Health Plan Weekly

In acquiring Aetna, CVS Health Corp. promoted the value of integrating health benefits with the company’s thousands of existing pharmacies and retail clinics (see story, p. 1). Other health insurance carriers seem to have taken heed, as national health plans such as Anthem, Inc. and Humana Inc. recently have sought to establish or expand clinics in a variety of markets.

Anthem is contracting with CareMax Inc. “to build medical centers in areas where Anthem will offer a value-based care model to improve patient outcomes,” per an Aug. 13 press release. Meanwhile, Humana will expand its Humana Neighborhood Centers line of clinics, which already operate in Asheville and Greensboro, to several other North Carolina markets including Charlotte.

Aetna, the health insurance arm of CVS Health Corp., has launched what it calls the first national health plan built around virtual primary care. The benefit design, which is a further expansion of CVS’s longstanding relationship with virtual care provider Teladoc Inc., will be available to self-funded plans — and experts say that the model could generate strong demand from such clients, which are looking to cut costs and increase member satisfaction.

According to a CVS press release, the new plan is designed with an emphasis on continuity of care and convenience, starting with “a continuous relationship with a virtual care physician beginning from the first 30-45 minute comprehensive primary care visit and extending to every visit thereafter,” and it promises “timely primary care appointments.” The plan also aims to keep incidental care events like testing and urgent care in-house by offering members a “$0 co-pay for virtual primary care visits and select in-person services at MinuteClinic and CVS HealthHUB locations.” In addition, members will have access to “a virtual nurse care team through unlimited in-app text or phone” while retaining access to “in-person visits with in-network health care providers with no referral requirements [and] existing Aetna virtual care offerings such as mental health counseling, dermatology services, and 24/7 urgent care.”

Even after a rule requiring unprecedented price transparency from hospitals was upheld in federal court, it remained unclear whether the health insurance industry would go to court to challenge a similar rule targeting their industry. Now, just months from when the “transparency in coverage” regulation is slated to go into effect, that question has an unexpected answer: A lawsuit has been filed, but not by health insurers.

Instead, the U.S. Chamber of Commerce and chief PBM trade group Pharmaceutical Care Management Association (PCMA) filed a pair of lawsuits seeking to strike down the transparency in coverage rule, which was proposed in November 2019 and finalized last October. While it isn’t clear yet how the courts will respond to the litigation, one health insurer trade group says plans are proceeding as though the rule will be implemented as written.

✦ The U.S. Court of Appeals for the District of Columbia Circuit on Aug. 13 overturned a key court victory notched by UnitedHealthcare regarding Medicare Advantage overpayments. In 2018, a lower federal court sided with the insurer’s challenge of a CMS rule, which required MA payments to be actuarially equivalent to those in Medicare fee-for-service and which UnitedHealth claimed resulted in the federal government underpaying MA plans. But D.C. Circuit Judge Cornelia Pillard ruled that actuarial equivalence did not apply to the overpayment rule.

✦ CVS Health Corp.’s Aetna launched what it called the “first nationwide virtual primary care” program, which will be available to self-funded employer plans through a partnership with Teladoc Health Inc. Per an Aug. 10 press release, the program will place members in “a continuous relationship with a virtual care physician beginning from the first 30-45 minute comprehensive primary care visit and extending to every visit thereafter” and will offer a $0 copay “for virtual primary care visits and select in-person services at MinuteClinic and CVS HealthHUB locations.”

CMS will refocus and redouble its efforts on health equity and whole-person health outcomes as the Biden administration evaluates ongoing and potential programs and initiatives, CMS Administrator Chiquita Brooks-LaSure said during an Aug. 12 webcast. Brooks-LaSure, who was confirmed to the post on May 25, spoke during the webcast sponsored by Health Affairs about the overarching goals and principles that CMS will follow under her leadership. Health equity forms the bedrock, she said. “Last year at the start of this pandemic, I think the world got a lesson on the holes in our health care system and what that means when we are not providing equal care across the country,” Brooks-LaSure said. “We cannot be in this position again. And so the first question that we are asking ourselves as a team is, does our policy, does our operation advance health equity? Changing that lens and focus is very much changing...