Health Plan Weekly

As the country continues to grapple with the COVID-19 pandemic, the issue of “long COVID” is becoming increasingly visible — posing thorny challenges not only for the patients suffering from it but also health care providers, payers and policymakers alike.

Known clinically as post-acute sequelae of COVID-19, long COVID can be characterized by a slew of different symptoms, including neurologic, behavioral and cardiopulmonary ones. In addition to the often-debilitating symptoms associated with long COVID, patients with this condition may face the added burden of struggling to get their treatment covered.

The Biden administration has revamped the strategy of the Center for Medicare and Medicaid Innovation: In the coming years, CMMI will focus on consolidating models, increasing insurer and provider participation in models, and advancing equity — and it aims to have most Medicare and Medicaid members served by value-based payment models by the end of the decade. Health care insiders applauded the new direction, saying the “strategy refresh” should bring the agency closer to its original mission and make its budget go further.

CMMI has tested more than 50 models since its creation in 2010 as part of the Affordable Care Act. Experts outside the agency have criticized the proliferation of models: The Medicare Payment Advisory Commission (MedPAC) recommended in June that HHS “should implement a more harmonized portfolio of fewer alternative payment models that are designed to work together to support the strategic objectives of reducing spending and improving quality.”

Not every person who calls 911 needs to be transported to a hospital for emergency treatment. But people who make those phone calls do need some kind of health care; they just don’t know how to access the services they need.

With that in mind, the health insurer CareOregon recently made a $2.5 million investment in a new Portland Fire & Rescue (PF&R) initiative to connect community members with the care they need. The Community Health Assess & Treat (CHAT) program will take a proactive approach to assessing and meeting the needs of members of Oregon Health Plan, the state’s Medicaid program.

MCO Stock Performance, October 2021

See a full list of director compensation for Presidents and/or CEOs of Blue Cross and Blue Shield Affiliates at https://bit.ly/3oTfcAn, compiled by AIS Health.