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管理式医疗:2020健康保险研讨会概述

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管理式医疗:2020健康保险研讨会概述

 

 Equit y

 R es ea r ch A mer ic a s

 |

 U nit ed

 S ta tes

  O n

 W ednes da y ,

 May

 27 th ,

 s ix

 i nd us tr y

 ex pe r ts,

 ex ecu ti ves ,

 a nd

 c ons ult a nts

 pr es ented

 a t

 our vir tua l

 2020

 H e alth

 I n su r anc e

 S ym p osi u m .

 T he

 sy m pos ium

 cover ed

 a va r iet y

 of

 t opic s

 a nd w a s

 well - a tt ended

 by

 investor s .

 We

 of f e r

 k ey

 t a k ea w a y s

 f r om

 each pr es enta ti on

 bel ow ,

 a nd

 a m or e det a il ed

 di s cuss ion

 in

 the

 p a g es

 t ha t

 f oll ow .

 K e y

 Ta keaw ays fro m M e d i c ai d

 S e ssi o n :

 Uns urpr isin g ly ,

 the

 e mer g ence o f

 t he

 C O VID - 19

 pa ndem ic

 ha s

 been

 disr upti ve

 t o

 t he

 M edic a id

 m a r k et

 la nds ca pe .

 T he

 over a ll

 ba ck dr op of

 t he

 M edic a id

 m a r k et

 ha s

 c ha ng ed

 a s

 unemployment

 inc r ea s es

 a nd

 a s

 sta te s

 f a ce s tr a ined

 f ina nci als f r om

 l os t

 r eve nue

 a long

 with

 a ddit iona l

 ex pens es .

 F or

 ex a mple

 a f ter Medi ca id

 ex pa ns ion

 N evada

 s a w

 it s

 mem ber s hip

 double

 f r om

 300 K

 to

 600 K

 li ves .

 O ur pr es enter

 noted

 tha t

 N evada

 m a y

 a dd

 a nother

 300 - 400 K

 li ves on

 M edic a id

 a s

 t he

 sta te

 ha s

 seen unem ploy ment

 s w ell

 t o

 40 % .

 R eg a r din g

 sta te

 Medi ca id

 cont r a ct s ,

 our

 p r es enter indi ca ted

 tha t

 a number

 of

 states

 ha ve

 a lr ea dy

 a nnounced

 tha t

 they

 a r e del a y ing

 new pr ocur em ents, a nd

 our

 e x per t

 e x pect s

 mos t

 s ta tes

 to

 dela y

 pr ocur em ents

 f or

 1 - 2

 y ea r s .

 He

 hig hli g hted

 tha t

 O hio

 w a s

 s upposed

 to

 do

 a n

 R FP

 in

 2020

 w hic h

 w a s

 dela y ed

 ( pr e - C O VID) , a nd

 c over s

 1 - 2

 mln

 l ives.

 In

 C a li f or nia ,

 the

 R FP

 ti m ing

 w a s

 a lso

 dela y ed

 ( pr e - C O VID) ,

 w it h the

 la s t

 upda te

 indi ca ti ng

 2 Q 21

 ti m ing

 f or

 2023 - 2024

 i mplementa ti on.

 In

 T ex a s ,

 our pr es enter

 not ed

 t ha t

 he

 ha s

 hea r d

 a necdot a ll y

 t ha t

 the

 dela y

 ha s

 been

 dr iven

 mor e by pr ocur em ent

 cha ll en g es

 ( e. g. ,

 pr otest)

 a nd

 l es s

 by

 t h e C O VID - 19

 pa ndem ic .

 K e y

 Ta keaw ays fro m Co mm e r c i al

 M arket

 S e ssi o n

 &

 Ben e fi t

 Co n su l ta n t

 S e ssi o n : A s

 c a rr ie r s

 a nd

 c ons ult a nts

 pr oje ct

 c os t

 tr ends a nd

 t hink

 a bout

 r a t es

 f or

 2021 ,

 insu r er s

 will w a nt

 to

 be

 c ons er v a ti ve

 a s

 t her e i s

 l ittl e post - C O VID

 ex pe r ienc e upon

 which

 to

 ba s e pr ojec ti ons ;

 f ur the r

 c om pli ca ti ng

 bids

 is the

 40 - 50 %

 d r op

 i n

 hea lt hca r e ut il iz a ti on

 seen over the

 la s t

 few

 months .

