Health Plan Weekly

The Biden administration on Jan. 10 issued much-anticipated details about its new requirements for private health plans to pay for at-home COVID-19 tests, sparking immediate questions from industry observers and insurer trade groups alike about whether this is the right way to go about expanding testing access.

“We absolutely agree that a comprehensive national testing strategy is desperately needed and overdue,” says Ceci Connolly, president and CEO of the Alliance of Community Health Plans (ACHP). Members of the organization representing nonprofit health plans have been covering physician-ordered, lab-based tests — as required by pandemic relief legislation — throughout the public health emergency, she tells AIS Health, a division of MMIT. “Unfortunately, this approach runs the risk of confusing a lot of people, frustrating people who probably have trouble getting tests and probably not reaching the target audiences. So it misses the mark.”

In 2021, investors poured a record amount of capital into health care, and industry insiders say that the flood of cash is likely to continue flowing in 2022. Experts predict that investments in health tech, which drew the highest level of investment of any health care sector last year, will continue to grow — and carriers may want to make a splash in new areas of business.

According to a white paper prepared by PricewaterhouseCoopers (PwC), deals in the U.S. health care sector increased by 56%, for a total volume of $203 billion, through Nov. 15, 2021, compared to the same period in 2020. Meanwhile, a report by Silicon Valley Bank (SVB) found that venture capital funding of health care startups in the U.S. and Europe hit $80 billion, “beating 2020’s record by more than 30%.”

The rise of artificial intelligence (AI) and machine learning within health care — from clinical decision-making tools to population health stratification efforts — is loaded with potential, but experts warn that embedded data flaws can heighten health disparities and stanch the promise of an equitable playing field for consumers.

As AI-fueled devices and algorithms gain in popularity and practical use, regulators are increasingly taking notice. Multiple agencies, including HHS, the FDA and the Office of the National Coordinator for Health Information Technology (ONC) are quickly adopting regulatory frameworks to address health equity within big data.