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October 29, 2021

The Biden administration released a diminished version of its proposed spending package, and several health care policies coveted by progressive Democrats — including drug price reform — are among the items that got cut. Critically, Medicare drug price negotiation is not included in the so-called “Build Back Better framework.” However, House Speaker Nancy Pelosi (D-Calif.) reportedly was working on a last-ditch effort to include some drug-pricing provisions. The package would extend the expanded tax credits for Affordable Care Act exchange premiums, made available during the pandemic, to 2025, and Medicare would be expanded to include hearing benefits, but would not include vision or dental.

The Biden administration released a diminished version of its proposed spending package, and several health care policies coveted by progressive Democrats — including drug price reform — are among the items that got cut. Critically, Medicare drug price negotiation is not included in the so-called “Build Back Better framework.” However, House Speaker Nancy Pelosi (D-Calif.) reportedly was working on a last-ditch effort to include some drug-pricing provisions. The package would extend the expanded tax credits for Affordable Care Act exchange premiums, made available during the pandemic, to 2025, and Medicare would be expanded to include hearing benefits, but would not include vision or dental.

The annual Kaiser Family Foundation (KFF) Medicaid Budget Survey found that, in a majority of the 47 surveyed states, 75% or more of Medicaid enrollees are members of a managed care organization (MCO) run by a private carrier. KFF produced the survey with help from Health Management Associates and the National Association of Medicaid Directors. The survey also found enrollment in Medicaid MCOs has grown since the start of the pandemic, as has Medicaid enrollment as a whole. On balance, states added more benefits to Medicaid than they removed in 2021: “most states used Medicaid emergency authorities to temporarily adopt new benefits, adjust existing benefits, and/or waive prior authorization requirements,” KFF said.

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With COVID Testing Set to Surge, Insurers Fret About Costs

Infographic: With Many Insurers Ending COVID Cost-Sharing Waivers, Patients Face Steep Bills

October 22, 2021

While two separate administrations have now specified that health insurers must cover, without cost sharing, all COVID-19 tests used for individual diagnostic purposes, one trade group says that health plans are still getting stuck with the bill for workplace-related testing — and the problem is only going to get worse.

In an Oct. 5 letter to CMS Administrator Chiquita Brooks-LaSure, the Alliance of Community Health Plans (ACHP) says its member organizations are already seeing testing costs for 2021 surpass levels for full-year 2020, and that for many members, “August was their highest month of tests paid for throughout the entire pandemic, with September data likely to continue the trend.”

While two separate administrations have now specified that health insurers must cover, without cost sharing, all COVID-19 tests used for individual diagnostic purposes, one trade group says that health plans are still getting stuck with the bill for workplace-related testing — and the problem is only going to get worse.

In an Oct. 5 letter to CMS Administrator Chiquita Brooks-LaSure, the Alliance of Community Health Plans (ACHP) says its member organizations are already seeing testing costs for 2021 surpass levels for full-year 2020, and that for many members, “August was their highest month of tests paid for throughout the entire pandemic, with September data likely to continue the trend.”

“As Americans return to their workplace, children return to in-person school and social events begin to return to pre-pandemic normalcy, it is essential that the Administration reaffirm the financial responsibility for COVID testing,” the letter states. In February, the Biden administration issued guidance reaffirming that health plans are not responsible for covering tests done for “public health surveillance or employment purposes” — only tests that are for “individualized diagnosis or treatment of COVID-19.” (The Trump administration took the same stance, drawing the ire of some Democratic lawmakers.)

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Could Payers, Plan Sponsors Pick Retail ‘Dance Partners?’

October 22, 2021

In a series of recent moves, large retailers with pharmacy operations have struck deals with or acquired smaller companies with the aim of adding on-demand, retail clinics at national scale — and marketing them to health plans or employers. While storefront clinics aren’t new, especially in big box stores, health care insiders say the emphasis on selling to plans over consumers is novel, and that health plans may come to see such agreements as an essential benefit.

Experts tell AIS Health that the retail clinic deals build on several trends that have transformed health care delivery in recent years. The pandemic has changed patient and member expectations in countless ways: In particular, patients have come to expect on-demand access to virtual care. Also, patients now rely on urgent care for a growing number of encounters. That trend is related to declines in primary care affiliations, especially among younger people. And, perhaps most of all, new players — venture capital and large firms seeking new growth — are making inroads into the potentially lucrative health care space.

In a series of recent moves, large retailers with pharmacy operations have struck deals with or acquired smaller companies with the aim of adding on-demand, retail clinics at national scale — and marketing them to health plans or employers. While storefront clinics aren’t new, especially in big box stores, health care insiders say the emphasis on selling to plans over consumers is novel, and that health plans may come to see such agreements as an essential benefit.

