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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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