Health Plan Weekly

Continuing its spree of approving ambitious waivers before the end of the Trump administration, CMS on Jan. 8 gave Tennessee its blessing to become the first state in the nation to cap its Medicaid funding in exchange for a range of operating flexibilities. Industry insiders tell AIS Health that while the future of Tennessee’s demonstration is uncertain, its approval could still be a point of concern for Medicaid managed care organizations.

“Similar to medical loss ratio (MLR) requirements in the Medicaid managed care final rule, the waiver would give Tennessee more oversight over their Medicaid plans, from flexibility in managed care contracting to rate setting,” explains Abner Mason, founder and CEO of ConsejoSano, a health tech startup specializing in linguistically and culturally aligned Medicaid and Medicare health plan member outreach.

Insurers and other health care organizations are halting or reconsidering donations to federal lawmakers who voted against certifying the results of the presidential election, in moves they say are designed to counter the extremism that led to the Jan. 6 insurrection at the Capitol.

In some cases, these decisions could have a noticeable impact, as many of the organizations announcing changes to their policies gave to members of Congress who voted against certifying election results. But in other cases, the decisions may not have a substantial result since the organization in question hadn’t made many donations in the past or was announcing a review, rather than a change in policy.

With the new Congress largely in place, and the new presidential administration set to take power on Jan. 20, health care insiders are beginning to make sense of what legislation and rulemaking the Biden administration and Democrats intend to develop that could affect health insurers. Experts say that large, structural changes like a public option are unlikely, given Democrats’ narrow Senate majority, but smaller reforms including expanded subsidies in the Affordable Care Act (ACA) exchanges are up for discussion, along with pandemic-related coverage protections.

The Biden transition team included increased ACA subsidies and temporary COBRA subsidies for laid-off workers as part of the pandemic relief package that President-elect Joe Biden announced on Jan. 14, as AIS Health went to press. But that policy does face some hurdles.

✦ Three years after they unveiled a joint venture tasked with lowering the cost and improving the quality of employee health care, Amazon, JPMorgan Chase & Co. and Berkshire Hathaway are disbanding the company called Haven. CNBC broke the news on Jan. 4, citing people with direct knowledge of the fact that Haven employees were being informed that the venture will shut down by the end of February. The news outlet noted that many of Haven’s 57 workers were expected to be divided among the venture’s three founding companies. In May, Haven CEO Atul Gawande, M.D., stepped down from managing the nonprofit venture. “At the time the JV was formed in early 2018, there was much fanfare and significant stock impact to the managed care sector” (HPW 2/5/18, p. 1) amid concerns that Haven would disrupt the current system, Citi analyst Ralph Giacobbe advised investors in a Jan. 6 note. “In retrospect, the Haven disbanding isn’t overly surprising after three years without any major announcements or apparent breakthroughs in lower healthcare costs and improving outcomes.” Read more at https://cnb.cx/35iClU7.

✦ Regence, a Blue Cross and Blue Shield plan serving Idaho, Oregon, Utah and Washington, and MultiCare Connected Care, an accountable care organization owned by MultiCare Health System, unveiled a “first-in-the-nation” value-based model on Dec. 23. The model is unique because it uses a national interoperability standard to share member attrition data, which the organizations say will reduce the data-management burden on providers. The use of the standard also “establishes a foundation for the development of future population data interoperability applications, such as the exchange of data for measuring care quality and outcomes,” the companies noted in a press release. Read more at https://bit.ly/2XmqFuU.

While CMS has been busy issuing health care regulations in the Trump administration’s final days, industry trade groups have likewise been churning out comment letters that detail their position on those proposals.

One of the proposed rules in question is the 2022 Notice of Benefit and Payment Parameters (NBPP), the annual omnibus regulation that governs the Affordable Care Act (ACA) exchanges. Released on Nov. 25, the lengthy rule raised eyebrows by proposing to permit states to abandon a centralized health insurance exchange in favor of relying on private entities like brokers, agents and insurers (HPW 12/4/20, p. 1).