Health Plan Weekly

Air ambulances have been villainized in recent years for charging patients with surprise bills at eye-popping amounts. Comprehensive new research by FAIR Health confirms that air ambulance costs went up very fast — and experts say that even though surprise billing has been banned, high prices are here to stay.

“From 2017 to 2020, average charges, estimated allowed amounts and Medicare reimbursements all increased for both fixed-wing and rotary-wing air ambulance transport,” the Sept. 28 white paper says. The white paper is the most authoritative study of air ambulance charges in the commercial market to date: Most previous research into air ambulance studies focused on Medicare reimbursement. The paper also found that:

✦ CMS for the first time on Oct. 12 approved a state’s request to provide gender-affirming care as an essential health benefit (EHB) in the individual and small-group health insurance markets. Colorado’s new EHB-benchmark plan will offer transgender individuals access to a wider range of services than what is currently covered by their health plans, such as eye and lid modifications, face tightening, facial bone remodeling for facial feminization, breast/chest construction and reductions, and laser hair removal. Effective Jan. 1, 2023, Colorado is also adding EHBs in its benchmark plan to include mental wellness exams and expanded coverage for 14 prescription drug classes.

✦ Humana Inc. is expanding its use of Cohere Health’s digital prior authorization platform for musculoskeletal services, the Boston-based digital health company said on Oct. 13. As part of its initial implementation of Cohere Health’s platform, Humana in January 2021 had rolled out the digital solution to 12 states and has since “made significant progress toward achieving its vision to reimagine and modernize processes for prior authorization by reducing approval times, increasing provider satisfaction, and improving delivery of care, all while preserving important benefits such as safety, predictability, and reducing waste,” according to a press release.

Although addressing members’ nonmedical needs — such as transportation, housing and nutrition — has become a popular initiative at many health plans, not all payers have been able to link such actions to improved outcomes and cost savings.

Pittsburgh-based integrated delivery system UPMC, however, recently reported promising results from a pilot program it conducted in its Medicaid managed care plan, in which it partnered with Mom’s Meals to deliver clinically appropriate meals to a select population.