Bright Health Group reports progress on claims processing, risk adjustment

Bright Health Group says it is getting better at paying claims on time and estimating how much money it owes other carriers in risk adjustment payments — both problems that plagued the health insurer's financial results last year.

The Bloomington-based company reported the improvements on its first-quarter results Wednesday. Executives also said they expect to save $100 million in operating expenses and reduced capital needs, in part because of an April decision to exit certain health insurance markets across six states next year.

The commentary buoyed investors who have seen the company's share price plummet since Bright Health went public last summer in the state's largest initial public offering of stock.

The stock closed Wednesday at $2.24, up 33% for the day.

"Overall, we're off to a solid start for 2022," Mike Mikan, the company's chief executive, said during a call with shareholders.

Bright Health Group sells health insurance coverage to individuals under age 65 as well as seniors who opt to receive their government insurance benefits through private Medicare Advantage health plans.

Since its founding in 2015, the company has quickly grown health plan membership. As of March, Bright Health had a little more than 1 million individual market enrollees and 120,000 people in Medicare Advantage plans. But fast growth in 2021 was difficult for the young company to manage, leading to the troubles with claims processing and risk adjustment.

In March, the company announced it would cut about 150 jobs to curtail expenses. The following month Bright Health announced a geographic downsizing for where it would offer individual market coverage.

With the pullbacks, Mikan said Wednesday the insurer now can focus on its remaining 10 states for individual market coverage, including Florida, Texas and North Carolina.

He added that Bright Health will discontinue its business unit that provides coverage for employer groups. The markets represent about 8% of total membership, Mikan said, and they are forecast to contribute less than 5% of revenue for the year.

Significant enrollment growth during 2021, particularly in Florida, meant Bright Health struggled to load data for new health care providers into its claims processing system. That led to a backlog of unpaid claims, many of which wound up getting paid during the fourth quarter.

After the company disclosed the problem in March during an earnings report, the stock dropped 20% that day.

The insurer made additional progress reducing the backlog during the first quarter, Chief Financial Officer Cathy Smith said. The number of claims that are more than 60 days past due declined by 13%, she said.

Smith told investors technology improvements allowed the company to "meaningfully improve our prompt-pay performance and decrease the average age of claims in our pending claims cue."

Claims processing troubles were part of an investigation by Colorado insurance regulators that resulted in a $1 million fine against Bright Health last month.

Risk adjustment problems emerged when the company reported third-quarter results, but the situation is getting better, Mikan said Wednesday.

In the new year, the company has a higher percentage of returning enrollees, which helps in forecasting risk adjustment payables. In addition, Bright Health says it's having more success this year connecting new enrollees with medical groups, which should help develop accurate risk scores.

In the individual market, carriers must score the risk of health plan enrollees for the purposes of a market-wide risk adjustment system, a complex calculation where some insurers pay into the system while others are compensated for covering riskier patients.

Amid the challenges, Bright Health in December announced a $750 million fundraising package including a strategic investment from health insurance giant Cigna.

On Wednesday, Smith told investors that "based on our growth and our performance, we do believe we have enough capital to support the business for the next year."

During the first quarter, Bright Health Group reported a net loss of $180.6 million on $1.8 billion of revenue.

After adjusting for one-time factors, the loss before interest, taxes, depreciation and amortization (EBITDA) came in at $74.8 million — better than analysts expected, according to a research note from J.P. Morgan.

For the year, Bright Health expects revenue of $6.8 billion to $7.1 billion and an adjusted EBITDA loss of between $500 million and $800 million.