Health Plan Weekly

Six payers have signed a memorandum of understanding (MOU) to become the first members of the California Advanced Primary Care Initiative, a new program intended to expand the use of value-based primary care in the state.

The initiative is in its early stages, and plenty of work needs to be done to finalize the plans, according to participants in the program who spoke with AIS Health, a division of MMIT. But the agreement calls for the companies to work together to increase their investment in primary care, contract with providers in value-based arrangements, adopt measures that will be publicly released, and hold practices accountable for meeting benchmarks and reward them for strong performance.

CVS Health Corp. is on the verge of making a bid on home health care provider Signify Health, Inc., according to an Aug. 7 report from the Wall Street Journal. Health care insiders tell AIS Health, a division of MMIT, that CVS’s rumored move — part of a planned $25 billion transaction spree — accelerates an existing trend of diversifying health care firms buying their way into home care, even as the rate of transactions in the space slows.

CVS, the parent company of Aetna, is just the latest national health insurance firm with designs in the home care market. As the deal has not been announced, terms have not been disclosed, but Signify’s market capitalization is north of $4.5 billion, per the Journal. UnitedHealth Group, the multi-hyphenate parent company of insurer UnitedHealthcare, announced a $6 billion cash bid for home care provider LHC Group, Inc. in June.

Reforms to telehealth and insulin pricing are stalled in Congress despite notable progress on health care policies like enhanced marketplace subsidies in recent days. D.C. insiders tell AIS Health, a division of MMIT, that comprehensive fixes to either issue are unlikely to make their way into the landmark Inflation Reduction Act of 2022 (IRA), which seems poised to pass the Senate.

Telehealth reforms have passed the House of Representatives, but insiders tell AIS Health that they are unlikely to pass the Senate. They are also not expected to be included as part of a final version of the IRA, which should emerge in the coming days. Some insulin reforms may be included in the IRA, but D.C. experts expect that reforms affecting the commercial market are unlikely to pass as part of the bill. Instead, the insulin price changes are likely to be restricted to Medicare.