vice ✦ In 2021, 30 health insurers are ployee benefits, according to a new president of specialty business devel- entering the Affordable Care Act survey from Anthem, Inc. In the opment at Anthem. Read more at exchanges across 20 states, and latest edition of the insurer’s biennial https://bit.ly/3fwFXWh.