Becker's Hospital Review

25 CFO / FINANCE Oscar Health, Bright Health, Clover Health post Q1 losses topping $330M By Jakob Emerson D espite explosive growth in revenues and total membership, some of the largest insurtech companies posted losses exceeding a com- bined $332 million in the first quarter of 2022. For all of 2021, the three companies posted com- bined losses topping $570 million. Bright Health e Bloomington, Minn.-based company reported a 110 percent boost in revenue year over year, growing to $1.84 billion in 2022. Commercial enrollment grew 117 percent year over year, with 1.04 million total members in 2022. NeueHealth value-based plans saw massive growth year over year, rising 1,667 percent from 30,000 to 530,000 members. But the company's operating expenses topped $2 billion in the first quarter, leaving the group with $180.6 million in losses. Oscar Health During its earnings call with investors, the New York City-based company said its biggest insurance priority this year is profitability in 2023. e company's total revenue increased 163 percent year over year, rising to $972.8 million in 2022. Membership nearly doubled between the fourth quarter of 2021 and the first quarter of 2022, growing from 542,220 in 2021 to 1,073,595 million in 2022. Operating expenses, however, increased to $1.04 billion from $433 million year over year, leaving the company with net losses of over $77 million. e company's losses did go down though, decreasing from nearly $89 million in the first quarter of 2021. Clover Health e Franklin, Tenn.-based insurtech company reported a staggering total revenue increase of 337 percent in the first quarter, rising to $874.4 million in 2022 compared to $200.3 million year over year. Total lives under Clover management in 2022 were 257,442, a 288 percent increase year over year. Operating expenses also rose significantly, growing 201 percent from $319.4 million in the first quarter of 2021 to $961.7 million in 2022. Despite the extreme growth for the Medicare Advantage plan provider, the company's net loss in the first quarter was $75.3 million, increasing from $48.4 million year over year. n Physician 'gold card' exemptions for prior authorizations gain steam By Alia Paavola S tates are looking at ways to improve the prior authorization process for providers, including "gold card" exemptions. Gold carding is a prior authorization reform supported by numer- ous organizations, including the American Medical Association, American Hospital Association, American Pharmacists Association and American Academy of Family Physicians. Under these exemptions, physicians that have high prior authorization approval rates are exempt from prior authorization requirements for cer- tain services. In recent years, states began to implement these laws. West Virginia was first to pass a "gold card" exemption for providers in 2019. Under that state's policy, providers are exempt from prior authorization rules if they have a 100 percent approval rate on a certain service for six months. More recently, Texas passed a law that exempts physicians who have a 90 per- cent prior authorization approval rate over a six-month period on certain services from needing to submit prior authorizations for those services. Other states are looking at adding these exemptions. For example, Ver- mont is piloting a program that rewards providers with 100 percent prior authorization approval rates for a procedure performed at least 30 times per year over a six-month window. Other states that have introduced gold card legislation include New York, Colorado, Indiana, Kentucky, Mississippi and Oklahoma. n Providence hospital receives $53M gift from anonymous donors By Marissa Plescia O range, Calif.-based Providence St. Joseph Hospital received a $53 million donation from a couple who chose to remain anonymous. It is the largest gift in the Southern California region for the Rent- on, Wash.-based health system and the second largest in the organiza- tion's history, according to a May 3 Providence news release. The money will create an endowment fund for the hospital. "We're blessed to have such charitable benefactors living in our commu- nity," Amy Daugherty, the chief philanthropy officer of Providence St. Jo- seph Hospital, said in the release. "These donors should take great pride in knowing that this contribution will touch tens of thousands of lives for the foreseeable future." n

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