 O ne

 of

 our

 pr es enter s

 i ndic a ted

 tha t

 the r e a r e t w o

 c om peti ng

 f a ct o r s f or

 2021

 c os t

 tr end:

 C O VID - 19

 costs

 a nd

 suppr es s ed

 c a r e.

 O ne

 model,

 w hic h

 t a kes

 i nto a cc ount

 conver s a ti ons with

 hea lt h

 i ns ur er s ,

 a ss um es

 i n

 i ts

 ba s e model

 tha t

 50 %

 of

 c a r e not

 being

 c u rr entl y

 del ive r ed

 will

 be

 el imina ted

 s uch

 a s

 r eg ula r ly

 o cc ur r in g

 phy s i ca l

 ther a py visits,

 chi r opr a ct i c

 visits,

 ma mm og r ams ,

 ur g ent

 ca r e visits,

 et c.

 A d dit iona ll y ,

 ther e i s

 a cut e ca r e f or

 which

 a n

 i ndividua l

 m ig ht

 ha ve

 r ecei ved

 c a r e but

 w hic h

 is now

 no

 long er

 r equir ed. Emer g ing

 C O VID - 19

 da ta

 i n

 t he

 U .S .

 indi ca tes

 lower

 ul ti m a te

 inf l ect ion

 levels

 a nd

 g r ea ter ca r e def er r a l

 than

 i nit i a ll y

 e x pect ed. U s ing

 a n

 a ss um pti on

 of

 5 %

 i nf ect ion

 levels

 a nd

 a medium

 to

 hig h

 l evel

 o f

 def e rr a ls,

 i t

 is es ti m a ted

 tha t

 em ploy er

 hea lt h

 c a r e c os ts

 in

 2020 coul d

 be

 down

 1.6 - 3.3

 per cent a g e poi nts

 r ela ti ve

 to

 p r evious

 5 - 6 %

 tr end

 f or e ca s ts .

 K e y

 Ta keaw ays fro m P B M

 Co n tr ac ti n g

 S e ssi o n :

 Potenti a l

 P B M

 cont r a ct

 t r i gg er s

 due to

 C O VID

 coul d

 l ea d

 t o

 f a vor a ble

 a djustm ents

 to

 discount/ r eba te

 g ua r antees. T hes e tr ig g er s

 c ould

 inc lude

 m em ber s hi p

 c ha ng es

 a t

 em ploy er s

 ( t y pic a ll y

 a 10 %

 t hr es hold) , cha ng e i n

 c ha nnel

 m ix

 ( m a il

 vs r e ta il ) ,

 cha ng es

 i n

 d r ug

 mix ,

 benef it

 desig n

 c ha ng es ,

 or F or ce

 Ma jeur e .

 T he

 shif t

 to

 90 - d a y

 specia lt y

 c ould

 a ll ow

 PB Ms

 to

 hi t

 r eba te

 g ua r a ntees ea r li er

 but

 pl a ces

 a sig ni f ic a nt

 up f r ont

 cost inc r ea s e f o r

 employ e r

 plan

 spons or s .

 F ur ther , plan

 spons or s

 nee d

 t o

 t a k e i nto

 consider a ti on

 t he

 shif t

 f r om

 30 - da y

 r eta il

 t o

 90 - da y

 ma il .

 Rese ar c h

 An aly sts

 A . J.

