塑造医疗保健止损市场的主要趋势

IN THIS ISSUE11 2018–2023statutoryfinancial results12 Stop lossmarket trends13 High dollarclaims trends14 Advancedanalyticsapplicationsfor stop lossportfolios andlarge claims © Oliver Wyman2018–2023 STATUTORY FINANCIAL RESULTSBy Marc Lambright, FSA, MAAA and John Rienstra, FSA, MAAAMARKET-WIDE STOP LOSS PREMIUM AND ENROLLMENT TRENDSWe summarize enrollment, premiums, claims, and loss ratio trends of carriers with 2018–2023 reported statutoryfinancial information for the various segments of the stop loss market. Overall, the market has seen considerablegrowth in total premium, which has increased at an average rate of almost 12% annually driven primarily throughhigher premiums per member per month (PMPM), which have increased at an average rate of about 10% per year,while average covered lives increased at an annual rate of only about 1% over the period.Note that these amounts are as reported other than that we removed certain data that appeared questionable,though there may still be some reporting inconsistencies amongst carriers in addition to mix differences in the typeof business written by different types of carriers.Table 12018201920202021202220235-year averagegrowth rateAverage coveredlives (millions)56.956.557.956.359.861.1Premium(millions)$19,974$23,284$25,299$27,352$31,188$35,066Premium PMPM$29.24$34.31$36.38$40.52$43.49$47.86 1.4%11.9%10.4% © Oliver WymanCARRIER TYPESWe assigned a carrier type to each company that had premiums and lives reported in the AHPEE based on eachcompany’s characteristics, including distribution approach.MGU PaperBrookfield Asset Management Reinsurance Partners Ltd.Fairfax Financial Holdings LimitedFidelity Security Life Insurance CompanyNationwide Mutual GroupPan-American Life Mutual Holding CompanyWestern & Southern Mutual Holding CompanyComprehensive MedicalAultman Health FoundationHealthPartners, Inc.Humana Inc.Lifetime Healthcare, Inc.Medica Holding CompanyMedical Mutual of OhioPreferred Insurance GroupSpecialty & Life Ins CosAXA SABerkshire Hathaway Inc.Cameron Associates, Inc.Educators Mutual Insurance AssociationQBE Insurance Group LimitedSwiss Re AGThe Westaim CorporationTrustmark Mutual Holding CompanyUllico Inc.W. R. Berkley CorporationZurich Insurance Group AGLarge National MedicalCentene CorporationCigna CorporationCVS Health CorporationUnitedHealth Group IncorporatedLarge Direct ESLSumitomo Life Insurance CompanySun Life Financial Inc.Tokio Marine Holdings, Inc.Voya Financial, Inc. BluesElevance / Anthem, Inc.Aware Integrated, Inc.BCS Financial CorporationBlue Cross & Blue Shield of Mississippi, a Mutual InsuranceCompanyBlue Cross & Blue Shield of Rhode Island Inc.Blue Cross and Blue Shield of AlabamaBlue Cross and Blue Shield of Kansas CityBlue Cross and Blue Shield of Kansas, Inc.Blue Cross and Blue Shield of Massachusetts, Inc.Blue Cross and Blue Shield of North CarolinaBlue Cross and Blue Shield of South CarolinaBlue Cross and Blue Shield of VermontBlue Cross Blue Shield of Arizona, Inc.Blue Cross Blue Shield of Michigan Mutual Insurance CompanyBlue Cross Blue Shield of WyomingBlue Cross Complete of Michigan LLCBlue Cross of Idaho Health Service, Inc.BlueCross BlueShield of Tennessee, Inc.California Physicians'Service, Inc.Capital Blue Cross, Inc.CareFirst, Inc.Elevance Health, Inc.GoodLife Partners, Inc.GuideWell Mutual Holding CorporationHawaii Medical Service AssociationHealth Care Service Corporation, a Mutual Legal ReserveCompanyHealthyDakota Mutual HoldingsHighmark HealthHorizon Healthcare Services, Inc.Independence Health Group, Inc.Louisiana Health Service and Indemnity CompanyPREMERAPremera Blue CrossProsano, Inc.Trigon Healthcare, Inc.Wellmark, Inc. 3 © Oliver WymanPREMIUM AND CLAIMS TRENDS BY CARRIER TYPETable (2) shows annual direct premiums and calculated trends by carrier type. Large National Medical Carrier, MGUPaper, and Comprehensive Medical carrier types have seen higher premium growth than the total market’s 11.9%annual rate for 2018–2023, and expanded their market share, while the Large Direct writers, Blues, and Specialty& Life Ins Cos have seen their shares decline. Overall, the Large National Medical, the Blues, and Large Direct ESLcontinue to dominate the market as they still represent almost 80% of total premium earned.Table 2: Total direct premiums by carrier type 2018–2023In millionsLarge NationalMedicalBluesLargeDirect ESLSpecialty &Life Ins CosMGU Paper2018$6,532$5,028$4,391$1,686$7042019$7,669$5,633$4,990$1,848$1,3312020$8,234$6,159$5,483$1,985$1,4602021$9,141$6,709$5,897$1,855$1,5002022$10,463$7,336$6,650$2,292$1,5732023$12,100$7,808$7,322$2,451$1,7005-year avgargegrowth rate13.1%9.2%10.8%7.8%19.3%Growth varianceto total market1.2%-2.7%-1.1%-4.1%7.4%2017 marketshare32.7%25.2%22.0%8.4%3.5%2022 marketshare34.5%22.3%20.9%7.0%4.8%In table (3), we show the premium PMPM and resulting trends by carrier type. The Blues and Specialty and LifeInsurance Cos carrier types have seen the lowest average premium increases. MGU Paper ca