Health Plan Weekly

Medicaid managed care organizations and states that are working to implement value-based payment within Medicaid must overcome challenges posed by provider consolidation and limited state resources, researchers from the Medicaid and CHIP Payment and Access Commission (MACPAC) reported recently.

MACPAC’s deep dive into value-based payment for Medicaid, highlighted at the commission’s February meeting, found that some states take a prescriptive approach, requiring MCOs to implement specific value-based programs, while others take a more flexible strategy.

As the new coronavirus continues to spread throughout the world, the U.S. federal government, states and private health insurers have responded with a flurry of actions aimed at lowering cost barriers that could discourage people from getting tested or treated. But health policy experts tell AIS Health that the sheer number of such announcements lays bare one of the U.S. health care system’s biggest flaws — its decentralized nature.

More than 40 different health insurers so far have stepped forward to unveil new coronavirus-related policies, according to a running list compiled by America’s Health Insurance Plans (AHIP). Many are waiving cost-sharing and prior-authorization requirements for members who need to get tested for the virus, and some of them are also waiving deductibles. Other measures include relaxing restrictions on telehealth and prescription refills, and opening emotional-support help lines. However, most of the new cost-sharing policies apply only to fully insured commercial plans, Medicaid managed care and/or Medicare Advantage (MA) plans, as employers have more discretion when it comes to self-insured health plans.

✦ Cigna Corp. said in a March 5 press release that it will waive all copays or cost sharing for members whom health practitioners recommend receive coronavirus (COVID-19) testing. America’s Health Insurance Plans’ board of directors, meanwhile, pledged that it will “work with public and private-sector partners to implement solutions so that out-of-pocket costs are not a barrier to people seeking testing for, and treatment of, COVID-19.” Visit https://bit.ly/3ct0adE.

✦ Humana Inc. on March 4 launched the Social Determinants of Health Value-Based Program, which is “designed to support clinicians in addressing nonmedical health risk factors affecting Humana members.” The initiative will focus on food insecurity, social isolation, loneliness and housing instability, and it aims to offer providers tools and resources to identify and address those social determinants. The program will also provide compensation for enhanced care coordination centered on patient screenings, documentation of assessment findings and connecting the patient to appropriate resources. Humana said the program’s inaugural participant is Ochsner Health, the largest non-profit, academic health care system in Louisiana. Visit https://bwnews.pr/2TDTlNH.

by Jinghong Chen

Three in 10 likely voters are very or moderately worried about their ability to afford health care over the next year, according to a recent poll from NBC News and the Commonwealth Fund. The poll asked 2,303 people, including 1,594 likely voters, about their health care opinions between Jan. 28 and Feb. 16. More than half of likely voters said they are very or somewhat confident that a Democratic candidate would take actions to make health care more affordable, while four in 10 likely voters said they are confident that President Donald Trump will tackle the issue if he is re-elected.

On March 2, the Supreme Court agreed to hear Texas v. United States, the latest lawsuit intended to overturn the Affordable Care Act (ACA). Though health insurance trade groups indicated they are anxious for a resolution in the case, health care law experts tell AIS Health that the survival of the ACA is far from certain.

“We applaud the Supreme Court’s decision to grant certiorari in TX v US, which will remove the continued legal uncertainty that undermines the stability of coverage for nearly 300 million Americans,” said America’s Health Insurance Plans CEO Matt Eyles in a March 2 press release.