Teledermatology Program Reduces Patient Wait Time But Doesn’t Increase Utilization

November 25, 2020

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 and the University of Pennsylvania.

“Dermatology is an ideal specialty for telemedicine due to the visual nature of the clinical assessment,” says study co-author Aaron Smith-McLallen, director of health informatics and advanced analytics at Independence Blue Cross. “Using telemedicine, patients can get quality care very quickly and reduce wait times for patients with more acute needs that are not suitable for telemedicine intervention.”

By Jane Anderson

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 and the University of Pennsylvania.

“Dermatology is an ideal specialty for telemedicine due to the visual nature of the clinical assessment,” says study co-author Aaron Smith-McLallen, director of health informatics and advanced analytics at Independence Blue Cross. “Using telemedicine, patients can get quality care very quickly and reduce wait times for patients with more acute needs that are not suitable for telemedicine intervention.”

The study provides a blueprint for teledermatology programs that plans could potentially implement as soon as 2021, and also could show a path forward for telemedicine in other specialties, says F. Randy Vogenberg, Ph.D., principal, Institute for Integrated Healthcare in Greenville, S.C.

“Carriers are assessing how to best manage new technology-enabled care delivery in a more systematic manner that addresses their need to control financial risk while providing appropriate access to care,” Vogenberg tells AIS Health. “A study result like this clearly establishes the value proposition of providing a win-win scenario by leveraging technology to aid broader, easier access to care without increasing total costs associated with such expanded care delivery.”

The study, published in the journal Telemedicine and e-Health, examined implementation of teledermatology at five University of Pennsylvania Health System primary care practices in 2016 and 2017.

In the teledermatology arm of the study, dermatologists’ average response time was five hours, while in the “usual care” control arm, it took 84 days for primary care physicians to consult with dermatologists.

Teledermatology patients who were recommended for in-person evaluation completed visits to the dermatologist in fewer than four weeks, compared with longer than 14 weeks for controls, according to the study. Meanwhile, there were no significant differences detected in average outpatient costs or total medical costs between the two groups.

The store-and-forward evaluation approach has been used in other specialties, such as radiology and pathology, and Independence is exploring ways to expand its use, Smith-McLallen says.

Datapoint: HealthCare.gov Sees 1.6 Million Sign-Ups in First Two Weeks of Open Enrollment

November 24, 2020

During the first two weeks of open enrollment, more than 1.6 million people signed up for 2021 exchange coverage through HealthCare.gov, according to CMS. The agency said 1,278,478 of those sign-ups were renewals, and 343,628 were new customers. 11,434,845 people are currently enrolled in exchange plans nationwide, according to the latest update to AIS’s Directory of Health Plans.

During the first two weeks of open enrollment, more than 1.6 million people signed up for 2021 exchange coverage through HealthCare.gov, according to CMS. The agency said 1,278,478 of those sign-ups were renewals, and 343,628 were new customers. 11,434,845 people are currently enrolled in exchange plans nationwide, according to the latest update to AIS’s Directory of Health Plans.

Source: AIS’s Directory of Health Plans

Centene Expands ACA Footprint But Faces More Competition

November 24, 2020

Centene Corp., which has come to dominate the Affordable Care Act exchange market by continuing to expand even when other carriers pulled back, is facing more competition now that the market has stabilized and insurer participation has increased.

Given that dynamic, Citi analyst Ralph Giacobbe advised investors recently that he was placing a “negative catalyst watch” on Centene due to the new competitive pressures it’s facing. Centene, he observed, “was displaced as the lowest priced plan in a number of markets,” and so the insurer “will have to rely on retention and new market entry to offset competitive pressures, which could prove challenging and may stunt growth relative to expectations.”

By Leslie Small

Centene Corp., which has come to dominate the Affordable Care Act exchange market by continuing to expand even when other carriers pulled back, is facing more competition now that the market has stabilized and insurer participation has increased.

Given that dynamic, Citi analyst Ralph Giacobbe advised investors recently that he was placing a “negative catalyst watch” on Centene due to the new competitive pressures it’s facing. Centene, he observed, “was displaced as the lowest priced plan in a number of markets,” and so the insurer “will have to rely on retention and new market entry to offset competitive pressures, which could prove challenging and may stunt growth relative to expectations.”

SVB Leerink analyst Stephen Tanal, however, takes a more optimistic view. “I’m pretty comfortable saying Centene’s likely to grow their overall HIX [health insurance exchange] earnings, because they’re going to be in so many more places with higher premiums,” he tells AIS Health.

According to Tanal’s analysis, Centene is increasing its county-level, member-weighted bronze plan premium by about 4% and raising premiums across all metal levels by 4% to 6%. Centene is also expanding its geographic footprint next year, a move that Tanal estimates will put the insurer in 61% more counties than it covered in 2020.

