How Might the Pandemic Affect Health Premiums, Utilization, and - - PowerPoint PPT Presentation

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How Might the Pandemic Affect Health Premiums, Utilization, and - - PowerPoint PPT Presentation

Dec 19, 2023 40 likes •203 views

How Might the Pandemic Affect Health Premiums, Utilization, and Outcomes in 2021 and Beyond? October 19, 2020 Agenda Introduction Cynthia Cox, vice president and director of the Program on the ACA, KFF Presentations Krutika Amin,

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October 19, 2020

How Might the Pandemic Affect Health Premiums, Utilization, and Outcomes in 2021 and Beyond?

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Introduction

  • Cynthia Cox, vice president and director of the Program on the ACA, KFF

Presentations

  • Krutika Amin, associate director for the Program on the ACA, KFF
  • Nisha Kurani, senior policy analyst for the Program on the ACA, KFF
  • Luke Greenwalt, vice president, Market Access Center of Excellence, IQVIA
  • Michael Kleinrock, research director, Institute for Human Data Science, IQVIA
  • Christopher Mast, Clinical Informatics, Epic
  • Nichole Quick, Clinical Informatics, Epic

Audience Q&A Closing Remarks

  • Jay Want, executive director, Peterson Center on Healthcare

Agenda

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Science and Medicine Epidemiology Vaccine/ testing development Severity and disease management Public Health and Policy Response Private individuals’ and companies’ behaviors Public institutions (local, state, federal)

Sources: Peterson-KFF Briefs Available at: https://www.healthsystemtracker.org/brief/how-health-costs-might-change-with-covid-19/, https://www.healthsystemtracker.org/brief/covid-19-test-prices-and-payment-policy/

Uncertainty Due to COVID-19 Affects Various Drivers of Future Health Insurance Enrollment, Premiums, and Claims Costs

  • $20-$850/test?

Testing

  • Costs to plans and overall system?

Vaccines

  • Est. $10,000 - $90,000 for

pneumonia hospitalization; rest?

Hospitalization/ Treatment

  • Telehealth?

Changes in Utilization

  • Pent-up demand/ backlog/ more

complications later?

Delayed/ Foregone Care

  • Churn between markets?

Coverage Changes

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Sources: Cost-Sharing Waivers and Premium Relief by Private Plans in Response to COVID-19. https://www.kff.org/health-costs/issue-brief/cost-sharing- waivers-and-premium-relief-by-private-plans-in-response-to-covid-19/ Explaining California v. Texas: A Guide to the Case Challenging the ACA. https://www.kff.org/health-reform/issue-brief/explaining-california-v-texas-a- guide-to-the-case-challenging-the-aca/

Policy changes are moving targets

What has already happened?

  • Expansion of services provided over

telehealth

  • Federal policies on telehealth services

‒ Medicare ‒ Individual/small group markets

  • Insurers’ MLR and premium holidays
  • Legislative actions on testing/ coverage

What is unknown for 2021+?

  • Patient cost sharing for

testing/treatment

  • Premium stabilization options

‒ Reinsurance ‒ Risk corridors

  • California v. Texas SCOTUS case
  • Election
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2021 Premium Changes in the ACA Marketplace

Overall Rate Change and COVID-19 Load Among ACA Marketplace Plans Overall Rate Increase Impact of COVID-19 on Rates

(among insurers with unredacted justifications)

25th Percentile

  • 3.5%

0.0% Median 1.1% 0.0% 75th Percentile 4.6% 2.0%

  • Modest increase in overall rates: 1.1% (median)
  • So far in 2020, insurers have remained profitable and loss ratios have

been low

Sources: 2021 Premium Changes on ACA Exchanges and the Impact of COVID-19 on Rates. https://www.kff.org/private-insurance/issue-brief/2021-premium- changes-on-aca-exchanges-and-the-impact-of-covid-19-on-rates/

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Impact of COVID-19 on Premiums

  • General uncertainty around impact of COVID-19 on rates
  • 23 of the 63 filings (37%) specified the impact of COVID-19 on premiums, including:

– COVID-19 testing and treatment costs – Vaccination costs; e.g., $75/dose, with 80% of population receiving a dose – Demand for services deferred in 2020 – Morbidity adjustments

“Given the level uncertainty and range of plausible outcomes, we are not including an explicit factor for the impact of COVID-19 on our 2021 premium rate development at this time.” - Insurer on Ohio Marketplace

Sources: 2021 Premium Changes on ACA Exchanges and the Impact of COVID-19 on Rates. https://www.kff.org/private-insurance/issue-brief/2021-premium- changes-on-aca-exchanges-and-the-impact-of-covid-19-on-rates/

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6

0M 10M 20M 5M 15M 25M

1.3

14- Mar 8- Feb

22.4 1.7

15- Aug 7- Mar

1.8 4.4

15- Feb 22- Feb 29- Feb 11- Jul

1.7 1.4

21- Mar 28- Mar 13- Jun 4- Apr 11- Apr 18- Apr 25- Apr 2- May 9- May

1.7

16- May

1.0

23- May 30- May

5.2

27- Jun 6- Jun 20- Jun

1.7 0.2

4- Jul 18- Jul

18.1

25- Jul 1- Aug

7.4

8- Aug

3.9

22- Aug 29- Aug

0.2 15.8 0.2 17.3 0.2 1.7 3.2 6.6 0.2 0.2 1.7 2.1 0.3 3.3

12- Sep

3.1 11.9 6.9 18.0 22.5 1.0 2.7 24.9 2.4 20.8 21.3 1.9 20.6 1.6 20.3 1.5

1- Feb

1.5 18.8 1.4 1.4 17.8 1.4 16.2 17.0 1.2 16.1 15.5 1.1 14.8 19.2 0.9

5- Sep 19- Sep 26- Sep

0.8 12.0 11.0 12.4 0.9 0.9 12.8 13.1 0.9 13.3 Initial Jobless Claims Continuing Unemployment