 R i c e

 212

 325

 8134

 a j.ric e @ c redit - s uis s e. c om

  Edua r d o R o n

 212

 325

 7491

 edua rdo. ron@ c red it - s uis s e. c om

  Ca l e b

 Ha rri s,

 CPA

 212

 325

 7458

 c a leb.ha rri s @ c redit - s uis s e. c om

  A l e xa n d e r

 K h a n

 212

 325

 7714

 a lexander. k ha n@ c redit - s uis s e. c om

 D IS CLOSU RE

 AP P E ND IX

 AT

 TH E

 B ACK

 O F

 TH IS

 REP O RT

 CONTA IN S

 IMP O RT ANT

 D IS CLOSU RE S ,

 ANALYST CE RT IFICATIONS, LE G AL

 E NTITY

 D IS CLOSU RE

 AND

 TH E

 S TA TU S

 O F

 NON - U S

 ANALYSTS.

 U S

 Discl os ur e :

 C r edit

 S uiss e does a nd

 s eek s

 to

 do

 business w it h

  compa nies

  cover ed

  in

  it s

  r e s ea r ch

 r epor ts.

  A s

  a

 r es ult ,

  inve s tor s

  s hould

  be

  a w a r e

 tha t

  the

  F ir m

  m a y

  ha ve

  a

 conf li ct

  of

  int e r e s t

  tha t

  coul d

  K e y

 Ta keaw ays fro m M e d i c ar e

 S e ssi o n :

 O ur

 c ons ult a nt

 on

 M edic a r e A dvanta g e sa id m a ny

 pl a ns

 see

 s ett ing

 bi ds

 f or

 2021

 a s

 a ma jor

 c ha ll enge due

 t o

 C OVID,

 a s

 well

 as uncer ta int ies a r ound

 a ny

 t iming

 a nd

 r ebound

 of

 de f er r ed

 ut il iz a ti on.

 O ur

 c ons ult a nt

 a lso noted

 tha t

 s he

 c oncur s

 with

 a model

 f r om

 t he

 U r ba n

 Ins ti tut e t ha t

 i ndic a tes

 tha t

 Medi ca r e enr oll ment

 is li k ely

 t o

 no t

 be

 sig ni f ic a ntl y

 impa cted

 by

 t he

 C O VID - 19

 pa ndem ic .

 T his

 model es ti m a tes

 tha t

 Ma r k etpl a ce

 enr oll ment

 w ill

 inc r ea s e by

 4 . 3 - 8.1

 mln

 l ives.

 S he

 not es

 t ha t

 a s these

 people

 enr oll

 i n

 indi vidua l

 pla ns

 now,

 tha t

 m a y

 pr ovide

 t hem

 mor e c om f or t

 i n

 ma k ing insur ance pur cha s e dec isions ,

 a nd

 t hey

 ma y

 be

 mor e c om f or ta ble

 opti ng

 f o r

 M A

 pl a ns

 a s they

 bec om e el ig ibl e f o r

 M edic a r e.

 O ur

 M A

 p r es enter

 a lso

 s ug g es ted

 tha t

 m a ny

 pl a ns

 do not

 beli eve

 they

 a r e a dequa tel y

 p r epa r ed

 f o r

 a n

 i nf lu x

 of

 E S RD

 pa t ient s .

 S he

 bel ieves

 the r e w ill

 be

 a r ea s ona ble

 upta k e of

 ES RD

 pa ti ents

 enr ol li ng

 i n

 M A ,

 a nd

 t ha t

 m os t

 ES RD

 pa ti ents a r e not

 c os t

 neutr a l

 o r

 a cc r eti ve .

 K e y

 Ta keaw ays fro m D .C.

 P o l i c y

 U pd at e

 S e ssi o n :

 O ur

 D. C .

 c ons ult a nt

 beli eves t ha t C ong r es s

 i s

 l ik ely

 t o

 pa ss

 a n

 a ddi ti ona l

 C O VID - 19

 a ss ista nce pa ck a g e,

 thoug h

 t imin g

 i s uncer ta in .

 O ur

 c ons ult a nt

 beli eve s

 t he

 ea r li es t

 the

 bil l

 w ill

 be

 pa ss ed

 i s

 j us t

 bef or e the F our th

 of

 J uly

 br ea k ,

 a nd

 tha t

 the

 la test

 ti m ef r a m e would

 be

 the

 f ir s t

 w eek

 of

 A ug us t.