But Tanal did notes that the exchanges next year will feature “more competition in the form of fewer monopoly markets and a larger number of local market competitors.”

“It is definitely more competitive,” Kathy Hempstead, senior policy adviser at the Robert Wood Johnson Foundation, says of the 2021 ACA exchange market. “There’s more participants and it’s not just the Medicaid MCOs spreading out into more places.”

In fact, a new Kaiser Family Foundation analysis found that 30 insurers are entering the individual market next year across 20 states, and 61 insurers are expanding in states where they already operated.

However, “even though there’s a lot of new competition in the marketplace this year, I think that it’s definitely pretty fragmented so far,” Hempstead says. “UnitedHealth came back into a handful of states, Bright Health went into a handful of states, but it’s nothing like the scale that Centene has.”

Datapoint: BCBS Michigan to Create Health & Wellness Centers for Employer Groups

November 23, 2020

Blue Cross Blue Shield of Michigan earlier this month said it is partnering with Premise Health to create onsite health and wellness centers for its employer group clients. The insurer’s goal is to remove common barriers of access to care, such as time away from work and unexpected costs. BCBS Michigan currently serves 4,560,108 members, with 28.9% enrolled in a risk-based group commercial product.

Blue Cross Blue Shield of Michigan earlier this month said it is partnering with Premise Health to create onsite health and wellness centers for its employer group clients. The insurer’s goal is to remove common barriers of access to care, such as time away from work and unexpected costs. BCBS Michigan currently serves 4,560,108 members, with 28.9% enrolled in a risk-based group commercial product.

Source: AIS’s Directory of Health Plans

Biden is More Likely to Maintain Stability in MA Than Make Major Change

November 23, 2020

From strengthening the Affordable Care Act to addressing the COVID-19 pandemic, President-elect Joe Biden will have plenty of health care-related items on his plate when he moves into the White House. Part of Biden’s campaign pledge to improve health care coverage included lowering the Medicare eligibility age to 60, but his ability to enact any kind of sweeping health care reform will be severely limited by a likely divided Congress.

If Biden were to succeed with his Medicare-at-60 plan, “it would probably be a very big boon for Medicare Advantage,” given that a younger aging population might not use as many services as an older population and since MA is now a popular alternative to traditional Medicare, observes Stephanie Kennan at McGuireWoods Consulting. Passing such a change, however, depends on several key factors, says Kennan.

By Lauren Flynn Kelly

From strengthening the Affordable Care Act to addressing the COVID-19 pandemic, President-elect Joe Biden will have plenty of health care-related items on his plate when he moves into the White House. Part of Biden’s campaign pledge to improve health care coverage included lowering the Medicare eligibility age to 60, but his ability to enact any kind of sweeping health care reform will be severely limited by a likely divided Congress.

If Biden were to succeed with his Medicare-at-60 plan, “it would probably be a very big boon for Medicare Advantage,” given that a younger aging population might not use as many services as an older population and since MA is now a popular alternative to traditional Medicare, observes Stephanie Kennan at McGuireWoods Consulting. Passing such a change, however, depends on several key factors, says Kennan.

One factor is the makeup of the Senate, which will be determined by runoff elections in Georgia that are scheduled for Jan. 5. If Republicans retain control of the Senate, some might interpret Medicare-at-60 as a progressive, public option-style plan, therefore making it harder to pass legislation enacting such a change, suggests Kennan. The other major issue is that the Medicare Hospital Insurance Trust Fund “really needs to be shored up,” she says.

Meanwhile, MA organizations under the current administration have enjoyed a fair degree of flexibility. Could a Biden administration rein in any of that?

“I think that when it comes to things like network adequacy and quality of care and making sure there’s enough access,” that’s where a Biden administration is more likely to focus rather than “trying to retract benefits,” says Kennan. “I think in general they’re going to be very concerned about access to services, affordability of services…and making sure that there’s information available to folks so they can make a good decision” and understand their health care choices.

During a Nov. 5 webinar hosted by Avalere Health, Avalere Founder Dan Mendelson suggested that regulatory changes aimed at maintaining stability and protecting consumers are far more likely than any major legislative change to MA.

“I think the opportunities arise in these more regulatory changes around the edges to shape the plans in a way that…protects the beneficiary, [helps] to close racial disparities, those kinds of things that are primary policy objectives of a new administration,” Mendelson said.

