Health Plan Weekly

Telemedicine utilization boomed during the COVID-19 pandemic, filling some of the unprecedented gaps in care. But its greatly expanded use uncovered some areas where more investment is needed to encourage adoption, while at the same time creating fears that because of its convenience, the pendulum could swing to overutilization, stakeholders say.

In a webinar held June 8, CareFirst BlueCross BlueShield convened a panel of experts to discuss the future of telemedicine services and their potential role in reaching patients with chronic illnesses. They discussed potential barriers to telemedicine use and how they expected the service to evolve post-pandemic.

National primary care provider OneMedical Group Inc., a startup with an annual subscription service and virtual care offerings, on June 7 announced it will purchase senior-focused provider Iora Health, Inc. for $2.1 billion in an all-stock deal. Experts say the deal is a good bet for a firm that is already an appealing employer for talented, young primary care physicians who don’t want to enter private practice — or work for a large hospital group.

The primary care field has changed since the beginning of 2020, as long-term challenges related to fee-for-service reimbursement, regional provider consolidation and virtual care accelerated because of the pandemic. The OneMedical rollup is an indication that some of the changes to primary care wrought by the pandemic are becoming permanent. Executives expect the deal to close in the third or fourth quarter of this year.

UnitedHealthcare — which recently followed in the footsteps of Anthem, Inc. by rolling out a policy that would retroactively deny certain emergency room visit claims — is now planning to hold off on implementing the change after facing fierce blowback from provider groups. Health care policy experts, meanwhile, have mixed opinions about whether the policy was wise to implement in the first place during an ongoing pandemic.

“How anyone at United thought this was a good idea is a mystery for the ages,” says Joe Paduda, principal of Health Strategy Associates LLC. “The correct reaction would be for the company to ask why it handled this so poorly.”

✦ The Oklahoma Supreme Court ruled on June 1 that the Oklahoma Health Care Authority (OHCA) cannot create a managed care program as part of the state’s voter-approved Medicaid expansion — on the same day that enrollment for the expanded Medicaid program began. The decision is the result of a suit brought by medical professional associations including the Oklahoma State Medical Association and groups representing dentists, pediatricians, osteopaths and anesthesiologists. The court held that OHCA acted improperly in awarding MCO contracts to payers because “the Legislature has not authorized the creation of the SoonerSelect [Medicaid managed care] program.” For now, the state is obliged to avoid a capitated model for the program, as the authorizing initiative “in no way authorize[s] this course of action. The OHCA, through an RFP process and competitive bidding, awarded contracts to MCOs without legislative authorization or required rules in place. In effect, the OHCA moved ahead without the required legislative authorization.” OHCA in January selected four MCOs to begin serving enrollees in October.

✦ President Joe Biden’s proposed budget would create a public option on the Affordable Care Act exchanges, lower the Medicare eligibility age to 60, close the Medicaid coverage gap in non-expansion states, and increase ACA subsidies. The document’s health care provisions are very similar to those included in the American Families Plan, the massive spending package that Congress has begun to consider in recent weeks. Citi analyst Ralph Giacobbe wrote in a June 1 note to investors that “federal spending for Medicare would grow from $767B in 2022 to $1,415B in 2031…while the federal government’s portion of Medicaid spending would grow from $518B in 2022 to $828B in 2031.”