1、 Managed Care Annual Small Group/Individual&Medicare Advantage Markets Survey Managed Care|Annual We surveyed 62 health insurance brokers selling thousands of policies in Small Group and Individual insurance markets,as well the Medicare Advantage market across the country.UNH Ranked Highest Among Pu
2、blic MCOs in the Small Group&Individual Markets.With respect to individual categories,UNH was ranked by insurance brokers as the leader in the Networks category,while Kaiser ranked as the leader in the Care Management and Consumer Education/Engagement Tools and Services categories.Overall,Kaiser was
3、 ranked as the leader as rated by broker respondents in the small group and individual markets,followed by UnitedHealth.Compared to last year,overall scores increased for Centene and Kaiser,while decreasing for Cigna,Molina,non-Anthem Blues,UnitedHealth,Humana,Aetna,and Anthem.Cost Trends Expected t
4、o Rise,with Specialty Drugs&Inpatient Hospital Costs Being Key Drivers.In the individual market,on a weighted average basis,the surveyed brokers believe that health insurers have assumed a medical cost increase of roughly 7.9%Y/Y in their pricing for 2020,while in the small group market,our broker r
5、espondents believe that health plans baked in a roughly 8.3%Y/Y medical cost increase in their pricing.Some 40%of broker respondents believe that the health insurers expectations for medical cost increases in 2020 is higher than last year in the individual market.In the small group market,some 61%of
6、 broker respondents believe that the health insurers expectations for medical cost increases in 2020 is higher than last year.When asked about the drivers of the increase in cost expectations for 2020,74%of individual market broker respondents highlighted specialty drug costs,followed by inpatient h
7、ospital costs(68%),and drug costs generally(63%).Interestingly,ACA mandates were no longer selected as the top driver of increased cost trend for 2020 compared to our prior two surveys.Premiums Expected to Rise Greater than 2019.On a weighted average basis,our survey indicates an 8.2%Y/Y increase in
8、 premiums in the off-exchange non-ACA compliant small group policies for 2019.Some 59%of broker respondents highlighted higher premium increases for 2020 vs.2019 in the small group market(vs.35%last year).Non-Anthem Blues Aggressive on a Relative Basis.Non-Anthem Blues were once again picked by the
9、highest percentage of brokers as having lower Y/Y premium increases in 2020 in the individual market.Molina and Kaiser were flagged by 30%of respondents as having lower premium increases/more price discounted compared to the prior year.During a healthcare conference in January,Molina indicated that
10、it placed a 4%price decrement into the market to have a competitive product offering which would have the impact of reducing margins while increasing revenues due to modestly increased membership.In the small group market,non-Anthem Blues were picked by the highest percentage of brokers as having hi
11、gher premium increases in 2020 vs.2019,while also being picked by the highest percentage of brokers(followed by Cigna)for having lower premium increases in 2020 vs.2019.27 January 2020 Equity Research Americas|United States DISCLOSURE APPENDIX AT THE BACK OF THIS REPORT CONTAINS IMPORTANT DISCLOSURE
12、S,ANALYST CERTIFICATIONS,LEGAL ENTITY DISCLOSURE AND THE STATUS OF NON-US ANALYSTS.US Disclosure:Credit Suisse does and seeks to do business with companies covered in its research reports.As a result,investors should be aware that the Firm may have a conflict of interest that could affect the object
13、ivity of this report.Investors should consider this report as only a single factor in making their investment decision.Research Analysts A.J.Rice 212 325 8134 aj.ricecredit- Eduardo Ron 212 325 7491 eduardo.roncredit- Caleb Harris,CPA 212 325 7458 caleb.harriscredit- Alexander Khan 212 325 7714 alex
14、ander.khancredit- 27 January 2020 Managed Care 2 Executive Summary We surveyed 62 health insurance brokers selling thousands of policies in small group and individual insurance markets across the country during the annual selling season and open enrollment periods.Overall,Kaiser and UNH were ranked
15、as the leaders as rated by broker respondents in the small group and individual markets.UNH was ranked as the leader in the Networks category,while Kaiser ranked as the leader in the Care Management and Consumer Education/Engagement Tools and Services categories.Overall,Kaiser was ranked as the lead
16、er as rated by broker respondents in the small group and individual markets,followed by UnitedHealth.Compared to last year,the overall scores increased for Centene and Kaiser,while decreasing for Cigna,Molina,non-Anthem Blues,UnitedHealth,Humana,Aetna,and Anthem.Cost Trends Expected to Rise,with Spe
17、cialty Drugs&Inpatient Hospital Costs Being Key Drivers.In the individual market,on a weighted average basis,the surveyed brokers believe that health insurers have assumed a medical cost increase of roughly 7.9%Y/Y in their pricing for 2020,while in the small group market,on a weighted average basis
