Health Plan Weekly

✦ HHS Secretary Xavier Becerra on June 9 sent a letter to health insurers and providers warning them that COVID-19 vaccines and tests must be provided free of charge to patients. “In light of recent reports of consumer cost concerns,” he wrote — citing a recent New York Times article that indicated concern over unexpected medical bills was a reason cited by people who indicated they are hesitant to get the coronavirus vaccine — “I am reminding health care providers of their signed agreements to cover the administration of COVID-19 vaccines free-of-charge to patients, and group health plans and health insurers of their legal requirement to provide coverage of COVID-19 vaccinations and diagnostic testing without patients shouldering any cost.” Health plans that fail to comply with those legal requirements may be reported to appropriate state insurance departments or CMS “for possible enforcement action,” Becerra said.

✦ Clover Health Investments, Corp. on June 9 unveiled plans to expand its in-home primary care program, Clover Home Care, through CMS’s Direct Contracting model. The Medicare Advantage-focused startup insurer has bet big on that new model, which aims to lower costs and improve care quality for fee-for-service Medicare beneficiaries, but it also revealed during its first-quarter 2021 earnings report that it will likely have far fewer people covered by that program than it originally anticipated. In its most recent announcement, Clover said that “the goal of Direct Contracting is to make the Medicare program more financially sustainable for taxpayers while improving health outcomes for beneficiaries, which aligns with the work of Clover Home Care.” The company said its first two partners in the new effort, Spiras Health and Upward Health, “were chosen because of their record of exceptional care delivery in the home via a multidisciplinary model, which is core to Clover’s strategy for complex care management.”

Telemedicine utilization boomed during the COVID-19 pandemic, filling some of the unprecedented gaps in care. But its greatly expanded use uncovered some areas where more investment is needed to encourage adoption, while at the same time creating fears that because of its convenience, the pendulum could swing to overutilization, stakeholders say.

In a webinar held June 8, CareFirst BlueCross BlueShield convened a panel of experts to discuss the future of telemedicine services and their potential role in reaching patients with chronic illnesses. They discussed potential barriers to telemedicine use and how they expected the service to evolve post-pandemic.

National primary care provider OneMedical Group Inc., a startup with an annual subscription service and virtual care offerings, on June 7 announced it will purchase senior-focused provider Iora Health, Inc. for $2.1 billion in an all-stock deal. Experts say the deal is a good bet for a firm that is already an appealing employer for talented, young primary care physicians who don’t want to enter private practice — or work for a large hospital group.

The primary care field has changed since the beginning of 2020, as long-term challenges related to fee-for-service reimbursement, regional provider consolidation and virtual care accelerated because of the pandemic. The OneMedical rollup is an indication that some of the changes to primary care wrought by the pandemic are becoming permanent. Executives expect the deal to close in the third or fourth quarter of this year.

UnitedHealthcare — which recently followed in the footsteps of Anthem, Inc. by rolling out a policy that would retroactively deny certain emergency room visit claims — is now planning to hold off on implementing the change after facing fierce blowback from provider groups. Health care policy experts, meanwhile, have mixed opinions about whether the policy was wise to implement in the first place during an ongoing pandemic.

“How anyone at United thought this was a good idea is a mystery for the ages,” says Joe Paduda, principal of Health Strategy Associates LLC. “The correct reaction would be for the company to ask why it handled this so poorly.”