This is Jacob Emerson with the Becker's Payer Issues podcast. Here's your biweekly industry news briefing for January 6th. The majority of health plan executives say they're focused on growth and have a favorable outlook for 2025. That's according to a new survey from Deloitte. Between August September of last year, Deloitte surveyed 40 c suite executives from large health plans and large health systems nationwide with revenues greater than $500,000,000.
Do you identify the top trends expected to affect business strategies this year? Among those respondents, 65% said developing growth strategies is their top priority for the year, and 59% have a favorable outlook for the year ahead. A rise in revenues is expected by 69% of respondents, and a rise in profitability is expected by 71%.
Overall, large health care companies should be focused on consumer acquisition and retention, meeting the needs of those customers, investing in digital platforms, strengthening cybersecurity, and prioritizing health equity. Insurers specifically should also be prioritizing working more closely with employers on certain health products, expanding alternative and virtual care sites and consumer facing digital tech, and enhancing operational efficiencies.
60% of insurance executives expect the adoption of digital technology to accelerate in 2025, while 53% expect that generative AI and other tech like unlimited reality and digital twins will impact organizational strategies. Executives were asked to list the emerging trends they are tracking most heavily, and 58% identified AI and automation first.
Many health plans are already using generative AI for claims processing, underwriting, personalized treatment plans, fraud detection, and document extraction. Also among the health plan respondents, 58% expect that recent and upcoming regulatory changes will influence their organization's strategies this year, and 63% are already prioritizing compliance strategies to address those challenges. The UnitedHealth Group has been named the world's largest insurer by net premiums written for the
10th year in a row. That's according to AM Best annual ranking published this January. The top 10 insurers in the world by 2023 net premiums written. Number 1 is UnitedHealth Group. 2nd, Centene, and it's Elavance Health. 4th is Kaiser Permanente. 5th is China Life Insurance Company. 6th is Humana, then State Farm, then Alliance SE. Number 9 is Berkshire Hathaway. And number 10 is AXA SA out of France.
Well, Elavance Health has completed its acquisition of Indianapolis based Indiana University Health's insurance business. With the closure of the deal that was first announced back in September, IU Health Plans will now operate as part of Anthem BCBS of Indiana. IU Health Plans serves 19,000 Medicare Advantage members across 36 counties and just under 10,000 fully insured commercial group members through employers.
The acquisition of IU's health plans is one of several that Elavance has announced or completed in 2024. The company said back in April that it plans to acquire Center's plan for Healthy Living, a New York based Medicaid long term care plan. The company also closed on its acquisition of infusion center and specialty pharmacy operator, Paragon Healthcare.
And in October, the company said it intends to purchase Nashville based CareBridge, which is a value based home and community based care provider for patients with chronic and complex needs. Florida Blue is the latest insurer to sue CMS over its Medicare Advantage star ratings for 2025.
In that lawsuit filed in December in a federal district court in Washington, attorneys for Florida Blue argued that CMS did not account for the effects of natural disasters when it calculated the insurer's Medicare Advantage star ratings. Severe flooding in Broward County in April 2023 caused a significant drop in rates of office visits and prescription refills for Florida Blues MA plan members according to the insurer.
Though Florida governor Ron DeSantis and president Joe Biden declared a state of emergency in areas affected by the flooding, CMS did not grant an 1135 waiter, designating a public health emergency for the flooding. In 2019, CMS adopted an extreme circumstances rule to account for the impact of natural disasters and other uncontrollable circumstances that might affect star ratings.
If the flooding in Broward had been granted public emergency status, Florida Blue's HMO MA plan would have received a 4 and a half star rating rather than a 3 and a half stars for plan year 2025. According to the payer, its Medicare Part D plan would have received a 3 star rather than a 2 and
a half star rating. Florida Blue said it will lose out on tens of 1,000,000 of dollars in bonus payments as a result of those lower ratings, and it is asking the courts to require CMS to recalculate those ratings. Several other insurers have challenged those 2025 ratings in courts, though on different grounds. In December, CMS increased the ratings for several UnitedHealth and Centene plans, and Humana and Elavance have also filed similar challenges.
The new California law that went into effect January 1st will prohibit payers from making coverage decisions based solely on artificial intelligence algorithms. Under that new law, any denial, delay, or modification of care based on medical necessity must be reviewed and decided by a licensed physician or qualified health care provider with expertise in the specific clinical issues at hand.
California senator Josh Becker, the bill's sponsor, said that AI has immense potential to enhance health care delivery, but it should never replace the expertise and judgment of physicians. An algorithm cannot fully understand a patient's unique medical history or needs, and its misuse can lead to devastating consequences.
And finally, a former chief human resources officer at Elevance Health, Troy Hennigan, has filed a lawsuit against the company in a georgia federal court alleging age discrimination after his termination in June of last year. The lawsuit claims that mister Hannigan, who is 62, was unlawfully replaced as the CHRO at Carillon by a younger individual, and he alleges that his termination violated the age discrimination in employment
act. Elevance denied those allegations in an October legal response, asserting that mister Hennigan's termination was based on legitimate business decisions unrelated to his age. Mister Hennigan had been with elevance since 2019. According to the September complaint, his supervisor informed him in February of 2024 that the company wanted to go in another direction and hire a younger person for his role, describing the decision as a win win because people assumed he wanted to retire.
Mister Hennigan resisted this alleged narrative, proposing to remain through the end of the year, though that proposal was rejected. He claims that his departure was falsely framed as a retirement in company communications, and this position was ultimately filled by someone under the age of 43. In its response, elevance denied any discriminatory statements attributed to mister Hennigan's supervisor, such as his
desire to hire a younger person. And the company is arguing that he agreed to describe his his departure as a retirement and asserts that it acted in good faith to comply with anti discrimination laws. If you like the latest health insurance industry news delivered straight to your inbox every morning, subscribe to the Becker's payer issues enewsletter on our website at beckerspayer dotcom.