Experts tell AIS Health that the retail clinic deals build on several trends that have transformed health care delivery in recent years. The pandemic has changed patient and member expectations in countless ways: In particular, patients have come to expect on-demand access to virtual care. Also, patients now rely on urgent care for a growing number of encounters. That trend is related to declines in primary care affiliations, especially among younger people. And, perhaps most of all, new players — venture capital and large firms seeking new growth — are making inroads into the potentially lucrative health care space.

Walgreens Boots Alliance on Oct. 14 acquired a controlling stake in VillageMD for $5.2 billion. Walgreens previously held a 30% stake in the primary care firm, which focuses on value-based contracts with payers. According to a Walgreens press release, the firm plans to open “at least 600 Village Medical at Walgreens primary care practices in more than 30 U.S. markets by 2025 and 1,000 by 2027, with more than half of those practices in medically underserved communities.”

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UnitedHealthcare, Cigna Join ‘Virtual-First’ Health Plan Fray

October 22, 2021

UnitedHealthcare and Centene Corp. have added “virtual first” plan designs to their employer-sponsored offerings, becoming the latest commercial insurance giants to offer benefit designs built around virtual primary and urgent care. Health care insiders tell AIS Health that while there is some demand among employers for such services, they don’t expect the virtual-first model to replace traditional benefit designs any time soon.

UnitedHealthcare, the country’s largest carrier and a subsidiary of UnitedHealth Group, said on Oct. 18 that it will offer employers in nine markets — Little Rock, Ark.; Fort Myers, Fla.; Pittsburgh; Springfield, Mass.; Minneapolis/St. Paul, Minn.; Richmond, Va.; Indianapolis; Dallas; and Houston — what it dubs “NavigateNOW.” Will Shanley, director of public relations at United Healthcare, tells AIS Health, a division of MMIT, that NavigateNOW is currently available only to fully insured employers. The carrier plans to make the benefit design available to self-funded employers for the 2023 plan year. Shanley adds that “we anticipate expanding to 25+ markets by the end of 2023.”

UnitedHealthcare and Centene Corp. have added “virtual first” plan designs to their employer-sponsored offerings, becoming the latest commercial insurance giants to offer benefit designs built around virtual primary and urgent care. Health care insiders tell AIS Health that while there is some demand among employers for such services, they don’t expect the virtual-first model to replace traditional benefit designs any time soon.

UnitedHealthcare, the country’s largest carrier and a subsidiary of UnitedHealth Group, said on Oct. 18 that it will offer employers in nine markets — Little Rock, Ark.; Fort Myers, Fla.; Pittsburgh; Springfield, Mass.; Minneapolis/St. Paul, Minn.; Richmond, Va.; Indianapolis; Dallas; and Houston — what it dubs “NavigateNOW.” Will Shanley, director of public relations at United Healthcare, tells AIS Health, a division of MMIT, that NavigateNOW is currently available only to fully insured employers. The carrier plans to make the benefit design available to self-funded employers for the 2023 plan year. Shanley adds that “we anticipate expanding to 25+ markets by the end of 2023.”

In a press release, UnitedHealth said members will enjoy “unlimited 24/7 access to care” and $0 copays for “virtual and in-person primary care and behavioral health visits, virtual urgent care and most generic medications, with unlimited chat, online scheduling and on-demand, same-day appointments.” The press release also claimed that the offering will “reduc[e] plan premiums by approximately 15%.”

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Anthem Becomes Second Insurer to Ease 3Q MLR Worries

October 22, 2021

Anthem, Inc.’s third-quarter 2021 financial results — combined with UnitedHealth Group’s strong showing less than a week earlier — have helped to ease investors’ concerns about the Delta variant’s potential impact to insurers’ medical costs, according to equities analysts.

The Blue Cross Blue Shield insurer said on Oct. 20 that its medical loss ratio (MLR) was 87.7% for the quarter, beating the Wall Street consensus of 88.4%. Anthem’s “government business drove MLR upside, with commercial earnings below expectations — consistent with the pandemic pattern of more persistent commercial utilization and more COVID sensitivity/deferred care in Medicare/Medicaid,” Evercore ISI analyst Michael Newshel pointed out in a note to investors.

Anthem, Inc.’s third-quarter 2021 financial results — combined with UnitedHealth Group’s strong showing less than a week earlier — have helped to ease investors’ concerns about the Delta variant’s potential impact to insurers’ medical costs, according to equities analysts.

The Blue Cross Blue Shield insurer said on Oct. 20 that its medical loss ratio (MLR) was 87.7% for the quarter, beating the Wall Street consensus of 88.4%. Anthem’s “government business drove MLR upside, with commercial earnings below expectations — consistent with the pandemic pattern of more persistent commercial utilization and more COVID sensitivity/deferred care in Medicare/Medicaid,” Evercore ISI analyst Michael Newshel pointed out in a note to investors.

Overall, Newsel added, Anthem’s results “should provide further relief on top of [UnitedHealth’s] results for investor concerns going into the quarter about MLRs from the Delta COVID wave.”

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