News Briefs

Priority Health, a subsidiary of integrated health system Spectrum Health and Michigan’s second-largest payer, announced a new suite of incentives for provider agreements that are intended to improve social determinants of health, while Pennsylvania-based payer Health Partners Plans (HPP) announced plans to expand its own SDOH mitigation program. A Priority Health press release claims that the insurer is the first in Michigan to offer such incentives to network members. “We understand that to effectively manage the health and wellness of a patient population, you need to look outside of the clinic walls. Being able to reward providers who are identifying these specific needs based on social factors is a step in the right direction,” said Mike Jasperson, senior vice president of provider network strategy at Priority Health. “Having access to this type of data will eventually allow for both providers and payers to increase the quality of care that is delivered, reduce total cost of care for members, and directly address the needs of vulnerable populations.” Meanwhile, HPP unveiled plans for an “SDoH Regional Council,” which will convene community stakeholders to address social challenges. Read more at https://bwnews.pr/3lvS6N7 and https://bit.ly/3nyODyX.

Based on oral arguments before the U.S. Supreme Court, legal experts say that PBMs have a good chance of winning repeal of a 2015 Arkansas law that strictly regulates how drug benefits are managed. The case, Rutledge v. Pharmaceutical Care Management Association, centers on whether a law known as Act 900 is preempted by the Employee Retirement Income Security Act of 1974 (ERISA), which bars states from enacting laws that “relate to any employee benefit plan” covered by the federal law. “My impression was that Arkansas got the toughest questions from the bench but was bolstered by the Trump administration’s response,” Katie Keith, a health care attorney and faculty member at Georgetown University’s Center on Health Insurance Reforms, tells AIS Health. “And it certainly seems like the Justices are considering the broader impact of their ruling, on PBMs specifically and on ERISA plans and state regulation more broadly.” Read more at https://bit.ly/2SADYpg.

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AIS Health Staff

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