CEO says CMS’ Medicare Advantage changes won’t slow UnitedHealth down

Program designed for UnitedHealth Group projected to enroll more Medicare Advantage members than expected this year despite regulatory changes Officials said on Friday to curb excessive profits of health insurance companies.

Center for Medicare and Medicaid Services decision last month Steps in Risk-Adjustment Changes Andrew Witty, CEO of UnitedHealth Group, said during its first-quarter earnings call that the three-year period would give the company time to adjust its operations and mitigate cuts in benefits to members.

He said he expects to add more than 900,000 Medicare Advantage members this year, ahead of the company’s projections. Despite the consolidation of CMS and the removal of more than 2,200 risk codes used to catalog complex conditions, signing up dually eligible members for Medicare and Medicaid remains a focus of the company.

“We feel good, we intend to grow in 2024 and we expect the market to continue to grow in 2024,” Vitti said.

Additionally, UnitedHealth does not expect regulatory changes to the Medicare Advantage program to reduce providers’ appetite for shared risk contracts.

Parent company UnitedHealth Group, the largest insurer and employer of physicians, reported net income rose 16% year-over-year to $8.1 billion on revenue growth of 15% to $91.9 billion.

UnitedHealthcare insurer’s net income rose 14% to $4.3 billion, driven by increased subscriptions and slower recoveries of non-urgent procedures. Revenue rose 13% to $70.5 billion. The insurer counted 52.8 million members this year, up 3.7% from 50.9 million.

Officers addressed during the meeting UnitedHealth plans to acquire physicians, increased scrutiny of the pharmacy benefit manager industry by lawmakers, coverage of pricey new weight loss drugs and more. Here’s what to know.

hired more doctors

Optum’s net income grew 19% to $3.7 billion on revenue growth of 25% to $54.1 billion, primarily driven by more patients arriving at OptumHealth clinics and an increase in OptumRx pharmacy scripts processed. Optum expects to add 10,000 physicians this year, Vitti said. The healthcare provider reported to hire more than 70,000 physicians by the end of 2022. In February, Optum paid an undisclosed amount for Crystal Run Healthcare, a network of about 400 providers in New York.

remove prior authorization

UnitedHealthcare’s decision last month remove prior authorizations About 20% of its services will not put a strain on the company’s finances, UnitedHealthcare CEO Brian Thompson said during the call. He added that the company also plans to remove all prior authorization requirements for certain physician practices, which would translate to a 10% reduction in prior authorizations. The insurer expects most of these changes to be rolled out during the third quarter.

olympic costs less

While pharmacy expenses represented 20% of the company’s total medical expenses in the first quarter, less than 1% of those charges were for GLP-1 weight loss drugs, such as Novo Nordisk’s Ozempic or Vegovy. “The price has to be affordable, that’s going to be a major element of how this develops,” Witty said. “We will keep a close eye on prices in Europe.”

Regulatory Scrutiny Isn’t Slowing OptumRx Down

MPs’ Investigating the PBM Industry Business hasn’t slowed down at OptumRX, Vitti said. He said OptumRX’s revenue grew 14.9% to $27.4 billion, with “record levels of retention” among employer customers. OptumRx is the third largest PBM controlling 21% of the market in 2021, according to the latest data from Drug Channels, a research group. “There has to be a counterbalance to drug company pricing, and the only players working really hard to drive down costs are the PBMs,” Vitti said. “We are very happy when people cut list prices, and we are very happy when we get extended discounts, because that cuts costs.”

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