People on the Move

November 20, 2020

Health Insurers Owe $2.5 Billion in MLR Rebates This Year

November 20, 2020

Insurers that participate in the individual, small-group and large-group markets will issue a record high $2.5 billion in medical loss ratio (MLR) rebates to more than 11.2 million customers this year, an increase of almost $1.1 billion from rebates issued last year, according to CMS. Because health care utilization remains depressed, many health insurers are thriving amid the coronavirus pandemic. Several insurers have waived costs for COVID-19 treatments and offered up premium credits to lower the MLR rebates they could owe over the next couple of years (HPW 10/30/20, p. 1), as MLR rebate amounts are calculated on a rolling three-year average.

by Jinghong Chen

Insurers that participate in the individual, small-group and large-group markets will issue a record high $2.5 billion in medical loss ratio (MLR) rebates to more than 11.2 million customers this year, an increase of almost $1.1 billion from rebates issued last year, according to CMS. Because health care utilization remains depressed, many health insurers are thriving amid the coronavirus pandemic. Several insurers have waived costs for COVID-19 treatments and offered up premium credits to lower the MLR rebates they could owe over the next couple of years (HPW 10/30/20, p. 1), as MLR rebate amounts are calculated on a rolling three-year average.

NOTE: Rebates for 2019 are based on MLR reports filed through Oct. 16, 2020.

SOURCES: “2020 Medical Loss Ratio Rebates,” Kaiser Family Foundation. Visit https://bit.ly/2zosGOH. CMS, visit https://go.cms.gov/38B1bky, https://go.cms.gov/36suLWz and https://go.cms.gov/3loeY1n.

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November 19, 2020

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Datapoint: Humana to Launch MA Products in Massachusetts

November 19, 2020

Humana Inc. will offer Medicare Advantage (MA) products in Massachusetts for the first time in 2021, according to a Nov. 12 press release from the insurer. The initial offerings, four PPO plans, will be available in two counties, Worcester and Bristol. Tufts Health Plan is currently the largest MA insurer in Massachusetts, serving 97,144 lives, 35.9% of the state’s market.

Humana Inc. will offer Medicare Advantage (MA) products in Massachusetts for the first time in 2021, according to a Nov. 12 press release from the insurer. The initial offerings, four PPO plans, will be available in two counties, Worcester and Bristol. Tufts Health Plan is currently the largest MA insurer in Massachusetts, serving 97,144 lives, 35.9% of the state’s market.

Source: AIS’s Directory of Health Plans

Insurer-Affiliated PBMs Propel Parent Firms’ Revenues in Third Quarter

November 19, 2020

Large insurer-affiliated PBMs saw strong results for the third quarter of 2020, in several cases driving revenues for parent companies that are grappling with various disruptive effects of the coronavirus pandemic.

At CVS Health Corp., which reported earnings on Nov. 6, total revenues increased 3.5% year over year to $67 billion, and the company posted earnings per share (EPS) of $1.66, beating analysts’ estimates.

By Jane Anderson

Large insurer-affiliated PBMs saw strong results for the third quarter of 2020, in several cases driving revenues for parent companies that are grappling with various disruptive effects of the coronavirus pandemic.

At CVS Health Corp., which reported earnings on Nov. 6, total revenues increased 3.5% year over year to $67 billion, and the company posted earnings per share (EPS) of $1.66, beating analysts’ estimates.

“Our pharmacy services segment delivered double-digit operating income growth versus [the] prior year, reflecting strength in specialty along with favorable purchasing economics, and our 2021 [PBM] selling season is wrapping up quite nicely, with $3.3 billion of net new business,” President and CEO Larry Merlo said.

Still, SVB Leerink equities analyst Stephen Tanal said in a Nov. 6 investor note that CVS’s Caremark business remains at risk from state-level initiatives involving Medicaid pharmacy benefits.

Cigna Corp.’s new Evernorth segment, which includes the company’s Express Scripts PBM business, its Accredo specialty pharmacy division and its eviCore utilization management business, drove strong third-quarter earnings that beat analysts’ expectations.

Evernorth helped to boost Cigna’s overall revenues to $40.8 billion, said Citi analyst Ralph Giacobbe in a Nov. 5 investor note. Revenues for the Evernorth segment were $29.83 billion, a 20% increase year over year.

Evercore ISI analyst Michael Newshel said in a Nov. 5 investor note that Evernorth showed higher script volume and a slightly better margin than anticipated in the quarter, along with lower corporate expenses than expected.

UnitedHealth, which also handily beat analyst expectations with earnings of $3.51 per share, brought in $65.1 billion in the third quarter, representing an 8% increase year over year. However, the $3.51 adjusted EPS is a 10% drop from last year’s third-quarter earnings.

Health insurer Anthem, which has launched its own in-house PBM, IngenioRx, reported third-quarter adjusted EPS of $4.20, a decline of 14% year over year that reflected the company’s obligations to pay out its $594 million share of a recently settled lawsuit against Blue Cross and Blue Shield plans.

Anthem’s revenues increased by 15.9% year over year to $30.6 billion, which Chief Financial Officer John Gallina attributed largely to growth in the firm’s Medicare and Medicaid businesses, although he also gave a nod to “pharmacy revenue related to the launch of IngenioRx.”