Health Plan Weekly

When the Affordable Care Act banned individual market insurers from denying coverage to people with pre-existing conditions or charging them higher rates, it created a new option for patients with end-stage renal disease (ESRD), who previously could not access affordable plans in that market. But the ACA’s reforms also opened the door to a practice that has stirred up controversy in the health care sector: dialysis facilities steering patients to higher-reimbursing private plans by indirectly subsidizing their premiums. While attempts to ban such behavior have failed so far, a new study offers reasons why policymakers may want to take another shot at addressing the issue.

The study, published in JAMA Internal Medicine, examined 2016 data from ACA-compliant on- and off-exchange health plans, finding that patients with ESRD comprised just 0.10% of individual market member months but 3.3% of spending. For such patients, average monthly spending on dialysis and other services was 33 times that of patients without ESRD, “underscoring the incentive for [dialysis] facilities to encourage individual market enrollment,” the study stated.

With COVID-19 vaccination becoming increasingly widespread, businesses of all types are starting to plan for what their workplaces — both remote and office-based — will look like in the “new normal” created in the pandemic’s aftermath. Health insurers are no exception: In fact, CareFirst BlueCross BlueShield recently unveiled “the next phase of a reimagined employee and workplace experience strategy” even though most of the mid-Atlantic insurer’s workers are still remote.

Another insurer that shared its plans with AIS Health, Pittsburgh-based Highmark Inc., says it won’t transition its employees back to the office until it can ensure their safety. But one expert says that even though the pandemic clearly isn’t over, companies still need to be carefully planning for the post-COVID future.

UnitedHealth Group’s deal to acquire Change Healthcare Inc. will receive extra scrutiny from the Dept. of Justice, according to a recent filing. Regulators’ decision regarding the deal could have significant implications in the broad digital transformation of the health insurance industry mandated by interoperability and price transparency rules, experts tell AIS Health.

UnitedHealth announced an agreement with Change in January to fold the health data company into the diversified health insurer’s in-house data analytics shop, Optum. DOJ antitrust regulators gave notice to both firms on March 24 that they would have to provide additional information and documentary materials in order to have the deal approved, according to a Securities and Exchange Commission filing. The expanded investigation follows a formal complaint letter from the American Hospital Association (AHA), which requested the DOJ take a deeper look at the deal.

✦ Anthem, Inc. will acquire myNEXUS, Inc., “a comprehensive home-based nursing management company,” the insurer said on March 24. The provider-facing myNEXUS platform facilitates authorization by a payer for home nursing services. “Bringing the right level of whole person care into the home has been demonstrated to improve outcomes, reduce readmissions and improve members’ and their family’s experience of wellbeing,” said Prakash Patel, M.D., Anthem executive vice president, and president of its Diversified Business Group. myNEXUS currently serves 1.7 million Medicare Advantage members across 20 states, according to the release, and “combines an advanced analytic rules engine, with a clinical staff of over 250 clinicians to effectively plan for and to optimize home care” and “has established a nationwide network of high performing home health providers and nurse agencies.” Read more at https://bit.ly/3cmWjAK.

✦ The Biden administration has extended the pandemic-driven special enrollment period (SEP) on HealthCare.gov through Aug. 15. The SEP started on Feb. 15, and previously was slated to end on May 15. The extension will allow enrollees to take advantage of expanded tax credits now offered as part of recently passed COVID-19 relief legislation — including people currently enrolled in exchange plans, who will have the opportunity to choose a new plan with an updated price. Research by the Kaiser Family Foundation found that “the number of people eligible for a subsidy to purchase Marketplace coverage has increased 20% from 18.1 million to 21.8 million” after passage of the pandemic relief bill. Learn more at https://go.cms.gov/31l6xvq and https://bit.ly/2NTkA8d.