Health Plan Weekly

A Sept. 9 report by the nonpartisan health care policy group United States of Care highlights the challenges posed to the government, private firms and health plan members by the country’s reliance on employer-sponsored insurance — and points out that COVID-19 has made existing problems worse.

However, while the report identifies some public policy limitations of the employer-sponsored health system, it stops short of advocating for universal health coverage.

Georgia recently reaffirmed its proposal to make dramatic changes in its individual market, saying it plans to abandon the Affordable Care Act (ACA) marketplace in favor of a new state program despite the widespread disruptions in health care and health insurance brought by the coronavirus pandemic.

In its revised Section 1332 waiver request to CMS, Georgia said it wanted to push back the start date for part of its plan, meaning the proposal’s two parts — the new state marketplace and a new reinsurance program — wouldn’t take effect until 2022.

The Trump administration — which has made price transparency one of its signature health care initiatives — recently finalized a rule that one expert warns is a signal that CMS is serious about requiring hospitals to reveal rates negotiated with health insurers.

Buried deep within the 2021 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long Term Acute Care Hospital final rule is a provision that would require hospitals to annually report the median rates they negotiate with Medicare Advantage plans, explains Mark Polston, who co-chairs the life sciences and health care industry group at the law firm King & Spalding.

The climate for payer mergers and acquisitions (M&A) has cooled substantially at a national level ever since the collapse of the proposed deals between Anthem, Inc. and Cigna Corp. and between Aetna Inc. and Humana Inc., and experts say transactions of that scale and type are unlikely to return. However, consolidation in the provider sector has increased since the start of the COVID-19 pandemic as such firms grapple with the rapid collapse of fee-for-service revenue — and experts say that cash-rich payers may start to expand their businesses into areas including care delivery, technology and retail.

Unlike Aetna and Humana, which amicably ended their deal after losing an antitrust challenge brought by the Dept. of Justice, the breakdown of Anthem’s bid to acquire Cigna got ugly — resulting in a public spat and dueling lawsuits over Cigna’s attempt to exit their agreement before exhausting the firms’ option to appeal a federal ruling against the transaction.

✦ CVS Health Corp.’s Aetna Inc. subsidiary expanded its partnership with WellBe Senior Medical to provide in-home primary care for the insurer’s senior members in the Chicago area. The partnership launched in the Atlanta market in July. In a company press release, WellBe CEO Jeffrey Kang, M.D., said the deal is part of Aetna’s pandemic response: “I’ve never understood why we would insist on a sick patient seeing us in the office, when it’s easier, more comfortable, and more effective for the patient to have medical care go to them. We can practically do everything that is done in a doctor’s office at the patient’s home. Bringing care to the patient is particularly important during the COVID-19 pandemic to keep patients safe in the comfort of their own home.” Aetna is also working with Landmark Health to bring in-home services to chronically ill Medicare Advantage members in the New York City boroughs and Long Island, Albany, Rochester and Buffalo. Read more at https://prn.to/3hY3RKG and https://yhoo.it/2F1V6AW.

✦ A new survey by the Harris Poll indicates that Americans trust their clinicians most for advice about whether to receive a potential COVID-19 vaccine, with 88% of respondents saying they found doctors and nurses very or somewhat trustworthy. Respondents perceived nationally known health systems like the Mayo Clinic and Cleveland Clinic to be nearly as trustworthy, with 84% of respondents finding those providers very or somewhat trustworthy — more than federal institutions like the CDC (72%) and FDA (72%). Health plans and employers were far behind providers, with 61% of respondents finding them trustworthy. Read more at https://bit.ly/3jH6ktx.