Health Plan Weekly

With the new Congress largely in place, and the new presidential administration set to take power on Jan. 20, health care insiders are beginning to make sense of what legislation and rulemaking the Biden administration and Democrats intend to develop that could affect health insurers. Experts say that large, structural changes like a public option are unlikely, given Democrats’ narrow Senate majority, but smaller reforms including expanded subsidies in the Affordable Care Act (ACA) exchanges are up for discussion, along with pandemic-related coverage protections.

The Biden transition team included increased ACA subsidies and temporary COBRA subsidies for laid-off workers as part of the pandemic relief package that President-elect Joe Biden announced on Jan. 14, as AIS Health went to press. But that policy does face some hurdles.

✦ Three years after they unveiled a joint venture tasked with lowering the cost and improving the quality of employee health care, Amazon, JPMorgan Chase & Co. and Berkshire Hathaway are disbanding the company called Haven. CNBC broke the news on Jan. 4, citing people with direct knowledge of the fact that Haven employees were being informed that the venture will shut down by the end of February. The news outlet noted that many of Haven’s 57 workers were expected to be divided among the venture’s three founding companies. In May, Haven CEO Atul Gawande, M.D., stepped down from managing the nonprofit venture. “At the time the JV was formed in early 2018, there was much fanfare and significant stock impact to the managed care sector” (HPW 2/5/18, p. 1) amid concerns that Haven would disrupt the current system, Citi analyst Ralph Giacobbe advised investors in a Jan. 6 note. “In retrospect, the Haven disbanding isn’t overly surprising after three years without any major announcements or apparent breakthroughs in lower healthcare costs and improving outcomes.” Read more at https://cnb.cx/35iClU7.

✦ Regence, a Blue Cross and Blue Shield plan serving Idaho, Oregon, Utah and Washington, and MultiCare Connected Care, an accountable care organization owned by MultiCare Health System, unveiled a “first-in-the-nation” value-based model on Dec. 23. The model is unique because it uses a national interoperability standard to share member attrition data, which the organizations say will reduce the data-management burden on providers. The use of the standard also “establishes a foundation for the development of future population data interoperability applications, such as the exchange of data for measuring care quality and outcomes,” the companies noted in a press release. Read more at https://bit.ly/2XmqFuU.

While CMS has been busy issuing health care regulations in the Trump administration’s final days, industry trade groups have likewise been churning out comment letters that detail their position on those proposals.

One of the proposed rules in question is the 2022 Notice of Benefit and Payment Parameters (NBPP), the annual omnibus regulation that governs the Affordable Care Act (ACA) exchanges. Released on Nov. 25, the lengthy rule raised eyebrows by proposing to permit states to abandon a centralized health insurance exchange in favor of relying on private entities like brokers, agents and insurers (HPW 12/4/20, p. 1).

by Jinghong Chen

Total U.S. health care spending increased 4.6% to reach $3.8 trillion in 2019, according to CMS’s Office of the Actuary. Medicare spending experienced a higher growth rate in 2019 than in 2018, increasing by 6.7% compared with 6.3%. Meanwhile, private health insurance spending growth slowed from 5.6% in 2018 to 3.7% in 2019. The relatively stable rise in overall health care expenditures reflected faster growth in spending for hospital care, physician and clinical services, and retail prescription drugs, which was offset by a decline in the net cost of health insurance due to a suspension of the health insurance tax in 2019.

An arbitration system to resolve payment disputes between insurers and out-of-network providers over surprise medical bills in New Jersey has resulted in payments that are much higher than prevailing in-network rates for the same services, researchers found.

The study, published in the January issue of Health Affairs, found that New Jersey’s final-offer arbitration system “appears likely to increase health care costs relative to other surprise billing solutions and perversely incentivizes providers to inflate their charges over time,” the authors wrote.