Managed Care Digest Series® Spotlight

Lines of Business Shift in 2020 for Commercial Insurers

Commercial insurers reported strong earnings in 2020—record levels in many cases—despite a 3.2% annual drop in employer-sponsored insurance membership.1,2 Elevated earnings were attributable to two factors: 1) pandemic-induced deferral of care; and 2) penetration into public insurance programs. The drop in medical utilization in 2020 likely led to the first time—since at least 1960—that U.S. health expenditures decreased annually, while the diversification of business lines reflects a years-long strategy for many insurers (see also page 6).3

With earnings strong and interest rates low, large commercial insurers are either deleveraging from previous acquisitions, as in the case of
CVS Health, or investing further through strategic acquisitions.4 The rise of telemedicine is driving both technology investments and plan redesigns. For example, virtual-first plans are meant to capitalize on recent changes in consumer and provider preferences, while also delivering on promises to reduce health care inflation. To enhance its digital strategy, UnitedHealth Group purchased Change Healthcare, a health analytics and technology company.5 And in particularly frank remarks soon before announcing the purchase of MDLIVE, the CEO of Cigna described sustainability problems that health care systems face globally.6

Assets tied to public health insurance programs also remain attractive, especially given recent enrollment trends.7 In June 2021, Anthem acquired managed Medicare and Medicaid plans in Puerto Rico from MMM Holdings.8 Later that year, GuideWell, the parent company of Florida Blue, announced a similar acquisition of Puerto Rico-based Triple-S Management.9 Centene, one of the largest offerors of managed care for public programs, acquired a technology company, Apixio; a specialty pharmacy, PANTHERx; and a diversified behavioral health company, Magellan Health. Centene announced a major restructuring initiative soon after.10

Finally, to address rising costs and expand its use of value-based care, Humana completed the purchase of Kindred at Home in August 2021, instantly becoming the nation’s largest provider of care in the home.11 Given the recent struggles of residential long-term care facilities and the relative success of hospital-at-home programs, it would not be surprising to see more insurers focus increasingly on the home as a primary site of care.

Click here to read the 2021 Commercial Payer Digest.

Number of Individuals With Commercial Insurance Coverage (in Millions),
            by Plan Type, 2013–2020

Data sources: U.S. Census Bureau and Centers for Medicare & Medicaid Services © 2021

1 U.S. Census Bureau. (2021). Health Insurance Coverage in the United States: 2020. Retrieved from https://www.census.gov/library/publications/2021/demo/p60-274.html. Accessed September 2021.

2 Burns, J. (2021). The Pandemic One Year in: Despite Large Profits in 2020, Health Insurers See Volatility Ahead. Retrieved from https://www.managedhealthcareexecutive.com/view/thepandemic-one-year-in-despite-large-profits-in-2020-health-insurers-see-volatility-ahead. Accessed September 2021.

3 Miller, G., et al. (2020). COVID-19 Shocks the U.S. Health Sector: A Review of Early Economic Impacts. Health Affairs. Retrieved from https://www.healthaffairs.org/do/10.1377/hblog20201214.543463/full/. Accessed September 2021.

4 CallStreet. (2021). CVS Health Corp. (CVS) Q2 2021 Earnings Call Transcript. Retrieved from https://s2.q4cdn.com/447711729/files/doc_financials/2021/q2/02.-CVS-Q2-2021-Earnings-Final-Transcript.pdf. Accessed August 2021.

5 Morse, S. (2021). Optum to Acquire Change Healthcare. Retrieved from https://www.healthcarefinancenews.com/news/optum-acquire-change-healthcare. Accessed September 2021.

6 Motley Fool. (2020). Cigna Corp. (CI) Q3 2020 Earnings Call Transcript. Retrieved from https://www.fool.com/earnings/call-transcripts/2020/11/05/cigna-corp-ci-q3-2020-earnings-calltranscript/.
Accessed September 2021.

7 See pages 4, 21, and 25 of the Public Payer Digest, 2021 for more information on enrollment trends for public health insurance programs.

8 Lagasse, J. (2021). Anthem Completes Acquisition of MMM Holdings From InnovaCare Health. Retrieved from https://www.healthcarefinancenews.com/news/anthem-completes-acquisitionmmm-holdings-innovacare-health. Accessed September 2021.

9 Minemyer, P. (2021). Florida Blue Parent GuideWell to Acquire Puerto Rico-based Triple-S Management. Retrieved from https://www.fiercehealthcare.com/payer/florida-blue-parent-guidewellto-acquire-puerto-rico-based-triple-s-management. Accessed September 2021.

10 Moorcraft, B. (2021). Centene Corp. to Slash 3,000 Jobs. Retrieved from https://www.insurancebusinessmag.com/us/news/breaking-news/centene-corp-to-slash-3000-jobs-246024.aspx.
 Accessed September 2021.

11 Humana. (2021). Humana Completes Acquisition of Kindred at Home. Retrieved from https://humana.gcs-web.com/news-releases/news-release-details/humana-completes-acquisitionkindred-home.
 Accessed September 2021.

12 The estimates by type of coverage are not mutually exclusive; people can be covered by more than one type of health insurance during the year.

13 Dashed lines reflect the U.S. Census Bureau’s previous methodology for direct-purchase plan counts. New methodology (as of 2018) is represented by solid lines.

14 On this page, Managed Medicare includes Medicare Advantage and other health plans.

15 Data for Managed Medicaid were unavailable for 2019 and 2020 at time of publication.


NOTE: Throughout this digest, PHI is private health insurance.

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