Health Plan Weekly
-
News Briefs
✦ Some health insurers received and then returned unsolicited payments from the $30 billion grant fund that HHS distributed to offer COVID-19 financial relief to health care providers, Modern Healthcare reported. UnitedHealth Group received and returned $49 million, Cigna Corp. returned $41 million, and CVS Health Corp., which owns Aetna, received and returned $43 million. Humana Inc. and Centene Corp. also told Modern Healthcare that they returned some relief funding, though they did not disclose how much. Read the article at https://bit.ly/2Xa9FZv.
✦ CVS Health Corp. is being sued by six Blue Cross Blue Shield plans that claim CVS “intentionally engaged in a fraudulent scheme” to overcharge them for prescription drugs by “submitting claims for payment at artificially inflated prices.” The lawsuit claims CVS “intentionally told third-party payors, including Plaintiffs, that the prices charged to cash customers for …generic drugs were higher — often much higher,” than they actually were. “Third-party payors then reimbursed CVS based on those higher, inflated prices — instead of the actual, lower, prices CVS offered to the general public, including through its Cash Discount Programs.” CVS is disputing the claims. View the lawsuit at https://go.aws/36FfpO5.
-
Outpatient Visits Rebound, Yet Remain a Third Lower Than Before COVID-19
The number of visits to ambulatory care practices has rebounded since April after a 60% drop in mid-March (HPW 05/18/20, p. 7), according to a recently updated analysis by researchers at Harvard University and health care technology company Phreesia. The visit rebound occurred across the nation, but the South Central census division — Alabama, Arkansas, Kentucky, Louisiana, Mississippi, Oklahoma, Tennessee and Texas — saw the greatest growth. The number of telehealth visits rose dramatically during the height of the pandemic, accounting for 14% of total outpatient visits during the baseline week of March 1-7, but have decreased slightly since mid-April. The decline in outpatient visits remained largest among surgical and procedural specialties and pediatrics.
-
Total Compensation for Publicly Traded Health Insurer CEOs in 2019
Click here for a pdf of the full issue
-
Academy of Actuaries Report Sizes Up Federal Options to Deflect Insurer Risk
Though COVID-19 has put significant pressure on the health care system at large, payers have not yet felt the financial pain confronting hospitals, since utilization for chronic and elective care is at unprecedented lows. But an anticipated spike in utilization (HPW 5/11/20, p. 4) as stay-at-home restrictions relax has led some in the health policy community to examine how the federal government might help mitigate that risk.
According to a May poll conducted by the Kaiser Family Foundation, 48% of Americans have skipped or postponed medical care due to the pandemic, and 32% of that group say they will seek to resume their care in the next three months. Among the people who delayed care, 11% reported their condition worsened because of the delay. That pent-up demand could combine with some level of ongoing need for care to drive claims above anticipated 2020 amounts.
-
CMS Final Rule Bolsters Telehealth, Allows ESRD Patients to Enroll in MA
CMS has finalized a set of proposals for Medicare Advantage and Part D plans that encourage MA plans to increase their telehealth benefits and give end-stage renal disease (ESRD) patients the right to enroll in regular MA plans. CMS also said it is moving forward with plans to increase the impact that patient experience and access measures have on plans’ overall Star Ratings.
The finalized rule, slated for June 2 publication in the Federal Register, gives MA plans more flexibility to count telehealth providers in certain specialty areas — including dermatology, psychiatry, cardiology, ophthalmology, nephrology, primary care, gynecology, endocrinology and infectious diseases — toward meeting CMS network adequacy standards.
The Latest