10.2%

Weekly Jobless Claims and Continuing Unemployment

Source: Bureau of Labor Statistics Jobless Claims data through 9/26/2020

Although trending in the right direction, 11M continuing unemployment claims reflects a challenged economy and potential shifts in health insurance enrollment Continuing unemployment is a precursor to shifts in health insurance enrollment, structural unemployment is not always readily apparent

11.1% 13.3% 14.7% 4.5% 3.5% 8.4% 7.9%

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7

31,689,061 42,491,262 48,590,074 72,701,268 74,633,849 6,210,000 8,149,000 14,265,000 17,750,000

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 June 2020

Medicaid Enrollment* Unemployment

Historically, Medicaid enrollment has been sticky despite the economic expansion over the last decade

Unemployment and Enrollment Growth Trend (based on monthly average)

Recession Recession ACA Expansion

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8

Patients are 3x as likely to switch to Medicaid in ACA expansion states than non-expansion

Consumers shifting payer channels is beginning to occur with increases in Medicaid enrollment – importantly more people show no Rx activity in 2020

92.4%

7.6%

51.0% 64.9%

23.1% 8.0%

17.0% 17.90% 4.50% 4.00%

Patients w/ Comm. MOP Expansion States Non-Expansion States

Rx Coverage Comparison Pre/Post COVID

Maintain Coverage Switch Coverage Cash/Discount Medicaid Medicare HIX Other

21.0% 15.2% 25.0% 19.5% 0% 5% 10% 15% 20% 25% 30% +19% +28% 2019 2020

Q2 Q3 Inactive Commercial Patients

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Medical claims have rebounded to a steady 80% of pre-COVID baseline with 8-10% from strongly adopted telehealth

Data for latest week date controlled against prior periods; estimates have been applied to reflect anticipated late-adjudicated claims based on historical rates

Source: IQVIA: Medical Claims Data Analysis, 2020; Baseline = Average of claims for period W/E 1/10/2020-2/28/2020, Estimated amounts for latest weeks applied based on likely claims still to be received due to data latency or claim processing delays; See Appendix for further details

1% 30% 19% 69% 50% 8% 0% 20% 40% 60% 80% 100% 120% Baseline 03-13 03-27 04-10 04-24 05-08 05-22 06-05 06-19 07-03 07-17 07-31 08-14 08-28 09-11 Total Visit Claims by Service Type Baseline Period – W/E 9/11 INSTITUTIONAL OFFICE TELEHEALTH

Jan May Sep

Year over Year Growth – Elective Procedu4e Across Time Aligned Weeks

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Pediatric and adult vaccinations were severely impacted early in COVID but have returned to more normal levels; Flu vaccinations a bright spot in 2020

Source: IQVIA Weekly Sales Perspectives (WSP), February – June 2020; Note: Data reflects sales to clinic channel as defined by IQVIA – No methodology has been applied to determine VACCINE USE BY AGE; Source: IQVIA NPA Weekly, Week ending Oct 02, 2020

0.0 1.0 2.0 3.0 4.0 5.0 6.0 19-Jun 3-Jul 17-Jul 31-Jul 14-Aug 28-Aug 11-Sep 25-Sep 9-Oct 23-Oct 6-Nov 20-Nov 4-Dec 18-Dec Dispensed Prescriptions for Flu Vaccine Millions

Week Number

Flu Vaccinations by week in 2020 compared to equivalent week in 2019 2020 2019

Aug 7-Oct02 2020: 23.5mn 2019: 12.6mn

  • 100,000

200,000 300,000 400,000 500,000 600,000 2/7 2/21 3/6 3/20 4/3 4/17 5/1 5/15 5/29 6/12 6/26 7/10 7/24 8/7 8/21 9/4 9/18 Weekly Volume Unit Clinic Sales for Selected Pediatric Vaccines* Through W/E 9/25

  • 50,000

100,000 150,000 200,000 250,000 300,000 2/7 2/21 3/6 3/20 4/3 4/17 5/1 5/15 5/29 6/12 6/26 7/10 7/24 8/7 8/21 9/4 9/18 Weekly Volume Unit Clinic Sales for Selected Adult Vaccines* Through W/E 9/25

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Delayed Cancer Screenings

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Pediatric Immunizations Drop in the Wake of COVID-19

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Trends in Overall and Non-COVID- 19 Hospital Admissions

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COVID-19 Racial Disparities in Testing, Infection, Hospitalization, and Death: Analysis of Epic Patient Data

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Ashley Joyce Communications Associate, DC Email: ajoyce@kff.org Phone: (202) 654-1348 An archived version of the webinar will be posted online later today. We will notify attendees by email when it is available. For the latest information and analysis of trends, drivers and issues that impact the performance of the U.S. system, visit the Peterson-KFF Health System Tracker:

healthsystemtracker.org

Contact Information and Additional Resources