Health Plan Weekly

With the COVID-19 pandemic getting worse than ever, health insurers are facing an uncertain level of exposure to testing costs. That’s because payers and plan sponsors are on the hook for the entire cost of coronavirus tests — which can vary widely — and they could be required to pay for even more testing depending on the strategy that the Biden administration plans to pursue.

The Families First Coronavirus Response Act and the Coronavirus Aid, Relief and Economic Security (CARES) Act require plan sponsors to pay all in- and out-of-network claims for diagnostic and antibody testing services. The CARES Act says those claims must be paid at a listed “cash price,” which essentially allows labs to name a price for test processing.

A pilot telemedicine program dramatically reduced the amount of time it took for primary care physicians to consult with dermatologists on skin ailments but did not increase utilization or cost, according to a new study from Independence Blue Cross.

The study, which was conducted with the University of Pennsylvania, holds lessons for how such programs could be implemented and expanded as the COVID-19 pandemic propels a much wider adoption of telemedicine for primary care and some medical specialties, stakeholders say.

Telemedicine has become an integral part of the health care delivery system as a result of the COVID-19 pandemic, but insurers still have to find the answers to important business questions about virtual care. Experts say payers and providers have only just begun the process of determining how much telehealth should be used and how it should be reimbursed.

Determining the appropriate amount of telehealth, the clinical settings where it is appropriate and reimbursement rates for virtual visits will all be critical for plans expanding virtual care. Some plans have announced they will continue reimbursing virtual visits at parity with in-person visits at least through the end of the year, though insiders say that may change in the years to come.

Centene Corp., which has come to dominate the Affordable Care Act exchange market by continuing to expand even when other carriers pulled back, is facing more competition now that the market has stabilized and insurer participation has increased. In recent notes to investors, Wall Street analysts shared diverging views about what that means for Centene’s 2021 earnings, but they — and other experts — generally agree that the insurer won’t be dethroned as the king of the exchanges anytime soon.

Citi analyst Ralph Giacobbe, in a Nov. 16 report, advised investors that he was placing a “negative catalyst watch” on Centene due to the new competitive pressures it’s facing. Centene, he observed, “was displaced as the lowest priced plan in a number of markets,” and although price is only one factor in an individual’s decision of which plan to buy, Centene “has been successful in part due to its lower cost offering historically.” As a result, the insurer “will have to rely on retention and new market entry to offset competitive pressures, which could prove challenging and may stunt growth relative to expectations,” Giacobbe wrote.

✦ During the first week of open enrollment for the Affordable Care Act exchanges (Nov. 1-7), 818,365 people selected plans on the federal platform, HealthCare.gov, according to CMS’s weekly enrollment snapshot released on Nov. 12. And in the second week — comprising Nov. 8-14 — 803,741 enrolled in plans. The number of HealthCare.gov signups during 2021 open enrollment won’t be directly comparable to last year’s, as Pennsylvania and New Jersey started using their own state-based exchanges for 2021 open enrollment, excluding them from the running tally reported by CMS. Open enrollment for the 36 states using the federal platform runs from Nov. 1 to Dec. 15. Visit https://go.cms.gov/3nznBqu and https://go.cms.gov/36StGaU.

✦ U.S. employers appear to be interested in exploring individual coverage health reimbursement arrangements (ICHRAs), in which companies reimburse workers who buy their own health coverage, according to Willis Towers Watson. The health benefits brokerage firm’s 2020 Health Care Delivery Survey found that 15% of employers are planning to offer or considering offering ICHRAs for at least some of their employees in 2022 or later. A 2019 rule issued by the IRS allowed employers to start offering ICHRAs this year, but relatively few opted to do so, “as the pandemic diverted much of their attention to other critical benefit matters,” said John Barkett, senior director of policy affairs, benefits delivery and administration at Willis Towers Watson. Read more at https://bit.ly/36Sxl8E.