Health Plan Weekly

✦ Priority Health, a subsidiary of integrated health system Spectrum Health and Michigan’s second-largest payer, announced a new suite of incentives for provider agreements that are intended to improve social determinants of health, while Pennsylvania-based payer Health Partners Plans (HPP) announced plans to expand its own SDOH mitigation program. A Priority Health press release claims that the insurer is the first in Michigan to offer such incentives to network members. “We understand that to effectively manage the health and wellness of a patient population, you need to look outside of the clinic walls. Being able to reward providers who are identifying these specific needs based on social factors is a step in the right direction,” said Mike Jasperson, senior vice president of provider network strategy at Priority Health. “Having access to this type of data will eventually allow for both providers and payers to increase the quality of care that is delivered, reduce total cost of care for members, and directly address the needs of vulnerable populations.” Meanwhile, HPP unveiled plans for an “SDoH Regional Council,” which will convene community stakeholders to address social challenges. Read more at https://bwnews.pr/3lvS6N7 and https://bit.ly/3nyODyX.

✦ Based on oral arguments before the U.S. Supreme Court, legal experts say that PBMs have a good chance of winning repeal of a 2015 Arkansas law that strictly regulates how drug benefits are managed. The case, Rutledge v. Pharmaceutical Care Management Association, centers on whether a law known as Act 900 is preempted by the Employee Retirement Income Security Act of 1974 (ERISA), which bars states from enacting laws that “relate to any employee benefit plan” covered by the federal law. “My impression was that Arkansas got the toughest questions from the bench but was bolstered by the Trump administration’s response,” Katie Keith, a health care attorney and faculty member at Georgetown University’s Center on Health Insurance Reforms, tells AIS Health. “And it certainly seems like the Justices are considering the broader impact of their ruling, on PBMs specifically and on ERISA plans and state regulation more broadly.” Read more at https://bit.ly/2SADYpg.

Editor’s note: An earlier version of this article indicated that the star ratings released on Oct. 8 were for the 2022 plan year, but they were in fact for the 2021 plan year. This version has been corrected.  

Star ratings for Medicare Advantage plans declined across the board for 2021, signaling an overall drop of around 5.5% in the number of members enrolled in contracts with 4 or more stars, according to an analysis of MA data.

When the coronavirus pandemic bore down on the U.S., health insurers not only moved to waive cost sharing for COVID-19 testing and treatment but also for telehealth visits of all varieties, as shutdowns and fears of contracting the virus kept most Americans out of traditional clinical settings. And there’s clear evidence that consumers embraced virtual care with gusto: a recent analysis from FAIR Health found that telehealth claim lines (an individual service or procedure listed on an insurance claim) in the privately insured population increased 3,806% between July 2019 and July 2020.

However, some major insurers have now ended their across-the-board cost-sharing waivers for non-coronavirus-related telehealth visits, putting certain members on the hook again for copays, coinsurance and/or deductibles if they opt for a virtual appointment.