 While

 not

 pr edi ct ing

 the

 outc om e of

 t he

 pr es iden ti a l

 elec ti on,

 ou r

 c ons ult a nt

 beli eves t ha t

 if pr es um pti ve

 Democr a ti c

 nomine e J oe

 B iden

 w ins

 the

 pr es idenc y ,

 Democr a ts

 w ill

 a lso na rr ow ly

 win

 a ma jor it y

 i n

 the

 S e na te

 a s

 well

 ( a nd

 t ha t

 Democr a ts

 w ill

 a lso

 re ta in

 a ma jor it y in

 the

 Hous e) .

 R e g a r dless of

 t he

 outc om e of

 t he

 elec ti on,

 our

 c on s ult a nt

 beli eves t ha t Medi ca r e A dvanta g e will

 r em a in

 in

 f a vor ,

 but

 noted

 tha t

 a Democr a ti c

 a dm ini s tr a ti on

 ma y be

 mor e a gg r es s ive

 with

 r eg a r d

 t o

 r eg ula ti ng

 upc oding

 iss ues .

 O ur

 c ons ult a nt

 beli eves t ha t if

 Pr es ident

 Tr ump

 is re - elec ted ,

 ther e wi ll

 c onti nue

 t o

 be

 a f ocus

 on

 r educi ng

 enr oll ment a nd

 spending

 i n

 Medi ca id.

 A ddit i ona ll y ,

 our

 c ons ult a nt

 beli eves t h a t

 both

 bloc k

 g r a nts

 a nd w or k

 r equir em ents, c ha mpioned

 by

 t he

 Tr ump

 a dm ini s tr a ti on,

 w ou ld

 be

 of f

 t he

 t a ble

 in

 a B iden

 A dm ini s tr a ti on.

 In

 a ddi ti on,

 a B iden

 A dm ini s tr a ti on

 would

 li k ely

 undo

 a ll

 M edic a id pr opos als a nd

 r eg ula tor y

 c ha ng e s

 t ha t

 Pr es ident

 T r ump

 ha s

 made ,

 a nd

 potenti a ll y

 t r y

 t o a dd

 m or e money

 i nto

 Medi ca id

 pr og r a m s .

 F ina ll y ,

 r eg a r din g

 t he

 A C A

 c a s e bef or e t he S upr em e C ou r t,

 our

 c ons ult a nt

 b eli eves t ha t

 the

 C our t

 w ill

 upho ld

 the

 bulk

 of

 t he

 A C A pr og r a m

 by

 a 5 - 4

 vote .

  T able

 of

 Co nte nts

 D e ta i l e d

 Rec ap

 o f

 th e

 2020

 C r e d i t

 S u i sse

 H e alth

 I n su r anc e

 S ym p osi u m

  5

 B enef it

 C ons ult a nt

 U pda te

  ...................................................................................................... 5

 Employ er

 F ocus

 a s

 a R es ult

 of

 C O VID - 19

  5

 Pr em ium

 R eli ef

 Due

 to

 C O VID - 19

  5

 C os t

 T r ends /D ef er r a l

 of

 P r ocedu r es

  6

 L a yof f s /F u r loug hs

  6

 T r a ns it ion

 B etween

 R isk - Ins ur ed

 a nd

 S elf - Ins ur ed

  6

 B enef it

 Desi g n

  6

 HDHP

  6

 S peci a lt y

 D r ug s

  6

 Views

 on

 PBM

 Di ff e r enti a ti on

  7

 Medi ca id

 Ma r k et

 U pda te

  ......................................................................................................... 7

 Medi ca id

 Enr oll ment

 G r ow th

  7

 Ma na g ed

 M edic a id

 Penetr a ti on;

 Ma r k et

 R em a ins

 L ea s t

 C oncent r a ted

  7

 C O VID

 Im pact s /C ons ider a ti ons

  8

 Medi ca id

 Ma r k et

 Pr ojec ti ons

  10

 Medi ca id

 Pr...

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