Health Plan Weekly
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News Briefs: Home Depot Appeals Settlement With BCBSA
The Home Depot, Inc. and two other employers — Topographic and Employee Services Inc. — have appealed a $2.67 billion settlement reached in connection with a class-action lawsuit against the Blue Cross Blue Shield Association (BCBSA). The litigation, which has been ongoing since 2012, challenges Blues plans’ agreement to divide the country among the association’s 36 members and to restrict members’ ability to offer non-Blues products, alleging that constitutes anticompetitive behavior. The decision to appeal the settlement could delay the disbursement of funds as well as the changes expected to come about from the settlement, which could give Blues plans more freedom to collaborate and consolidate, experts told AIS Health in 2020. A federal judge signed off on the settlement in August.
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Three Major Insurers Will Expand ACA Exchange Footprints in 2023
Galvanized by a growing, stable Affordable Care Act exchange market and a looming dropoff in Medicaid membership, some of the country’s largest health insurers in 2023 are once again expanding their ACA marketplace footprints. At the same time, two startup insurers are pulling out of select markets — although one policy expert tells AIS Health that those moves mainly reflect how difficult it is to compete against companies with dominant market shares.
Katherine Hempstead, senior policy adviser at the Robert Wood Johnson Foundation, says significant enrollment growth in Southern states appears to be driving some insurers’ expansion moves this year.
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Major National Health Insurers Expand ACA Presence in 2023
Cigna Corp. will expand its Affordable Care Act exchange offerings in 2023 by 50 new counties in Georgia, Mississippi and North Carolina and add three new states — Texas, Indiana and South Carolina — the insurer said in August. If approved by the state regulators, Cigna’s market expansion has the potential to reach roughly 730,000 additional enrollees. The carrier has been expanding its footprint over the past few years, currently ranking 11th in national ACA enrollment with 340,000 members. Its major state markets are Tennessee (85,000 members), Virginia (62,000) and Missouri (49,000).
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Study Suggests Higher Priced Medicare Advantage Plans Aren’t Always Higher Quality
The quality of care and patient experience significantly varies among Medicare Advantage plans with similar monthly premiums, according to an analysis published on Aug. 26 in JAMA Health Forum. The retrospective, cross-sectional study also found that there was only a small mean difference in quality among low- and high-cost plans.
Amelia Haviland, the study’s lead author, tells AIS Health that the results indicate “how little guarantee there is that by paying more you’re going to wind up in a plan with higher quality. You might pick one of the plans that’s well below the mean within that cost tier or much higher.” However, she suggests insurers that offer low-cost Medicare plans can use the findings to show that people can still receive top-notch plans without paying high premiums.
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Interstate Telehealth Licensure Improved Access to Care During Pandemic
During the early stages of the COVID-19 pandemic, states moved to temporarily allow health care providers licensed in other states to practice in their own jurisdictions with the goal of addressing staffing shortages and increasing access to telehealth. Many in the managed care industry have hoped that these short-term reforms would become permanent, with the goal of cutting costs and preserving telehealth access, but health policy experts are just beginning to make sense of the impact interstate licensure had during the early pandemic.
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