Datapoint: CareSource Plots Oklahoma Expansion

October 22, 2020

CareSource this week said it is partnering with Healthcare Highways, an Oklahoma-based health care administrator, to form CareSource Oklahoma. The new organization intends to submit a bid for a Medicaid contract in the state. CareSource is currently the seventh-largest managed Medicaid insurer nationally, with 1,660,382 members in Ohio, Georgia and Indiana. The insurer in January terminated its Medicaid contract in Kentucky.

CareSource this week said it is partnering with Healthcare Highways, an Oklahoma-based health care administrator, to form CareSource Oklahoma. The new organization intends to submit a bid for a Medicaid contract in the state. CareSource is currently the seventh-largest managed Medicaid insurer nationally, with 1,660,382 members in Ohio, Georgia and Indiana. The insurer in January terminated its Medicaid contract in Kentucky.

Source: AIS’s Directory of Health Plans

How Will the Limited Supply of Antibody Drugs for COVID-19 Be Allocated?

October 22, 2020

The Food and Drug Administration is evaluating two potential drugs that could help keep people healthy after they’ve been infected with the coronavirus.

So far, there’s no clear system to make sure they would be allocated fairly or how to pay for these expensive drugs over the long haul.

“Demand is going to far outstrip supply here,” says Rena Conti at Boston University’s Questrom School of Business.

The Food and Drug Administration is evaluating two potential drugs that could help keep people healthy after they’ve been infected with the coronavirus.

So far, there’s no clear system to make sure they would be allocated fairly or how to pay for these expensive drugs over the long haul.

“Demand is going to far outstrip supply here,” says Rena Conti at Boston University’s Questrom School of Business.

Even though manufacturers are gearing up to produce more than a million doses before the end of the year, some 50,000 Americans are getting infected every day, so the clamor for these drugs is likely to be considerable. (If the current pace of infection keeps up, there will be another 3.5 million infected Americans before the end of the year)….

Read the full NPR article

Premium Spikes in 2017, 2018 Fueled Unsubsidized Enrollees’ Individual Market Exodus

October 22, 2020

Between plan years 2016 to 2019, unsubsidized enrollment both on and off the Affordable Care Act exchanges declined by 2.8 million people, representing a 45% drop nationally, according to a recent report from CMS. That data, the Trump administration said, demonstrates that “people who do not qualify for subsidies continue to be priced out of the market.”

Indeed, as the CMS report shows, in 2014, 2015 and 2016 “premiums were reasonably flattish, then there’s a huge premium shock in ’17 and ’18 for the unsubsidized population,” says David Anderson, a research associate at the Duke-Margolis Center for Health Policy. “And when things are more expensive, people buy less of them.”

By Leslie Small

Between plan years 2016 to 2019, unsubsidized enrollment both on and off the Affordable Care Act exchanges declined by 2.8 million people, representing a 45% drop nationally, according to a recent report from CMS. That data, the Trump administration said, demonstrates that “people who do not qualify for subsidies continue to be priced out of the market.”

Indeed, as the CMS report shows, in 2014, 2015 and 2016 “premiums were reasonably flattish, then there’s a huge premium shock in ’17 and ’18 for the unsubsidized population,” says David Anderson, a research associate at the Duke-Margolis Center for Health Policy. “And when things are more expensive, people buy less of them.”

Anderson explains that from 2014 to 2016 there were a series “training wheels for the marketplace” — most crucially a three-year federal reinsurance program that paid for a significant chunk of insurers’ high-cost claims. That support disappeared, as the ACA dictated, starting in the 2017 plan year. Also in 2017, insurers that initially priced their plans far too low either started “pricing correctly or leaving the market because they went bankrupt,” Anderson says. And those market exits led to more insurer monopolies.

While subsidized enrollees were largely insulated from that the resulting price hikes, since advanced premium tax credit subsidies rise with premiums, unsubsidized enrollees saw their premium rates rise by hundreds of dollars a month in 2017.

