UnitedHealth exec’s murder unlikely to change insurer practices

Modern Healthcare – Friday, December 20, 2024
By Nona Tepper

Health insurance companies could scale back unpopular business tactics in response to anger directed toward the industry, but they probably won’t.

Many policyholders have seized on the murder of UnitedHealthcare CEO Brian Thompson to curse health insurance companies over prior authorization, rising premiums and narrow provider networks. All of these can be cost-cutting techniques insurers deploy to help drive returns for Wall Street investors. Without action by regulators or legislators, health insurers are unlikely to change unfavorable policies, said Katherine Hempstead, a senior policy officer at the Robert Wood Johnson Foundation, a healthcare think tank.

“Companies are weighing the bottom line versus doing something that a policyholder wants,” Hempstead said. “Unless the rules of the overall game change, chances are they’re going to defer to the bottom line.”

Additionally, companies do not want to endorse murder as an effective way to drive change, said Dr. Mark Fendrick, director of the University of Michigan’s Center for Value-Based Insurance Design. “You can’t be governing by terrorism.”

Nonprofit insurers are subject to the same regulatory standards and competition as for-profits, and are just as unlikely to cut back on claims denials despite assurances that their corporate structure aligns their incentives with policyholder interests, said Robert Blendon, professor emeritus of public health and health policy and political analysis at Harvard University’s T.H. Chan 

“They’re just going to say, ‘This is awful, the backlash is terrible,’” Blendon said. “But it’s not likely they’re just going to change the denial practices that have become very fundamental in the managed care world. It’s important to their profitability.”

Most insurers link executive compensation to their financial performance, giving those in charge another reason to maintain the status quo, Blendon said. UnitedHealth Group CEO Andrew Witty, who oversees the UnitedHealthcare insurer, received the majority of his pay in 2023 from long-term incentives such as stock options that rise and fall with share price. Witty was the highest-paid CEO among major health insurers last year.

The Blue Cross Blue Shield Association did not respond to an interview request.

In a statement, a spokesperson for insurance lobbying group AHIP said providers and drugmakers share responsibility with health insurers for the complex and costly nature of the healthcare system.

“In the fragmented and heavily regulated healthcare system, health plans, providers and drugmakers share a responsibility to make high-quality care as affordable as possible and easier to navigate for the people we collectively serve. Health plans are working to protect patients from the full impact of rising costs while connecting them to care that is safe, evidence-based and coordinated,” the spokesperson said.

‘We will continue’

Thompson, 50, was fatally shot in what was described as a “brazen, targeted attack” outside the New York Hilton Midtown hotel in New York City in the early morning of Dec. 4. A New York grand jury indicted Luigi Mangione, 26, on charges of murder and criminal possession of a weapon on Dec. 17. Authorities reported uncovering a three-page manifesto written by Mangione decrying the healthcare industry’s profit motives.

For some, murdering Thompson makes Mangione a folk hero.

Nearly 5,700 donors contributed upwards of $160,000 on Christian crowdfunding site GiveSendGo for Mangione’s defense fund as of Dec. 19. More than 40% of voters ages 18 to 29 surveyed on Dec. 17 by Emerson College described his actions as acceptable. Police arrested a Florida woman on Dec. 10 after she threatened a Blue Cross Blue Shield employee with the same phrase — “delay, deny, depose” — inscribed on bullets found at the scene of Thompson’s shooting.

“If you’re someone in the insurance industry, I would be really worried because these things tend to have infectious disease quality,” Blendon said.

Health insurers and other healthcare organizations have responded to criticisms by removing executive photos and information from their websites and changing in-person events to virtual presentations.

But commitments to overhaul their business practices are absent and unlikely to emerge, said Dr. Warris Bokhari, CEO of Claimable, a startup that uses artificial intelligence to challenge health insurance denials. He pointed to a Dec. 6 video of Witty addressing the company’s workforce: “We will continue to do the work we do,” Witty told staffers. In the video, Witty called social media criticism “noise” and “not in tune with reality.” UnitedHealth did not respond to an interview request.

On Dec. 13, UnitedHealthcare defended its denial rate after a survey by ValuePenguin, a personal finance website, reported the company refuses to pay for one in three claims went viral. UnitedHealthcare said it declines to pay the medical bills of one in 10 policyholders. Of those denied, 0.5% are for medical reasons, according to the UnitedHealth Group subsidiary. The rest are denied because of administrative errors, duplicative claims submissions or the patient not being a UnitedHealthcare policyholder, the company said.

“Any other numbers being discussed in some quarters purporting to be the UnitedHealthcare approval rate are wrong,” UnitedHealthcare said in a news release.

Research on how many claims specific health insurance companies decline across all lines of business is limited.

But in Medicare Advantage, UnitedHealthcare declined to pay 8.7% of prior authorization requests in 2022, above the industry average of 7.4%, according to an August report by KFF, a health policy think tank. Medicare Advantage policyholders appealed 12.6% of UnitedHealthcare’s declined claims and 86.1% of requests for a second look were successful, according to the report. Both UnitedHealthcare’s number of and rate overturning appeals were higher than average, based on the report.

Those claims denial wins by UnitedHealthcare policyholders fuel distrust of the industry, Hempstead said.

“The anger could be a little bit more manageable if there was less of a sense of like, ‘This is the deal that everybody gets versus this is the deal that I’m getting.’ That’s what makes it maddening,” she said.

Rearchers will soon have more data to work with. In 2026, the Centers for Medicare and Medicaid Services will require government-sponsored insurers to report the number and the reasons for their denials.

On one hand, Hempstead said the regulation could fuel more scrutiny because it will give critics data to lean on. But insurers also could view the requirement as a way to inject transparency into their decisions, she said. For their part, insurers have said they support the rule.

“Anything that can create more unity and more transparency would be an improvement over the system we have,” Hempstead said.

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