LUMINA Insights Blog

While U.S. providers have suffered profound financial losses because of COVID-19, health insurance companies have actually benefited from the pandemic. Providers require effective strategies to achieve a more equitable balance.

Healthcare utilization has dropped sharply as a result of COVID-19, causing most hospitals to experience a major drop in revenue and margin. But for most commercial payers, lower utilization has slashed claims expenses and created a  huge financial windfall.

For example, United  Healthcare’s net income doubled during the first  wave of the pandemic, jumping from $3.3 billion  (2019 Q2) to $6.6 billion (2020 Q2).^a 

Although these market dynamics clearly seem unfair to providers, there is no reason  that providers should simply accept the status  quo. As they struggle to recover financially from COVID-19, hospitals and health systems should  not hesitate to look to insurers to share their  excessive surpluses. 

Right now, the biggest potential opportunities for providers are in contracting with insurers. Financial leaders should focus on three broad areas where they should seek to renegotiate existing contracts and lay the groundwork  for beneficial new partnerships. 

While physicians as well as hospital clinical and operations staff are focused on patient care and the clinical side of health care, the financial leaders—including CFOs, financial analysts, business, strategy and contracting/payer relations teams—have their own focus: beginning to forecast the pandemic’s effects on the bottom line.

This forecasting and future planning is essential to ensuring the health care system is still viable and strong as leaders manage through the crisis. Understanding and modeling the financial impact is challenging, however, what with so many critical forces in play from all avenues and key stakeholders.