Health Plan Weekly

Even as the COVID-19 crisis continues, public health officials are warning that an influenza pandemic might emerge this fall or winter. A double pandemic would kill even more people than COVID-19 on its own and strain the already overworked health care system. To prevent that deadly combination, plans have stepped up their usual flu-season member outreach programs, particularly for seniors.

The public health community has issued stern warnings about the danger of a double pandemic. An Aug. 14 clinical update published on the Journal of the American Medical Association website called the “looming threat of concurrent influenza and COVID-19 epidemics” a “major concern for public health officials and clinicians.” The article urged health care leaders to take a proactive approach to getting the public vaccinated for influenza.

While a small proportion of people who have behavioral health conditions in addition to physical conditions account for 44% of all health care spending, most of that spending is on physical rather than behavioral treatment, according to a new study by Milliman, Inc., commissioned by The Path Forward for Mental Health and Substance Use. In fact, 50% of all patients with behavioral health conditions had less than $68 of total annual spending for behavioral health treatment, and another 25% had very limited spending on behavioral treatment — between $68 and $502 per year. “While the Milliman report did not study the effect of COVID-19 on mental health, its analysis of 2017 claims data provides a baseline for estimating the potential subsequent impact of the pandemic on the treatment of behavioral conditions and medical spending,” Andy Keller, Ph.D., president and CEO of Meadows Mental Health Policy Institute, said in a press release about the findings.

✦ The Supreme Court will hear oral arguments on Nov. 10 in a case seeking to dissolve the Affordable Care Act. Many health care policy watchers noted the timing of the arguments, as they are scheduled one week after the presidential election is set to take place. In California v. Texas, previously known as Texas v. United States, a coalition of Republican-led states is arguing that the ACA’s individual mandate is unconstitutional now that the tax penalty has been repealed. Thus, they contend, the entire law should be thrown out. Visit https://bit.ly/3aJdvy6.

✦ Anthem, Inc. and Quest Diagnostics said on Aug. 17 that they’re entering a new “strategic relationship.” The insurer and lab company plan to leverage “a broad range of tools and programs to drive operational improvements, create pricing transparency, and enhance health care consumer engagement and outcomes.” Visit https://prn.to/32aaa7d to learn more.

CVS Health Corp.’s Aetna division — having recently rolled out two new plan designs that aim to ease customers’ cost-sharing burden — is now presenting employers with “a cost-effective offering beyond Aetna’s typical broad network plans” that requires members to receive care from a select group of Cleveland Clinic-affiliated providers.

The co-branded Aetna Whole Health – Cleveland Clinic plans will be available to fully insured and self-insured employers in 10 northeast Ohio counties this fall, according to an Aug. 19 press release. Employers could save as much as 10% in health care spending by choosing the new plan over a current Aetna broad network plan, but the catch is that members must receive care from the “Cleveland Clinic Quality Alliance network of employed and independent physicians” or at any Cleveland Clinic facility. Cleveland Clinic, meanwhile, will be rewarded for achieving quality and cost targets.

While the COVID-19 pandemic has not caused employers to significantly alter their health care cost estimates for the coming year, it has unquestionably intensified their interest in embracing virtual care. Those are just a couple of the major findings from the Business Group on Health’s 2021 Large Employers’ Health Care Strategy and Plan Design Survey, which highlighted the variety of ways that the current public health crisis is — and isn’t — affecting how self-insured companies view the health care system.

Notably, 80% of respondents said they believe virtual health will play a significant role in how care is delivered in the future, up considerably from 64% last year and 52% in 2018. Further, when asked about actions they were taking to ease the burdens of COVID-19 for employees, the largest share of respondents — 76% — said they “made changes to allow for better access to virtual care solutions.”