Health Plan Weekly
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Insurance Industry, Biden Admin Trade Barbs Over Medicare Advantage ‘Cuts’
In the view of Medicare Advantage organizations (MAOs) and their allies, federal regulators have been unjustifiably assailing an increasingly popular program among seniors. But to the Biden administration, MAOs’ complaints are unfounded — and their attempt to paint the latest round of proposals as a pay cut is intentionally misleading.
To one longtime health care industry observer, both sides’ arguments amount to “just a lot of noise” that doesn’t do much to prove their cases in the court of public opinion.
As for whether MAOs are actually in line for a pay cut, “it’s one of those things where it’s too close to call…and they’re arguing in the review booth at an NFL game,” says John Gorman, who worked at CMS during the Clinton administration and is now chairman and CEO of Nightingale Partners LLC.
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CareSource, Health Alliance Plan Strike Up Medicaid Joint Venture
CareSource, an Ohio-based, nonprofit Medicaid MCO, will work with Michigan nonprofit insurer Health Alliance Plan (HAP) on a new Medicaid joint venture. One managed care insider tells AIS Health, a division of MMIT, that the deal is evidence that midsized, multistate carriers like CareSource feel competitive pressure to develop — and small plans feel the need to purchase — the kind of analytics and back-end software that diversified, publicly traded firms like UnitedHealth Group and the Cigna Group have spent billions to develop.
CareSource CEO Erhardt Preitauer said in a Feb. 21 press release that the deal came “as we looked for opportunities to strategically grow our business.” He added that “an alignment with HAP emerged as the perfect fit,” and that “HAP’s deep roots and strong brand in Michigan as a trusted health care provider along with a mission-driven approach that matches ours made this a great alignment.…We look forward to being able to bring our commitment to operational excellence, our nonprofit mission, and our best-in-class community model to Michigan as we partner with HAP.”
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Survey Finds Most People Spend Less Than an Hour Choosing Health Plans
When shopping for health plans effective in 2023, 72% of adults spent less than an hour deciding on a coverage option, according to a survey from the Employee Benefit Research Institute (EBRI). While 90% of employees said they were “extremely” or “very” satisfied with open enrollment, an EBRI executive tells AIS Health that health insurers can improve the process and better educate beneficiaries on their options.
“Something I think health plans can zero in on is, ‘How do we engage our plan members in their choice of plans so that they’re picking the best possible plan and there are no consequences later?’” says Paul Fronstin, EBRI’s director of health benefits research.
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‘Consumer-Driven Health Plan’ Adoption Rebounds in 2022
Enrollment in health savings account (HSA)-eligible health plans and health reimbursement arrangements (both of which are known as consumer-driven health plans) climbed back to a record high in 2022, with 19% of employees enrolled in such a plan, according to the annual Consumer Engagement in Health Care Survey, published by the Employee Benefit Research Institute (EBRI) and Greenwald Research. Enrollment in high deductible health plans (HDHPs) that were not eligible to be paired with an HSA fell from 15% in 2020 to 12% in 2022. HDHP enrollees were more likely to have a choice of health plan than traditional plan enrollees, with 29% of them having three health plans to choose from. However, about 72% of enrollees spent less than an hour on their health insurance decision during open enrollment. HDHP enrollees reported they spent more time selecting a health plan.
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News Briefs: CMS Denies Request to Reconsider Alzheimer’s Drug Coverage Decision
CMS said on Feb. 22 that it will not reconsider its national coverage determination (NCD) for a class of Alzheimer’s disease drugs that includes Biogen, Inc.’s Aduhelm and the more recently approved Leqembi. Both drugs are monoclonal antibodies that target amyloid plaque on the brain in patients with mild dementia, and under an NCD issued in April, CMS said Medicare will cover the treatments only for patients enrolled in randomized, controlled clinical trials conducted either through the FDA or the National Institutes of Health. The Alzheimer’s Association requested that CMS revisit its determination, but the agency said in a letter to the patient advocacy group that “there is not yet evidence meeting the criteria for reconsideration.” Still, CMS noted that it “will expeditiously review any new evidence that becomes available that could lead to a reconsideration and change in the NCD, such as evidence that answers the Coverage with Evidence Development (CED) questions or approval by the FDA based upon evidence of clinical benefit.”
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