Bits of horror about what went on with health insurance underwriting is creeping into some insurers’ 2016 rate filings, but, so far, it looks as if the big carriers got through 2014 intact.
Analysts at Mark Farrah Associates, an insurance industry tracking firm, say the big carriers seem to be reporting solid results.
“Profit margins for the leading companies were generally favorable,” the Mark Farrah analysts say.
Analysts at athenahealth, a company that provides support services for health care providers, say carriers seemed to be doing a good job of processing claims.
“Market pressures in 2014 presented unknown risks to providers and payers,” the athenahealth analysts say. “Top-performing payers, however, were able to navigate those challenges.”
For a closer look at what the analysts are seeing, read on.
1. The big health insurers made money.
Public exchange enrollees might have been sicker than expected in some states, and major medical market rules might have been more unpredictable than hoped, but, in the end, the big carriers earned solid profits in 2014, the Mark Farrah analysts say.
The analysts charted profit margins for Aetna Inc. (NYSE:AET), Anthem Inc. (NYSE:ANTM), Kaiser Permanente and UnitedHealth Group Inc. (NYSE:UNH) for 2009 through 2014 and found that all four are converging at having a profit margin of about 3 .5 percent to 6 percent, and that, as a group, they are doing about as well as they have throughout that five-year period.
2. Most of the big national and regional carriers processed claims about as quickly as they did before 2014.
The athenahealth analysts say carriers did about as well in terms of claim-processing performance indicators such as days in accounts receivable (DAR).
In the firm’s 2015 payer performance rating table, for example, the overall rankings are based on 2014 calendar-year performance.
The health plans in the middle of the table have had DARs of about 20 days to 30 days both in the 2015 table and in the 2014 table, which was based on 2013 DAR data.
About half of the carriers in the middle seem to have shortened their DAR averages a few days, and about half have let their DAR averages increase by a few days.
The plan at the top of the rankings held its DAR average steady at about 28 days.
See also: What’s under that PPACA World rug?
3. The carriers that sold coverage through the public exchange system in 2014 tended to be good at processing claims both in 2013 and in 2014.
The athenahealth analysts say the carriers that processed claims better in 2013 were more likely to try to sell coverage through the Patient Protection and Affordable Care Act (PPACA) exchange system in 2014, and that those high-performing carriers tended to continue to be the higher-performing carriers in 2014.
When athenahealth compured benefit reliability scores, for example, the exchange carriers had an average score of 87 percent, and the non-exchange carriers had an average score of 78 percent.
“Non-[exchange] payers must focus on benefit reliability to avoid slipping further behind,” the analysts say.
See also: Who hassles the providers?