Mark Bertolini, the chief executive officer of Oscar Health, says individual coverage health reimbursement arrangement plans can keep employees healthier — if prices in the individual major medical market stabilize enough to look better to employers.
Bertolini talked about the future of the ICHRA market Tuesday, during a conference call Oscar held to go over results for the fourth quarter with securities analysts.
Oscar, a health insurer, is not yet posting overall ICHRA sales figures, or sales figures for the ICHRA arrangements it's offering employers in the Des Moines, Iowa, area through a relationship with Hy-Vee, a big Midwestern supermarket chain.
But ICHRA membership "did double this year," Bertolini said.
One challenge has been the turmoil in the federal regulations shaping the Affordable Care Act public exchange system and the individual major medical insurance market.
"Given what happened in the individual market to rates, there was some employer reluctance to jump in now," Bertolini said.
But Bertolini predicted that a successful ICHRA market would have a big impact on workers' health, by helping workers use employer cash, federal subsidy cash and other cash to buy coverage that would fit their own needs.
The networks in the plans could be relatively narrow, because workers could choose plans offering the providers they wanted, Bertolini said.
Workers could also choose plans offering the right mix of wellness and condition management programs, he predicted.
If workers could ICHRAs and other arrangements to keep the same coverage in place for many years, rather than moving from plan to plan every few years, that "starts to create the opportunity for lifetime value of membership," Bertolini said.
Once insurers started to think of maximizing workers' health and minimizing claim costs over workers' entire lives, that would increase the incentive for the insurers to offer "lifestyle products" with a long-term impact on the workers' health, he said.
Oscar held the conference call to go over results for the latest quarter with the analysts. It streamed the call live and posted a recording on its website.
What it means: Employers, insurers and other payers are now wrestling with questions about how to pay for people who are fighting obesity to take Wegovy and other new-generation weight-loss drugs.
One concern for employers is that investments in the weight-loss drugs may be unlikely to reduce expenditures on heart disease, cancer and other obesity-related conditions enough within a few years to offset the cost of covering the drugs for obese but otherwise healthy workers.
If Bertolini is right about the impact of ICHRA plans on how long workers keep their coverage in place, a shift to ICHRA plans might make it easier for insurers to justify the cost of covering obesity drugs, by using projected health care savings that might occur when workers were in their 60s to offset the cost of helping those workers pay for weight-loss drugs when the workers were still in their 20s or 30s.
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