Health Plan Weekly

✦ Cigna Corp. will offer Affordable Care Act marketplace plans in three new states during the upcoming open enrollment period, the insurer said on Aug. 26. Those three states are Georgia, Mississippi and Pennsylvania, and the insurer also plans to offer coverage in additional counties in Arizona, Florida and Virginia. If regulators approve the marketplace expansion, Cigna will offer individual and family plans on the exchanges in 313 counties spanning 13 states. The company also noted that its new markets “have the potential to reach approximately 1.5 million additional customers.”

✦ Just days after the Pharmaceutical Care Management Association (PCMA) and the U.S. Chamber of Commerce filed suit against a regulation requiring health plans and PBMs to report historical net prices of prescription drugs, the Biden administration issued guidance that says the provision won’t be enforced pending further rulemaking. In guidance issued on Aug. 20, HHS and the Labor and Treasury departments also said they will delay by six months the enforcement date of the rule’s requirement to publish negotiated rates with in-network providers and historical allowed amounts to out-of-network providers in machine-readable files. PCMA and the Chamber filed lawsuits challenging all of the requirements that plans and PBMs must publish machine-readable pricing data — provisions that were set to go into effect on Jan. 1, 2022.

by Jinghong Chen

The COVID-19 pandemic has fueled and accelerated merger and acquisition activity in the health care sector, according to the 2021 HealthLeaders Mergers, Acquisitions, and Partnerships Survey conducted by the HealthLeaders Intelligence Unit. The analysis of 119 completed surveys of executives at health systems, hospitals, physician organizations, skilled nursing and assisted living facilities and other provider entities shows that while the pandemic delayed or stalled 49% of respondents’ M&A plans, 90% expect their organizations’ M&A activity to increase or remain the same within the next three years. The top driver of M&A activity is increasing scale to improve negotiations with payers (66%), followed by improving patient care (38%). Meanwhile, data compiled by market research firm Mercom Capital Group shows that digital health M&A set a record in the first half of 2021, with 136 digital health transactions compared to 83 during the same period last year.

A federal judge ruled on Aug. 20 that the Biden administration should not have cancelled Texas’ application for a Medicaid waiver that would give the state billions in federal funds to compensate providers for care provided to uninsured patients. While the ruling can be appealed, the future shape of Texas’ unexpanded Medicaid program remains unclear.

CMS on April 16 revoked an eleventh-hour Section 1115 waiver the Trump administration had granted to Texas. CMS had approved Texas’ waiver request on Jan. 15, less than a week before the end of the Trump administration. The waiver would have sent about $11.4 billion to Texas annually in order for the state to compensate providers for unreimbursed care. The Trump administration approved the waiver for 10 years, a term that experts say is unusually long. Health care insiders said in April that CMS’s move to cancel the waiver was an attempt by the Biden administration to push Texas to expand Medicaid — although the state’s legislature had recently voted down one such proposal.

Large employers, mindful of the effects of the pandemic on their workers’ wellbeing, accelerated plans for virtual health care and mental health services due to COVID-19, according to the 2022 Large Employers’ Health Care Strategy and Plan Design Survey conducted by the Business Group on Health (BGH).

At the same time, 15% of employers postponed efforts to drive care delivery reform, such as centers of excellence, accountable care organizations and high-performance networks, the survey found.

After the New York Times published an investigation into newly public negotiated rates between hospitals and insurers — and concluded that insurers have “little incentive” to negotiate lower costs — top industry trade group AHIP hit back with a blog post claiming that the article “spotlights a lot of numbers with little context, no clarity for patients, and no insight that helps anyone shop for care.”

Industry observers and health care economists who spoke to AIS Health, a division of MMIT, appear to be split on the issue of whether health plans are actually bad negotiators.