June

Payers Partner With Communities of Color to Battle Racism

June 29, 2020

COVID-19 has disproportionately infected and killed people of color, causing many health care leaders to renew their focus on racism’s role in social determinants of health (SDOH). Since George Floyd was killed by Minneapolis police and Black Lives Matter protests took over America’s streets, the conversation about racism in health care has become even more urgent. Experts and policymakers say payers can help battle racism and SDOH by partnering with organizations rooted in communities of color — and improve insurance business outcomes by doing so.

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Insurers Must Cover Only ‘Medically Necessary’ COVID Tests

June 29, 2020

As more employers turn to COVID-19 testing to see if employees are safe to return to the workplace, the Trump administration has clarified that insurers must cover only physician-ordered “medically necessary” diagnostic and antibody tests.

The guidance, released jointly on June 23 by the Department of Health and Human Services, the Department of Labor and the Department of the Treasury, also says self-funded employer plans must pay for COVID-19 testing that’s medically appropriate, and that providers of tests must publicly post retail prices for those tests.

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Reports: Medicaid MCOs Are ‘Dominant,’ Offer Quality Care

June 29, 2020

Two recent reports found that Medicaid managed care plans now enroll most Medicaid members, help keep costs and premiums low in the markets where they participate, and are competitive with commercial plans at the low end of the individual market in areas including network quality and benefit design.

One white paper was prepared by consultancy The Menges Group for America’s Health Insurance Plans (AHIP) and released on June 23, and the other was authored by researchers at the Robert Wood Johnson Foundation (RWJF) and Urban Institute and released on June 17. The Menges Group-AHIP study focused primarily on measuring the scale of Medicaid MCO market share nationally, while the RWJF-Urban Institute report surveyed Medicaid stakeholders about MCO quality and effectiveness.

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Key Financial Data for Leading Health Plans — First Quarter 2020 (Year-to-Date)

June 29, 2020

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News Briefs

June 29, 2020

✦ A federal district judge upheld the Trump administration’s proposed rule to force hospital systems to reveal the prices they negotiate with insurers. The American Hospital Association (AHA), which brought a suit against HHS over the rule, said it would appeal the decision. The judge, Carl Nichols, who was appointed by President Trump, said that HHS fulfilled all of its statutory obligations in issuing the rule and criticized the AHA’s evidence, writing that HHS’s case was “more persuasive than a decades-old case study involving Danish ready-mixed concrete contracts and research predating the transparency measures promulgated at the state level.”

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CMS Proposes Best Price Waivers for Costly New Therapies

June 25, 2020

In an effort to boost adoption and lower costs for curative therapies, CMS proposed a new rule that the agency says would allow state Medicaid plans to enter into value-based, outcome-dependent purchasing agreements with drug manufacturers using a new interpretation of best price rules. The new rule also criticized insurers’ redirection of copay accumulators, a common arrangement between plans and patients to pay for expensive specialty drugs.

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