Health Plan Weekly

The COVID-19 pandemic has led to a digital revolution in behavioral health care, with an explosion in virtual care that has increased access in the short-term. And care delivery is likely to fundamentally change even after the pandemic ends, two stakeholders say.

“Both our patients, as well as providers, have gotten comfortable with digital and virtual behavioral health care, and we’ve really seen these demonstrated advantages,” Douglas Nemecek, M.D., chief medical officer for behavioral health at Cigna Corp., told attendees during a Dec. 8 virtual panel during America’s Health Insurance Plans’ Consumer Experience & Digital Health Forum 2020.

by Jinghong Chen

So far in 2020, spending on health care services is down 2.4% compared to 2019, marking the first time that patient care expenditures have dropped since records became available in the 1960s, according to a recent analysis by the Kaiser Family Foundation. In April when the first surge of coronavirus infections was at its peak, personal expenditures on health care services saw an unprecedented 31.9% decrease on an annualized basis. Among health care facilities, outpatient care centers and physicians’ offices experienced the largest drops in revenue year-to-date. The use of telemedicine services has increased dramatically during the pandemic, yet it was not large enough to offset drops in in-person care. The analysis suggested that though health care spending and utilization have rebounded, they could fall again if the current spike in COVID-19 cases causes hospitals and patients to put off elective care.

With Pfizer Inc. and BioNTech’s coronavirus vaccine on the cusp of FDA authorization, Moderna Inc.’s offering not far behind and AstraZeneca plc also touting promising results from its vaccine, in the coming months there will undoubtedly be a variety of vaccines being administered to Americans. While in normal circumstances private insurers might steer members toward one manufacturer’s vaccine over another, or even refuse to cover certain inoculations, policy experts say that the usual rules do not apply when it comes to the COVID-19 pandemic.

“Few things in health policy are simple, but in the case of the COVID-19 vaccine, there is a very simple take-home message, which is that no one going to get the vaccine will be charged for the vaccine or its administration, no matter what type of insurance they have, or whether they have insurance at all,” Karyn Schwartz, a senior fellow at the Kaiser Family Foundation (KFF), said during a Dec. 3 web briefing about vaccination logistics.

Health care insiders praised President-elect Joe Biden’s decision to nominate California Attorney General Xavier Becerra, a Democrat, to be the next HHS secretary. Though he is not a specialist in health care, experts say Becerra brings relevant expertise to HHS, and they suggest his aggressive enforcement of market competition rules against one of California’s largest hospital systems could indicate the new administration will try to block provider consolidation.

Becerra does not have a public health or medical background, but he has frequently worked on health care matters over the course of his career. As a member of the House of Representatives from 1993 to 2017, during which time he rose to the position of chairman of the House Democratic Caucus, Becerra was a co-sponsor of the Affordable Care Act (ACA) and played a substantive role in getting it through the lower chamber.

✦ Humana Inc. on Dec. 3 unveiled that it will acquire the remaining 50% of iCare, a Wisconsin-based Medicaid plan that it already owned in part. iCare, which Humana previously co-owned with Centers for Independence, Inc., “currently serves 44,000 members through Wisconsin’s Medicaid SSI program, BadgerCare program, and Medicare D-SNP plans for people who are eligible for both Medicare and Medicaid,” according to a press release. The move will allow Humana to offer Medicare D-SNP plans in Wisconsin and increase the company’s overall Medicaid membership to more than 730,000 across four states: Florida, Illinois, Kentucky and Wisconsin. Visit https://bit.ly/2JBjE6j.

✦ America’s Health Insurance Plans and the Blue Cross Blue Shield Association sent a letter to lawmakers on Dec. 3 in an effort “to urge bipartisan action for COVID-19 relief in the final weeks of the 116th Congress.” Among other legislative priorities, the insurer groups call for “eliminating price gouging by setting a reasonable market-based pricing benchmark for [COVID-19] tests administered out of network,” and “providing temporary funding for the full cost of COBRA premiums for Americans who lose their job or are furloughed.” Read the letter to congressional leaders at https://bit.ly/39Np3lg.