For the 2018 plan year, similar dynamics remained at play, Anderson says, with the added complication of significant policy uncertainty tied to Republicans’ efforts to repeal and replace the ACA in 2017. Insurers responded by either exiting or pricing their products higher, driving even more unsubsidized enrollees from the individual market.

The story changed yet again in 2019. Although unsubsidized enrollment continued to decline that year, the rate of decline was substantially lower than the 24% drop in 2018 and the 20% decrease in 2017, CMS said in its report.

“The market stabilized at a new, lower enrollment, higher premium equilibrium,” Anderson says. Average monthly premiums for both 2019 and 2020 have been flat to slightly declining relative to 2018, he says, and more states have used reinsurance waivers to increase affordability for unsubsidized enrollees. And finally, competition among insurers has ramped back up in recent years, helping push down premiums.

As Covid-19 Intensifies, Shortages of Staple Drugs May Grow Worse

October 21, 2020

You can add a new worry to the health concerns caused by Covid-19: a sustained shortage of medicines needed to combat the coronavirus and countless other illnesses.

Across the U.S. and Europe, 29 out of 40 drugs used to combat the coronavirus are currently in short supply. And those shortages are expected to grow even worse as the number of Covid-19 cases and hospitalizations surge in the coming winter months, according to a new report by the Center for Infectious Disease Research and Policy at the University of Minnesota.

You can add a new worry to the health concerns caused by Covid-19: a sustained shortage of medicines needed to combat the coronavirus and countless other illnesses.

Across the U.S. and Europe, 29 out of 40 drugs used to combat the coronavirus are currently in short supply. And those shortages are expected to grow even worse as the number of Covid-19 cases and hospitalizations surge in the coming winter months, according to a new report by the Center for Infectious Disease Research and Policy at the University of Minnesota.

Moreover, the problem is likely to be exacerbated by the vagaries of the global pharmaceutical supply chain, which is heavily dependent on China for active pharmaceutical ingredients and on manufacturers based in India. As of now, 43% — or 67 of 156 — of acute care medicines used to treat various illnesses are running low. This group includes such staples as antibiotics, blood thinners, and sedatives….

Read the full Stat article

Datapoint: Blue Shield of California Saves $10 Million in Drug Costs

October 21, 2020

Blue Shield of California last week said its drug cost transparency tools have saved $10 million in less than two years. In partnership with Gemini Health, the insurer in 2019 launched a point-of-prescription drug price comparison tool for participating physicians. The insurer says it will next focus on finding lower-cost alternatives for members’ long-time prescriptions. Blue Shield of California is currently the third-largest insurer in the state, with 3,275,534 members.

Blue Shield of California last week said its drug cost transparency tools have saved $10 million in less than two years. In partnership with Gemini Health, the insurer in 2019 launched a point-of-prescription drug price comparison tool for participating physicians. The insurer says it will next focus on finding lower-cost alternatives for members’ long-time prescriptions. Blue Shield of California is currently the third-largest insurer in the state, with 3,275,534 members.

Source: AIS’s Directory of Health Plans

Racial Disparities Are Highlighted by Pandemic

October 21, 2020

The COVID-19 pandemic has been especially harmful to people of color in the U.S., as they are more likely to suffer financial hardship, extreme cases of the disease or death than the white population. Experts say the devastation to communities of color is the product of systemic racism — particularly a lack of access to insurance coverage and quality care — and the pandemic’s economic consequences will make all of those problems worse.

According to a Sept. 15 report released by the Kaiser Family Foundation (KFF) and the Epic Health Research Network, people of color were more likely to test positive for COVID-19 and to require a higher level of care at the time of diagnosis compared to white patients, and they also were more likely to be hospitalized and die from the novel coronavirus than white patients were.

