Health Plan Weekly

Lowering the Medicare eligibility age to 60 could add as many as 24.5 million individuals to the program, an analysis from Avalere finds. However, shifting people ages 60 to 64 to Medicare actually could have a mixed effect on coverage overall, since Medicare premiums may cost more than other forms of insurance, a separate analysis from the Kaiser Family Foundation (KFF) reports.

The two analyses point out the tricky dynamics that could be involved in expanding Medicare to cover those ages 60 to 64, as proposed by President Joe Biden during the 2020 campaign.

A previous version of this article incorrectly described Bela Gorman as the chair of the American Academy of Actuaries’ Health Equity Work Group. She is the vice chair.

The health insurance industry, prompted by patients, the activism of the Black Lives Matter movement and health care workers of color, is starting to examine how it contributes to institutional racism — and what it can do about it. Experts say that changing actuarial and operational processes can go a long way toward addressing health disparities caused by racial discrimination.

When President Joe Biden addressed a joint session of Congress late last month, he briefly exhorted lawmakers to “lower deductibles for working families” who get their health insurance on the Affordable Care Act exchanges. But Sen. Jeanne Shaheen (D-N.H.) in late February had answered that call by introducing legislation that would tie premium tax credits to gold-tier plans rather than silver, effectively making richer-benefit plans less expensive.

To find out how such a move would impact individual market consumers and insurers, AIS Health, a division of MMIT, spoke to health policy experts and actuaries who closely track the practical implications of ACA changes.

✦ Following on the heels of fellow startup insurers Alignment Healthcare, Inc., Clover Health Investments, Corp. and Oscar Health, Inc., Bright Health Group, Inc. on May 19 filed preliminary paperwork for an initial public offering (IPO) with the Securities and Exchange Commission. Bright Health has been rumored to be planning an IPO this year, and recently acquired telehealth platform Zipnosis, Inc. Founded in Minneapolis in 2015 by former UnitedHealth Group executives — including current Bright Health Executive Chairman Bob Sheehy — the insurer’s business model is based on close alignment with health care providers, a strategy that it says “provides consumers access to personalized care teams tailored to their individual needs.” It sells both individual market and Medicare Advantage plans and boasts “approximately 40 owned and managed advanced risk-bearing primary care clinics.”

✦ Anthem, Inc. said on May 19 that it is collaborating with the electronic medical record vendor Epic to “facilitate secure, bi-directional exchange of health information” between health care providers and Anthem’s affiliated health plans. By integrating Epic’s Payer Platform with Anthem’s operating system, Health OS, the initiative will allow payers and providers to seamlessly exchange clinical data as well as admissions, discharge and transfer data from patients’ hospital stays. Not only will that data exchange help close care gaps by providing point-of-care treatment decisions, it can also help streamline administrative processes like prior authorization, the companies said in a press release.

A recently reintroduced bipartisan bill would push health insurers to make “real-time” prior authorization determinations for Medicare Advantage (MA) beneficiaries. The bill, which was introduced by Rep. Suzan DelBene (D-Wash.) and co-sponsored by Reps. Mike Kelly (R-Pa.), Ami Bera (D-Calif.) and Larry Bucshon (R-Ind.), incorporates feedback from both payer and provider stakeholder groups.

“When seniors need critical medical care, doctors and other health care providers should be spending their time working with patients instead of going back and forth on requests that should be electronic, standardized, and eventually automated,” said DelBene in a May 13 press release. “The majority of the health care community agrees that prior authorization needs to be reformed. This bipartisan legislation creates sensible rules for the road and will offer transparency and oversight to the prior authorization process.”