Operation Recovery Episodes

Operation Recovery: 2020 Payor Trends

Resources

Download today's powerpoint slides. 

Major Trends in 2020

  • Increasingly aggressive towards providers
  • Lawsuits
  • Expanded Medicare offerings from payors
  • Payors continue moving into provider space
  • Huge profits during COVID-19 crisis

Major Trends for Each Payor Group

UnitedHealthcare

  • Not intimidated by public disputes, and continues to be the instigator 
  • United is terminating many physician groups, seemingly randomly, specifically anesthesiologists
  • Sophisticated communication apparatus that other payors may now be modeling

Blue Cross Blue Shield

  • Aggressive toward providers, disputes with market leaders
  • Pervasive cross-border intelligence and strategy sharing

Anthem

  • Terminate to negotiate approach common - waiting until late stages in negotiations and moving slowly
  • Super aggressive on non-negotiated changes (ER, imaging, rehab, and others)

Cigna

  • Recently more engaged in public disputes, seen public negotiations during COVID-19 (Memorial Hermann, UPMC Pinnacle) 
  • Quick to cut their losses, won’t delay deemphasizing
  • Doubling Medicare expansion in 2020 upwards of 25 markets. Going into new markets and more state-focused than country-focused

Aetna

  • Less sophisticated in communication during public disputes 
  • Uncomfortable with highly publicized campaigns and public attacks since 2018 merger with CVS
  • Remain more focused on ACO and collaborative deals more than other health plans (e.g., THR, Banner, Inova, VHAN, Cleveland Clinic) 

Humana

  • Investing in Medicare Advantage expansion 
  • Telemedicine expansion ($100 M deal with telehealth startup Heal)
  • Continued partnerships with Walmart, despite the recent departure of top executive Sean Slovenski, and Walgreens