Health Plan Weekly

✦ Cigna Corp. said in a March 5 press release that it will waive all copays or cost sharing for members whom health practitioners recommend receive coronavirus (COVID-19) testing. America’s Health Insurance Plans’ board of directors, meanwhile, pledged that it will “work with public and private-sector partners to implement solutions so that out-of-pocket costs are not a barrier to people seeking testing for, and treatment of, COVID-19.” Visit https://bit.ly/3ct0adE.

✦ Humana Inc. on March 4 launched the Social Determinants of Health Value-Based Program, which is “designed to support clinicians in addressing nonmedical health risk factors affecting Humana members.” The initiative will focus on food insecurity, social isolation, loneliness and housing instability, and it aims to offer providers tools and resources to identify and address those social determinants. The program will also provide compensation for enhanced care coordination centered on patient screenings, documentation of assessment findings and connecting the patient to appropriate resources. Humana said the program’s inaugural participant is Ochsner Health, the largest non-profit, academic health care system in Louisiana. Visit https://bwnews.pr/2TDTlNH.

by Jinghong Chen

Three in 10 likely voters are very or moderately worried about their ability to afford health care over the next year, according to a recent poll from NBC News and the Commonwealth Fund. The poll asked 2,303 people, including 1,594 likely voters, about their health care opinions between Jan. 28 and Feb. 16. More than half of likely voters said they are very or somewhat confident that a Democratic candidate would take actions to make health care more affordable, while four in 10 likely voters said they are confident that President Donald Trump will tackle the issue if he is re-elected.

On March 2, the Supreme Court agreed to hear Texas v. United States, the latest lawsuit intended to overturn the Affordable Care Act (ACA). Though health insurance trade groups indicated they are anxious for a resolution in the case, health care law experts tell AIS Health that the survival of the ACA is far from certain.

“We applaud the Supreme Court’s decision to grant certiorari in TX v US, which will remove the continued legal uncertainty that undermines the stability of coverage for nearly 300 million Americans,” said America’s Health Insurance Plans CEO Matt Eyles in a March 2 press release.

While payers have long used telephonic-based care management teams to improve outcomes for members with asthma, more recently, they’re also deploying algorithms to fine-tune their outreach to members who are in most need of support. Those algorithms incorporate data such as asthma-related emergency room visits and hospitalizations, first-time prescriptions for asthma medications, additional comorbidities and frequent refills for albuterol inhalers, which suggests that members’ asthma isn’t well managed using long-term control medications.

According to the Centers for Disease Control and Prevention, 7.7% of adults and 7.5% of children in the United States have asthma. Forty-five percent of working adults had an asthma attack between 2011 and 2016, whereas 10% visited the ER due to an asthma-related emergency, per the federal agency. Asthma is the cause of 1.6 million ER visits each year. The average cost of an ER visit to treat asthma is $1,502, according to a 2014 study.

As two federal proposed rules aimed at improving health care data sharing — interoperability — between payers, providers and patients await finalization, America’s Health Insurance Plans (AHIP), Medicaid Health Plans of America (MHPA) and other groups are advocating for phased-in or delayed implementation so that patient privacy, data standards, administrative and operational concerns can be addressed. Both rules are targeted for 2020 implementation. The 21st Century Cures Act provides for expanding interoperability to increase health care efficiency and transparency.

One proposed rule, from CMS, concerns interoperability and patient access and impacts Medicare Advantage organizations, state Medicaid and CHIP fee-for-service programs, Medicaid managed care plans, CHIP managed care entities, and insurers offering qualified health plans in federally facilitated exchanges. Those payers will be required to give patients access to their own health data via third-party apps, including claims information. The impacted organizations must also participate in a health information network of their choice.