Health Plan Weekly

✦ The Oklahoma Supreme Court ruled on June 1 that the Oklahoma Health Care Authority (OHCA) cannot create a managed care program as part of the state’s voter-approved Medicaid expansion — on the same day that enrollment for the expanded Medicaid program began. The decision is the result of a suit brought by medical professional associations including the Oklahoma State Medical Association and groups representing dentists, pediatricians, osteopaths and anesthesiologists. The court held that OHCA acted improperly in awarding MCO contracts to payers because “the Legislature has not authorized the creation of the SoonerSelect [Medicaid managed care] program.” For now, the state is obliged to avoid a capitated model for the program, as the authorizing initiative “in no way authorize[s] this course of action. The OHCA, through an RFP process and competitive bidding, awarded contracts to MCOs without legislative authorization or required rules in place. In effect, the OHCA moved ahead without the required legislative authorization.” OHCA in January selected four MCOs to begin serving enrollees in October.

✦ President Joe Biden’s proposed budget would create a public option on the Affordable Care Act exchanges, lower the Medicare eligibility age to 60, close the Medicaid coverage gap in non-expansion states, and increase ACA subsidies. The document’s health care provisions are very similar to those included in the American Families Plan, the massive spending package that Congress has begun to consider in recent weeks. Citi analyst Ralph Giacobbe wrote in a June 1 note to investors that “federal spending for Medicare would grow from $767B in 2022 to $1,415B in 2031…while the federal government’s portion of Medicaid spending would grow from $518B in 2022 to $828B in 2031.”

Last month marked the end of a three-month data collection cycle that will have a meaningful impact on the 2023 Medicare Parts C and D star ratings, when member experience measures take on a larger weight in star ratings calculations. While it’s too late to make a difference in how members responded to the recent Consumer Assessment of Healthcare Providers and Systems (CAHPS) that reflected the patient experience in late 2020 and early 2021, Medicare Advantage organizations should be focused on innovations that can prevent and resolve issues members face throughout the year to foster more positive feedback for future surveys, advises one longtime stars expert.

As numerous measures based on CAHPS and CMS administrative data move from a weighting value of 2 to 4 starting with measurement year 2021, the increased value of those measures will make up 32% of the overall 2023 star rating on a weighted basis. “We’ve always known member experience was important and we’ve always agreed we need to focus effort and attention in that area, but attaching such a heavy contribution to the overall star ratings to the surveys is the forcing function that most plans are seeing as the impetus for new actions,” says Melissa Smith, who is executive vice president of consulting and professional services at HealthMine, Inc., a Dallas- based member engagement firm.

An annual report on the cost of health care prepared by Milliman, Inc. found that, for the first time in years, health care costs for the average American family fell in 2020. However, experts say that is unlikely to happen again any time soon, as the COVID-19 pandemic caused a steep decline in health care utilization.

The report, the 2021 Milliman Medical Index, found that the cost of health care for an average American family of four covered by an employer-sponsored PPO health plan was $26,078, down from $27,233 in 2019, a decrease of 4.2%. The drop will not be permanent, warn the authors: Milliman projects costs will increase to $28,256 in 2021.