Health Plan Weekly

by Jinghong Chen
Although health care utilization started to rebound toward the end of 2020, spending on health care services was down by 1.0% in 2020 compared to 2019, according to a recent analysis by the Kaiser Family Foundation. Among health care facilities, outpatient care centers and physicians’ offices saw drops in revenue year-to-date, while revenue for laboratories and nursing homes went up. The analysis also compared health spending in the quarter before, the quarter of and the four quarters following the beginning of economic recessions, and found that the COVID-19 recession is the first of the past five during which health spending has decreased year over year.

Although urgent care centers have long been trumpeted as a more economical care option than the emergency department (ED) for non-life-threatening conditions, a new study suggests that health insurers might want to re-evaluate that truism.

The study, published in the April issue of Health Affairs, builds on past research by confirming that the presence of urgent care centers in any given area does in fact reduce lower-acuity ED visits. Yet researchers went a step further and asked whether urgent care centers reduced ED visits enough “to make up for the fact that more people are going to go to care when it’s more convenient and lower cost and closer and presumably lower wait time,” explains Ari Friedman, M.D., one of the study’s co-authors and an assistant professor of emergency medicine, medical ethics and health policy at the University of Pennsylvania.

UnitedHealthcare is facing a pair of headline-grabbing lawsuits that accuse the country’s largest health insurer of forcing U.S. Anesthesia Partners (USAP) out of its network and then using “unlawful tactics and pressure campaigns” to induce hospitals, surgeons and patients to stop doing business with the physician group. Yet health policy and law experts say it’s not clear that the anesthesiologists have valid claims against UnitedHealth, which might not be breaking any laws even if it is angering physicians.

“Some of the complaints USAP makes are honestly a bit odd, as they’re basically just complaining that an insurer is trying to use leverage in its negotiations, which is what we’d expect everyone to be doing here,” says Loren Adler, associate director of the USC-Brookings Schaeffer Initiative for Health Policy.

With the passage of the American Rescue Plan (ARP), states that haven’t expanded Medicaid have an extra reason to do so: the COVID-19 relief bill offers financial incentives to states that increase Medicaid eligibility under the Affordable Care Act (ACA). Some states where Medicaid expansion has historically been a nonstarter to conservative elected officials are reconsidering their status — and the biggest states that haven’t yet expanded Medicaid, Florida and Texas, may even change their tune in coming years.

The ARP gives states that expand Medicaid a 5 percentage-point increase in their Federal Medical Assistance Percentage (FMAP) for the first two years of expansion. That’s in addition to the 6.2 percentage-point FMAP increase that all states are getting for the duration of the COVID-19 public health emergency, and the 90% federal funding match rate that Medicaid expansion states receive under the ACA.

✦ Blue Cross and Blue Shield of Minnesota President and CEO Craig Samitt, M.D., will retire on May 3, the insurer said in a March 31 press release. Kathleen Blatz, who has served on the Blues plan’s Board of Trustees for more than a decade and is a former Minnesota Supreme Court justice, will serve as interim CEO effective April 1 while the board conducts a search for Samitt’s replacement. Samitt, the release noted, “was one of the first health care executives to declare racism as a public health crisis, and he made racial and health equity the cornerstone of Blue Cross’ initiative to make health care more equitable.” Read more at https://bit.ly/3sEFUNU.

✦ HHS said on April 1 that after advance payments of tax credits that have been bolstered by the American Rescue Plan, an average of three out of five eligible uninsured Americans can access zero-premium plans and an average of four out of five current HealthCare.gov consumers will be able to find a plan for $10 or less per month. Marketplace customers will see their premiums decrease, on average, by $50 per person per month and $85 per policy per month thanks to expanded subsidies in the COVID-19 relief legislation, the department said. HHS also said it will spend an additional $50 million on advertising to boost its outreach campaign promoting the pandemic-related special enrollment period, which runs through Aug. 15. Read more at https://bit.ly/3dohVw5.