18、,our broker respondents believe that health plans baked in a roughly 8.3%Y/Y medical cost increase in their pricing.Some 40%of broker respondents believe that the health insurers expectations for medical cost increases in 2020 is higher than last year in the individual market.In the small group mark
19、et,some 61%of broker respondents believe that the health insurers expectations for medical cost increases in 2020 is higher than last year.When asked about the drivers of the increase in cost expectations for 2020,74%of individual market broker respondents highlighted specialty drug costs,followed b
20、y inpatient hospital costs(68%),and drug costs generally(63%).Interestingly,ACA mandates were no longer selected as the top driver of increased cost trend for 2020 compared to our prior two surveys.Premiums Expected to Rise Greater than 2019.On a weighted average basis,our survey indicates an 8.2%Y/
21、Y increase in premiums in the off-exchange non-ACA compliant small group policies for 2019.Some 59%of broker respondents highlighted higher premium increases for 2020 vs.2019 in the small group market(vs.35%last year).Non-Anthem Blues Aggressive on a Relative Basis.Non-Anthem Blues were once again p
22、icked by the highest percentage of brokers in terms of having lower Y/Y premium increase in 2020 in the individual market.Molina and Kaiser were flagged by 30%of respondents as having the lower premium increases/more price discounted compared to the prior year.During a healthcare conference in Janua
23、ry,Molina indicated that it placed a 4%price decrement into the market to have a competitive product offering which would have the impact of reducing margins while increasing revenues due to modest increased membership.In the small group market,Non-Anthem Blues were picked by the highest percentage
24、of brokers as having higher premium increases in 2020 vs.2019,while also being picked by the highest percentage of brokers(followed by Cigna)for having lower premium increases in 2020 vs.2019.Premiums/Costs Continues to be Dominant Factor in Plan Selection.Despite the fact that roughly 87%of individ
25、uals who have signed up for insurance coverage on the HIX are receiving premium subsidies,premiums were once again highlighted as one of the most important plan selection criteria in the on-exchange individual market by 100%of our broker respondents(compared to 95%last year).Network of healthcare pr
26、oviders and benefit design were once again selected as the other two most important criteria.Consistent with prior years,brand of insurance carrier was highlighted as an important criterion by only 13%of our broker respondents.In the small group market,similar to last year,costs/discounts,network of
27、 healthcare providers,and benefit designs were highlighted as three most important selection criteria in the off-exchange small group market.Interestingly,brand of insurance carrier was highlighted as important criteria by only 16%of our broker correspondents.Minimal Switching from On-Exchange Produ
28、cts to Short-term Limited Duration Plans.On a weighted-average basis,our broker respondents see roughly 3.2%of their on-exchange individual clients switching to short-term limited duration plans for the 2020 coverage year.27 January 2020 Managed Care 3 UNH and Blues(both ANTM and non-ANTM)Seen as Ga
29、ining Market Share in Small Group Market in 2020 vs 2019.With respect to market share gains in 2020 vs.2019,UnitedHealth and Blues(both Anthem and non-Anthem)were picked by the highest number of brokers.With respect to market share losses in 2020 vs.2019,Centene/Health Net and UnitedHealth were pick
30、ed by the highest number of brokers.Employee Cost Sharing Push Reaccelerates.According to our survey,35%of broker respondents say that small group employers have been more aggressive in shifting insurance costs to employees.This represents an increase relative to last years figure of 21%but is still
31、 below the 43%indicated in our survey two years ago.In fact,only 9%of respondents(vs.30%last year)indicate that small group employers are less aggressive in shifting insurance cost to employees for 2020 compared with 2019.Further,roughly 23%of our broker respondents(vs.47%a year ago)say that small g
32、roup employers are putting strategies in place to increase employee plan costs(i.e.higher coinsurance and salary contributions)for not being compliant with certain health approaches or wellness/disease management programs.Small Group Switching to or Offering Association Health Plans Remains Minimal
33、in 2020.With respect to small group employer clients switching to/offering Association Health Plans,on a weighted average basis,our broker respondents see roughly 5.3%of their small group employer clients switching to or offering AHPs(vs 4%last year).Geographically,19.0%of small group employer clien
