Health Plan Weekly
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Key Financial Data for Leading Plans Second Quarter 2020 Year to Date
Click here for a pdf of the full issue
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Expert: Despite Study, Pandemic Adverse Selection Unlikely
An Aug. 20 study published in the journal Health Affairs found that costs for individual exchange plan members who enroll during special enrollment periods (SEPs) are higher than costs for members who enroll during open enrollment.
However, one expert says that the unique circumstances of the COVID-19 pandemic mean that adverse selection in SEPs meant to address the crisis is not as risky as in a normal SEP.
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Sharp Deal Tips Amazon’s Interest in Health Care Data
Health care industry insiders say that Amazon.com Inc.’s Aug. 27 deal to provide Halo fitness trackers to Sharp HealthCare indicates the retail and tech giant will make big bets on clinical and actuarial data analytics.
Sharp Chief Information and Innovation Officer Michael Reagin tells AIS Health that Amazon will provide the San Diego-based integrated plan and provider with about 500 of the wearable fitness trackers. According to Reagin, Amazon approached Sharp through Cerner Corp., the software vendor that Sharp uses for its electronic health record (EHR) platform.
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Plans Eye Levers, Tools to Keep ER Visits Low Post-Pandemic
Emergency room visits have plummeted since the onset of the COVID-19 pandemic, leading some health plans to consider how to capitalize on this trend to redirect non-emergent care away from the ER permanently, insiders say. Increased use of telemedicine and smart digital tools to provide real-time site-of-care options are on the table.
However, some analysts warn that fear of contracting the virus from a health care facility could lead some people to forgo necessary care, which ultimately could increase costs and lead to poorer health outcomes.
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Commercial Fees for Clinician-Delivered Services Averaged 122% of Medicare Rates in 2017
The amount that private insurers paid for professional health care services (i.e. those delivered by a clinician) were, on average, 122% of Medicare rates nationally in 2017, according to a recent Health Care Cost Institute report. In seven states, the average commercial prices exceeded 150% of Medicare rates, while eleven states saw average clinician fees within 10% of Medicare. Though no state reported payments higher than 200% of Medicare rates, five metro areas in Wisconsin had prices above this threshold. Places with higher commercial prices tended to be in the Northwest, and in the areas around large cities.
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