By Peter Johnson

The COVID-19 pandemic has been especially harmful to people of color in the U.S., as they are more likely to suffer financial hardship, extreme cases of the disease or death than the white population. Experts say the devastation to communities of color is the product of systemic racism — particularly a lack of access to insurance coverage and quality care — and the pandemic’s economic consequences will make all of those problems worse.

According to a Sept. 15 report released by the Kaiser Family Foundation (KFF) and the Epic Health Research Network, people of color were more likely to test positive for COVID-19 and to require a higher level of care at the time of diagnosis compared to white patients, and they also were more likely to be hospitalized and die from the novel coronavirus than white patients were.

The economic impact of the pandemic has been similarly dire for households of color. According to a Sept. 16 survey prepared by NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health, majorities of Latino (72%), Black (60%) and Native American (55%) households all “report facing serious financial problems during the coronavirus outbreak.”

The survey also found that 25% of Latino households, 18% of Black households and 12% of Native American households “report serious problems affording medical care during the coronavirus outbreak.”

Policymakers say that COVID-19’s poor outcomes within communities of color are sadly predictable. During an Oct. 7 webinar organized by Axios, Rep. Markwayne Mullin (R-Okla.), a member of the Cherokee Nation, said that the problems in Indian Country are a direct product of underfunding the federal Indian Health Service (IHS), which is the primary insurer and provider for Native Americans. According to Mullin, the IHS receives about one-third of the funding per patient as Medicare, Medicaid and the Veterans Administration.

Leading public health figures have argued that racial disparities must be accounted for in plans to distribute COVID-19 vaccines. On Oct. 6, a panel convened by the National Academies of Sciences, Engineering and Medicine released a draft of a report titled Framework for Equitable Allocation of COVID-19 Vaccine. The framework emphasizes the importance of accounting for existing racial disparities in vaccine distribution, and noted the skepticism that communities of color have toward vaccines and the medical profession in general.

As the Virus Surges, Stark Differences Over What Is Around the Corner

October 20, 2020

As the coronavirus continued to surge in many parts of the United States, officials and experts offered starkly different outlooks on Sunday about what was to come and when the situation might improve.

Alex Azar, the secretary of Health and Human Services, noted that many people had grown tired of pandemic precautions, and tried to paint an optimistic picture of how much longer they would be needed.

“Hang in there with us,” he said on Sunday on the NBC program “Meet the Press.” “We’re so close. We’re weeks away from monoclonal antibodies for you, for safe and effective vaccines. We need a bridge to that day.”

As the coronavirus continued to surge in many parts of the United States, officials and experts offered starkly different outlooks on Sunday about what was to come and when the situation might improve.

Alex Azar, the secretary of Health and Human Services, noted that many people had grown tired of pandemic precautions, and tried to paint an optimistic picture of how much longer they would be needed.

“Hang in there with us,” he said on Sunday on the NBC program “Meet the Press.” “We’re so close. We’re weeks away from monoclonal antibodies for you, for safe and effective vaccines. We need a bridge to that day.”

“Please,” Mr. Azar said, “give us a bit more time of your individual, responsible behavior,” referring to hand washing, wearing masks and maintaining social distance….

Read the full The New York Times article

Datapoint: CMS Approves Georgia Medicaid Expansion, Work Requirement

October 20, 2020

CMS last week approved Georgia’s waiver request to partially expand Medicaid in the state. Set to begin in July 2021, the partial expansion will cover about 65,000 additional adults, according to state officials, and includes a work requirement. Uninsured adults living at or below the federal poverty line will become eligible for Medicaid benefits if they participate in 80 or more hours per month of work, volunteering, school or another qualifying activity. Georgia currently serves 2,327,983 Medicaid beneficiaries, with 73% enrolled in managed care plans.

