Health Plan Weekly

✦ On Oct. 19, CMS released a report that found premiums for plans sold on HealthCare.gov have dropped for the third consecutive year, and insurer participation has increased. The average premium for 2021 benchmark silver plans dropped by 2% year over year, while benchmark plan premiums have dropped by 8% since 2018. In a press release, the agency said Iowa, Maine, New Hampshire and Wyoming will see “double-digit decreases in the average benchmark plan premiums for 27-year-olds.” The report also found that the number of HealthCare.gov enrollees with access to a single insurer has dropped from 29% in 2018 to 4% in 2021. However, premiums have grown substantially since the start of the Trump administration in 2017, with 27% net growth in benchmark premiums for 27-year-olds between that year and 2021. Read more at https://go.cms.gov/3jiOEUB.

✦ The Commonwealth Fund found in an Oct. 15 study that outpatient care visits per week have “fully rebounded” after dropping off earlier this year due to the COVID-19 pandemic. “In total, weekly visit counts now slightly exceed pre-pandemic levels,” the study found, though “there is considerable variation by patient age, geographic area, clinical specialty, and insurance coverage.” Outpatient care utilization dropped dramatically during the early days of the pandemic: according to the report, the lowest point in utilization was a 58% reduction in visits on March 29. Read more at https://bit.ly/3dNwjh2.

Blue Cross and Blue Shield of North Carolina is partnering with two vendors to offer free app-based smoking cessation and diabetes reversal programs to its individual and fully insured members. Around 500,000 members will be eligible to participate initially, the companies say.

The programs, run by Carrot Inc. and Virta Health, will be available beginning in November. They address two of North Carolina’s “most pressing health issues,” says Von Nguyen, M.D., vice president of clinical operations and innovations at the Blues insurer. Carrot will run the smoking cessation program and Virta will run the diabetes program.

Several months into a pandemic that has fundamentally changed American life, researchers are just starting to understand the impact of COVID-19 on the U.S. health care system. During an Oct. 19 webinar hosted by the Kaiser Family Foundation, experts attempted to shed some light on that wide-ranging impact while underscoring that the effects of the crisis are still evolving.

Michael Kleinrock, a research director at the IQVIA Institute for Human Data Science, said one of the questions he’s most often asked is “when are we going to start catching up” from the missed doctor visits, delayed surgeries and other types of health care utilization deferred by patients during the height of the COVID-19 lockdowns. Although utilization has bounced back from the significant drops it saw in the spring, based on IQVIA’s analysis it hasn’t yet completely returned to normal levels, he pointed out, “so we’re not catching up.”

With the 2020 election drawing ever closer, the Trump administration has been approving states’ waiver applications at a brisk pace — greenlighting Georgia’s Section 1115 Medicaid waiver on Oct. 15, and another Medicaid waiver from Nebraska on Oct. 20. Further, CMS has said that it’s on the cusp of approving Georgia’s unique plan to remake its individual insurance market.

Health policy experts tell AIS Health that the fate of the three waiver programs depends not only on who wins the White House on Nov. 3, but also on the outcome of a case pending before the Supreme Court. They also say that if former Vice President Joe Biden is elected, states may have to think about waivers very differently than they have under the Trump administration.

Several recent surveys on employer-sponsored health insurance have found that plan sponsors are following three major trends: expanding virtual care and telehealth benefits, narrowing provider networks and emphasizing centers of excellence in their benefit designs. Experts suggest that these trends are driven by the continuing growth in health care costs, which is reflected in growing premiums for firms and employees. Meanwhile, the COVID-19 pandemic has exposed plan sponsors to unforeseeable risk.

According to the 2020 edition of the Kaiser Family Foundation’s (KFF) Employer Health Benefits Survey (see infographic, p. 7), which was published Oct. 8, this year’s annual premium growth (4% for individuals and families) outstripped both wage growth (3.4%) and inflation (2.1%). That is in line with the dramatic growth in premiums in recent years, which have risen 22% in the last five years and 55% in the last 10.