Health Plan Weekly

While the COVID-19 pandemic complicated many smaller Medicare Advantage organizations’ efforts to connect with members during the Medicare Annual Election Period (AEP) last fall, reports of aggressive and misleading marketing practices also resulted in the unintentional disenrollment of individuals from their plans, which not only hurts from a revenue perspective but can negatively impact their star ratings. According to several sources who spoke with AIS Health, a division of MMIT, these tactics were more egregious than usual during the 2021 AEP and the Open Enrollment Period (OEP) that ran from January through March, when members who selected an MA plan in the fall may make a one-time coverage switch.

“We’ve always seen some very aggressive marketing practices, especially from some of the large, national players. But over the last two years, and especially in the last six months, it’s gone from aggressive marketing tactics to what many plans would qualify as teetering on the side of deceptive marketing practices. And it’s not just one large player,” says a source who works with health plans and asked not to be identified for this article.

Anthem, Inc.’s stock took a dive after its second-quarter 2021 earnings conference call on July 21, surprising equities analysts who saw the large Blue Cross Blue Shield insurer’s financial performance and outlook as relatively solid.

Jefferies’ David Windley, in a note issued to investors on the evening of July 21, attributed the “negative reaction” regarding Anthem’s results to “fear of the unknown.” The insurer’s management “didn’t bless growth above target range for ’22, despite several favorable indicators,” Windley acknowledged, and “it offered a couple of start-up headwinds” related to recent contract wins, “though nothing big enough to overwhelm unwinding COVID headwinds and already conservative balance sheet in ’21.”

The growth in hospital trauma center designations has coincided with increases in improper “trauma alert” coding and billing, leading to astronomical bills for patients and payers. This finding, reported in an investigation by Kaiser Health News (KHN), means payers will have to step up their scrutiny of emergency claims, experts say.

Trauma centers are special designations given to hospitals that can provide the highest standard of care in cases of severe, time-sensitive injuries. They employ a specially trained, highly experienced team of doctors and nurses who can scramble to attend to a severely wounded patient in minutes. Traditionally, these teams were stationed in one of several local hospitals and activated when EMTs requested they be ready as soon as the ambulance arrived at the emergency room door.

Just one day after the Biden administration extended the public health emergency (PHE) through mid-October, AHIP published a report arguing that price-gouging on COVID-19 tests continues to be a problem. Crucially, that issue was created when pandemic relief legislation removed health insurers’ ability to hold down out-of-network charges for COVID tests, the trade group says.

Health policy experts who have studied COVID test prices and pandemic relief legislation say that AHIP’s findings are not at all off base. However, there may be little chance of addressing insurers’ concerns anytime soon.

✦ More than two million people have signed up for health care coverage during the pandemic special enrollment period on HealthCare.gov, according to CMS. Signups have undoubtedly been boosted by the expanded premium subsidies that were included as part of the American Rescue Plan Act, the March pandemic recovery bill. According to CMS, “of the new and returning consumers who have selected a plan since April 1, 1.2 million consumers (34%) have selected a plan that costs $10 or less per month after the American Rescue Plan’s (ARP) premium reductions.

✦ Latinos were more likely to embrace virtual mental health care than people in other U.S. racial or ethnic groups, according to a new analysis prepared by Anthem, Inc. Anthem reviewed claims data from Medicaid members in 14 states and found that, during the peak of the pandemic, 40% of Latino members used virtual mental health services, compared to 34% of white members, 33% of Asian members and 28% of Black members. The payer also said that virtual visits accounted for 49% of its reimbursed Medicaid mental health visits during the pandemic and it reimbursed a lower volume of mental health visits during the pandemic than it normally would have: “While telehealth did boost visits during COVID-19, it didn’t make up for the dramatic drop in in-person visits for all races and ethnic groups.”