Health Plan Weekly
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Big Insurers Change Little About Coverage of At-Home COVID Tests
A little more than a month after the Biden administration directed private health plans to fully cover at-home COVID-19 tests, insurers now have additional clarity from regulators about how to operationalize that mandate. Still, the country’s largest insurers do not appear to have significantly changed their approaches for covering at-home COVID tests since mid-January — with some still requiring members to submit claims for reimbursement rather than setting up more consumer-friendly direct-coverage pathways.
A Jan. 10 guidance document issued by the administration stated that by Jan. 15, all private group and individual health plans had to start covering up to eight over-the-counter, at-home COVID-19 tests per month for each covered member without imposing cost sharing or utilization management requirements. Previously, pandemic relief legislation required insurers to cover only diagnostic tests that were processed by a lab and ordered by a health care professional.
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Will High Prices Follow Private Equity Investment in Primary Care?
Primary care practices are consolidating at a rapid pace: Independent physician practices are combining on their own, and growth-oriented, outside investors — such as private equity funds, health insurers and health systems — are taking stakes in practices or buying them outright. Experts tell AIS Health, a division of MMIT, that the impact of such deals will vary, but warn that consolidation and investment by private equity firms has raised prices across the board in other areas of health care.
According to a July 2021 report by investment bank Provident Healthcare Partners, 41 primary care transactions worth over $2 billion closed in 2020, a higher deal volume than any year since 2010. Meanwhile, 2019 set a record for capital invested, with $5.1 billion spread across 26 primary care deals. At the time, investors were on pace to shatter both records in 2021: 31 primary care deals worth $4.8 billion had been announced when the report was published. A February 2022 Provident report made note of several major transactions in the last quarter of 2021:
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If Direct Contracting Model Dies, MA Startups Could Suffer
Some Medicare Advantage insurers could take a hit if HHS decides to cancel an increasingly controversial care delivery model that allows participants to share risk and receive capitated payments for serving fee-for-service (FFS) Medicare beneficiaries.
The Global and Professional Direct Contracting (GPDC) model fully launched in April 2021, with 53 Direct Contracting Entities (DCEs) participating. Although most DCEs were provider-led organizations such as Iora Health, some MA insurers also threw their hats into the ring, including startup Clover Health; Humana Inc., under the CenterWell brand name; and Anthem, Inc., under the CareMore brand name.
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Experts Discuss Pros, Cons of Risk-Based Payment in Primary Care
As transactions and outside investment in primary care become more common, many health care insiders see an opportunity to shift primary care reimbursement toward risk-based payment — but experts warn that value-based contracting can’t solve all of primary care’s problems on its own.
Primary care practices (PCPs) operating on a fee-for-service basis faced a crisis in 2020, when the pandemic discouraged patients from making routine visits to the doctor’s office. Many PCPs turned to outside financing to fund capital investments or make payroll. Others combined horizontally with other PCPs or sold to health systems.
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Research Shows Various Ways Racial Disparities in Health Care Persist
While the Affordable Care Act improved health coverage across racial and ethnic groups, nonelderly American Indian and Alaskan Native (AIAN), Hispanic, Native Hawaiian and Other Pacific Islander (NHOPI), and Black populations remain much less likely than white individuals to have health insurance, according to a Kaiser Family Foundation study. In addition, the overall rate of cancer screening is lower among people of color compared to their white counterparts, though overall cancer incidence rates declined for all groups between 2013 and 2018. Meanwhile, as of late November 2021, Black and Hispanic people were more than 2.5 times as likely as white people to be hospitalized for COVID-19, accroding to data from the Centers for Disease Control and Prevention. Finally, a recent Commonwealth Fund report shows that closing the Medicaid coverage gap and extending enhanced marketplace premium subsidies under the Build Back Better Act would significantly improve racial equity in coverage rates, with people of color making up half of those slated to gain coverage.

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