Health Plan Weekly

While President-elect Joe Biden’s administration will likely move forward with some type of health insurer price transparency regulation, industry insiders say the new policy will likely differ from the rule the Trump administration recently finalized (HPW 11/6/20, p. 1).

“I think that the [new] administration will take a step back and think carefully about what makes the most sense,” Avalere Health Founder Dan Mendelson tells AIS Health. Mendelson doubts that the Trump administration rule will actually have an impact at the consumer level. Under the rule, by January 2023 health plans must offer members online shopping tools that allow them to see the negotiated rate between their provider and their plan, as well as a personalized estimate of their out-of-pocket cost for 500 of the most shoppable items and services. Effective one year later, those shopping tools will have to show the costs for all remaining items and services.

Reinsurance programs can help lower premiums in the individual insurance market, but they’re not enough by themselves — states will need to experiment with broader measures to impact underlying health care costs, particularly for unsubsidized individual market enrollees, a report from The Commonwealth Fund concludes.

However, such programs could be a tough sell as states tighten their budgets because of the COVID-19 pandemic, says study author Justin Giovannelli, an associate research professor and project director at Georgetown University’s Center on Health Insurance Reforms.

With the COVID-19 pandemic getting worse than ever, health insurers are facing an uncertain level of exposure to testing costs. That’s because payers and plan sponsors are on the hook for the entire cost of coronavirus tests — which can vary widely — and they could be required to pay for even more testing depending on the strategy that the Biden administration plans to pursue.

The Families First Coronavirus Response Act and the Coronavirus Aid, Relief and Economic Security (CARES) Act require plan sponsors to pay all in- and out-of-network claims for diagnostic and antibody testing services. The CARES Act says those claims must be paid at a listed “cash price,” which essentially allows labs to name a price for test processing.

A pilot telemedicine program dramatically reduced the amount of time it took for primary care physicians to consult with dermatologists on skin ailments but did not increase utilization or cost, according to a new study from Independence Blue Cross.

The study, which was conducted with the University of Pennsylvania, holds lessons for how such programs could be implemented and expanded as the COVID-19 pandemic propels a much wider adoption of telemedicine for primary care and some medical specialties, stakeholders say.

Telemedicine has become an integral part of the health care delivery system as a result of the COVID-19 pandemic, but insurers still have to find the answers to important business questions about virtual care. Experts say payers and providers have only just begun the process of determining how much telehealth should be used and how it should be reimbursed.

Determining the appropriate amount of telehealth, the clinical settings where it is appropriate and reimbursement rates for virtual visits will all be critical for plans expanding virtual care. Some plans have announced they will continue reimbursing virtual visits at parity with in-person visits at least through the end of the year, though insiders say that may change in the years to come.