AIS Health - Actionable intelligence for health care leaders

Time 2020-06-22 23:02:58

Web Name: AIS Health - Actionable intelligence for health care leaders

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AIS's Directory of Health Plans Datapoint: Highmark, HealthNow New York to Combine June 22, 2020 Highmark Inc. and HeathNow New York, the parent company of BlueCross BlueShield of Western New York and BlueShield of Northeastern New York, last week announced their intention to combine. While the move is officially being referred to as an “affiliation agreement,” HealthNow’s products will take on Highmark’s branding, making Highmark the primary Blue Cross and Blue Shield affiliate in HealthNow’s service areas. Financial terms of the deal, which still must meet regulatory approval, were not disclosed. Combined, the new entity will enroll 4,754,010 members nationwide. Highmark Inc. and HeathNow New York, the parent company of BlueCross BlueShield of Western New York and BlueShield of Northeastern New York, last week announced their intention to combine. While the move is officially being referred to as an “affiliation agreement,” HealthNow’s products will take on Highmark’s branding, making Highmark the primary Blue Cross and Blue Shield affiliate in HealthNow’s service areas. Financial terms of the deal, which still must meet regulatory approval, were not disclosed. Combined, the new entity will enroll 4,754,010 members nationwide.Source: AIS s Directory of Health Plans Radar on Medicare Advantage CMS Report Shows Increasing Racial Disparities in MA Plans June 22, 2020 As protests erupt across the U.S. calling for racial justice and police reforms, the COVID-19 pandemic continues to bring to light many of the racial disparities in health care, putting pressure on policymakers and the industry to take a hard look at health and access inequities. Meanwhile, CMS’s Office of Minority Research in April released a stratified report highlighting the racial and ethnic differences in health care experiences and care of Medicare Advantage (MA) enrollees. The data showed that black members enrolled in MA plans in 2018 received worse clinical care than white enrollees on 20 out of 44 measures, similar care for 20 and better care for four. And all minority populations reported experiences with care that were either worse than or similar to the experiences reported by white enrollees, including the experience measure for getting appointments and care quickly. By Lauren Flynn KellyAs protests erupt across the U.S. calling for racial justice and police reforms, the COVID-19 pandemic continues to bring to light many of the racial disparities in health care, putting pressure on policymakers and the industry to take a hard look at health and access inequities. Meanwhile, CMS’s Office of Minority Research in April released a stratified report highlighting the racial and ethnic differences in health care experiences and care of Medicare Advantage (MA) enrollees. The data showed that black members enrolled in MA plans in 2018 received worse clinical care than white enrollees on 20 out of 44 measures, similar care for 20 and better care for four. And all minority populations reported experiences with care that were either worse than or similar to the experiences reported by white enrollees, including the experience measure for getting appointments and care quickly.Not getting the proper care when it’s needed is a reflection of the provider network, says John Gorman, chairman and CEO of Nightingale Partners LLC. “And then when you look at the clinical measures where there’s huge racial disparities, all of those tie back to a lack of culturally competent physicians serving these populations in a manner that speaks to the way that they need to access health care,” he observes. John Weis, CEO of Quest Analytics, LLC, predicts that “there will be a significant impact on practice consolidation” from the pandemic. “Given the potential risk to providers, we predict that coming out of COVID, we’ll see an uptick in providers that want to minimize their exposure and consider retirement,” he suggests. And with fewer providers available, “if plans are not prepared, this will drive both out-of-network utilization and increase health care costs in rural areas.”Dan Mendelson, founder of Avalere Health, suggests that while MA plans have the tools to address racial disparities, they don’t necessarily have the incentives to prioritize them. “I think Medicare Advantage plans are uniquely equipped to measure, understand, identify and mitigate disparities…. So, a proactive form of engagement that is focused on disparities can work,” says Mendelson. “One thing that is not there at this point is any kind of direct incentive to the plans to act.” Infographic Health Insurers Could See Net Gain From COVID-19 Pandemic June 19, 2020 The estimated costs for treating COVID-19 could range from $60.2 billion to $182.2 billion over 2020 and 2021 combined, under a baseline risk scenario with a U.S. infection rate of 20%, according to an updated analysis prepared by Wakely Consulting Group on behalf of America’s Health Insurance Plans. The actuarial firm reduced the assumed rates of hospitalization and raised the estimated cost of a hospital admission based on new COVID-19 costs and utilization data. Factoring in the effect of care deferred by patients due to the pandemic, Wakely estimated that the net cost of COVID-19, under a 20% infection-rate scenario, would be -$71.0 billion to $13.8 billion for 2020 and 2021 combined. by Jinghong ChenThe estimated costs for treating COVID-19 could range from $60.2 billion to $182.2 billion over 2020 and 2021 combined, under a baseline risk scenario with a U.S. infection rate of 20%, according to an updated analysis prepared by Wakely Consulting Group on behalf of America’s Health Insurance Plans. The actuarial firm reduced the assumed rates of hospitalization and raised the estimated cost of a hospital admission based on new COVID-19 costs and utilization data. Factoring in the effect of care deferred by patients due to the pandemic, Wakely estimated that the net cost of COVID-19, under a 20% infection-rate scenario, would be -$71.0 billion to $13.8 billion for 2020 and 2021 combined.SOURCE: “COVID-19 Cost Scenario Modeling: Treatment, Estimating the Cost of COVID-19 Treatment for U.S. Private Insurer Providers,” America’s Health Insurance Plans. Visit https://bit.ly/2MJDoCI. AIS's Directory of Health Plans Datapoint: Blues Plans Enroll Nearly Half of Group Risk Market June 18, 2020 Nearly half (46.6%) of the national group commercial risk insurance market is enrolled in a Blue Cross and Blue Shield affiliate plan. Of the 26.7 million group risk lives enrolled in a Blues plan, 20.7% are Anthem, Inc. members. Nearly half (46.6%) of the national group commercial risk insurance market is enrolled in a Blue Cross and Blue Shield affiliate plan. Of the 26.7 million group risk lives enrolled in a Blues plan, 20.7% are Anthem, Inc. members.Source: AIS s Directory of Health Plans

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