CMS last week approved Georgia’s waiver request to partially expand Medicaid in the state. Set to begin in July 2021, the partial expansion will cover about 65,000 additional adults, according to state officials, and includes a work requirement. Uninsured adults living at or below the federal poverty line will become eligible for Medicaid benefits if they participate in 80 or more hours per month of work, volunteering, school or another qualifying activity. Georgia currently serves 2,327,983 Medicaid beneficiaries, with 73% enrolled in managed care plans.

Source: AIS’s Directory of Health Plans

Election’s End Should Boost Managed Care Stocks

October 20, 2020

In recent notes to investors, equities analysts have suggested that politically, the best-case scenario for the managed care industry might be a Democrat in the White House and a split Congress. Still, they say, the outcome of the upcoming elections is less important than the anticipated benefits of simply moving past the uncertainty that they’ve generated.

The election and concerns about the Affordable Care Act’s future “kept a lid” on MCO stock prices most of this year, Jefferies analysts David Windley and David Styblo wrote in an Oct. 12 research note. “We think those are starting to come to an end and will improve sentiment and valuation. We believe MCOs rise regardless of election outcome.”

By Leslie Small

In recent notes to investors, equities analysts have suggested that politically, the best-case scenario for the managed care industry might be a Democrat in the White House and a split Congress. Still, they say, the outcome of the upcoming elections is less important than the anticipated benefits of simply moving past the uncertainty that they’ve generated.

The election and concerns about the Affordable Care Act’s future “kept a lid” on MCO stock prices most of this year, Jefferies analysts David Windley and David Styblo wrote in an Oct. 12 research note. “We think those are starting to come to an end and will improve sentiment and valuation. We believe MCOs rise regardless of election outcome.”

In an interview with AIS Health, SVB Leerink analyst Stephen Tanal says that the “overhang” affecting the prices of managed care stocks first took root two years ago. “I trace it back to December 2018 when [Sen.] Bernie Sanders [I-Vt.] started to, let’s say, turn up the volume on his campaign,” he says. Not long after that, the left-leaning faction of the Democratic Party “got very loud very quickly,” culminating in the February 2019 introduction of a Medicare for All bill sponsored by Rep. Pramila Jayapal (D-Wash.).

“That was a really bad month for managed care,” Tanal says, regarding stock prices of publicly traded firms. “It’s interesting — now, almost two years later, we’re completely away from that debate, [but] the stocks haven’t fully recovered,” he adds.

Before the death of Justice Ruth Bader Ginsburg, a Joe Biden presidency/Democratic Congress was the worst scenario for MCOs because of uncertainty related to Biden’s health care agenda, risk of Medicare for All resurfacing, and a potential corporate tax hike, the Jefferies analysts suggested. “However, that’s now a hedge against the low-probability but very negative impact of SCOTUS ruling against the ACA,” they wrote, referring to latest challenge to the law’s constitutionality. “Moreover, Biden’s agenda increasingly sounds benign.”

But Tanal says if Democrats control the House, Senate and the presidency, “it’s much more likely they’ll be able to pass meaningful health care legislation.” And the industry — and its investors — remain wary of that possibility.

Datapoint: Four MA-PD Contracts Score Below 3 Stars in CMS’s 2021 Ratings

October 19, 2020

Just four Medicare Advantage Prescription Drug contracts (MA-PDs), from AgeWell New York, Bright Health, Prominence Health Plan and Virginia Premier, scored a 2.5 or below in CMS’s 2021 star quality ratings. The four contracts currently serve 12,553 members. The only contract to receive a low performance warning from the agency was Prominence HealthFirst of Texas, which currently enrolls 1,370 lives.

Just four Medicare Advantage Prescription Drug contracts (MA-PDs), from AgeWell New York, Bright Health, Prominence Health Plan and Virginia Premier, scored a 2.5 or below in CMS’s 2021 star quality ratings. The four contracts currently serve 12,553 members. The only contract to receive a low performance warning from the agency was Prominence HealthFirst of Texas, which currently enrolls 1,370 lives.

Source: AIS’s Directory of Health Plans