34、ts in the Southeast region were switching to or offering AHPs,compared to 1.4%in the West region.Interest in“Self-Insured with Stop Loss”Funding Arrangement Continues to Rise.We asked our broker respondents about the interest of small group employers in moving from a fully insured position to consid
35、ering a“self-insured with stop loss”option in 2020 vs.2019.Roughly 38%of our broker survey respondents(vs.54%last year)note that they saw a pick-up in small group employers interest in moving from a fully insured position to considering a“self-insured with stop loss”setting.Only 9%(vs.21%last year)n
36、oted that they saw a Y/Y decline in the interest.Telehealth/Expert Opinion Penetration Among Small Group Employers.According to our broker respondents,the percentage of employers offering telehealth benefits in 2020 is 47.2%compared to 41.8%in 2019.Separately,the percentage of employers offering sec
37、ond opinion/expert opinion benefits in 2020 increased 80 bps Y/Y at 27.4%compared to 26.6%in 2019.Broker Commission Trends in Small Group and MA Markets.We asked our respondents about broker commissions in the off-exchange small group market for 2020 compared with the prior year.Around 86%of survey
38、respondents reported broker commissions in the off-exchange small group market as being stable Y/Y.Roughly 14%of our respondents noted that commissions in the small group market were lower compared with last year,while none reported higher Y/Y commissions.Results were very similar to the last years
39、survey,when around 80%of survey respondents reported Y/Y stable broker commissions.Compared to the prior year,33%of respondents believe that broker commissions are higher in the Medicare Advantage market for 2020.In 2019,18%of respondents believed broker commissions were higher while 3%believed brok
40、er commissions were lower than that of the prior year.MA Supplemental Offerings.Our broker respondents highlighted routine dental,hearing and routine vision as the most important supplemental offerings for seniors.In contrast,pest control,carpet shampooing for asthma and non-medical transportation a
41、re the least important supplemental offerings.Interestingly,on a Y/Y basis,our broker respondents note increased interest from seniors in their Medicare Advantage/Medicare Supplement plan participating in fitness programs such as SilverSneakers,Silver&Fit,Optum Fitness Advantage(Renew Active),etc.Vi
42、ews on Switchers in OEP and Medicare Plan Finder Tool.Our broker respondents note that,on a weighted average basis,2.8%of enrolled Medicare Advantage customers decided to switch Medicare Advantage plans during the Open Enrollment Period(OEP)in January-March of 2019(churn was relatively higher in the
43、 Southeast region,while relatively lower in Northeast 27 January 2020 Managed Care 4 and West regions).When asked about how the recent updates to the Medicare Plan Finder Tool impacted business this year vs the prior year,30%of respondents believe that the recent updates negatively affected business
44、 with some additional comments highlighting the increased difficulty of using the tool.Only 16%of respondents believe that the updates positively impacted their business.27 January 2020 Managed Care 5 Strengths&Weaknesses for Insurers UNH Tops the List Among Public MCOs We asked brokers serving the
45、small group and individual markets to rank the national carriers across various attributes,primarily grouped under three categories:Networks,Care Management and Consumer Education/Engagement Tools,and Services.UNH was ranked as the leader in the Networks category,while Kaiser ranked as the leader in
46、 the Care Management and Consumer Education/Engagement Tools and Services categories.Overall,Kaiser was ranked as the leader as rated by broker respondents in the small group and individual markets,followed by UnitedHealth.Compared to last year,the overall scores increased for Centene and Kaiser,whi
47、le decreasing for Cigna,Molina,non-Anthem Blues,UnitedHealth,Humana,Aetna,and Anthem.Figure 1:How would you rate the strength of the MCOs in markets where you conduct business on the following aspects?(5=Very Strong,1=Very Weak)Source:Credit Suisse Networks UNH,Non-Anthem Blues and Kaiser were highl
48、ighted as leaders in the Networks category.Compared to last year,scores for Centene,Humana,and Kaiser improved Y/Y,while scores for Cigna,Molina,Anthem BCBS,Non-Anthem BCBS,UNH,and Aetna declined Y/Y.Specifically,Kaiser was ranked as the best MCO with respect to provider discounts,tiered or concentr
49、ic networks and in the Pay for Performance(P4P)programs subcategories.Anthem BCBS got the highest score for breadth of network,while UNH ranked highest for contractual relationship with key or specialty hospitals.AETANTM BCBSNon-ANTM BCBSCIHealth Net(CNC)HUMMOHUNHKaiserProvider discounts3.53.93.93.4
50、3.33.53.33.84.2Tiered or concentric networks3.33.53.83.33.33.62.73.93.9Breadth of network3.84.04.03.53.03.52.74.03.3Contractual relationship with key or specialty hospitals3.73.84.03.52.83.53.04.03.7Provider pay for performance(P4P)programs3.33.43.53.53.03.33.33.84.0Networks3.543.733.823.433.063.483
