Although overall customer satisfaction rankings improved year over year in the J.D. Power 2024 U.S. Commercial Member Health Plan Study, nearly all evaluated health plans struggled to provide a high-quality digital customer experience. Indeed, one perennially high-performing plan admits that it, too, has been striving to solve the digital-experience puzzle — but it hopes that a new affiliation agreement will help by adding much-needed scale and access to capital.

This year’s J.D. Power survey measured satisfaction among 29,188 members of 147 group and individual health plans in 22 regions throughout the U.S. from January to April 2024. Plans are scored based on performance in eight core dimensions: “able to get health services how/when I want,” “digital channels,” “ease of doing business," “helps save time and money,” “people,” “product/coverage offerings,” “resolving problems or complaints” and “trust.”

Amid an ongoing mental health crisis that has seen a near 40% increase in patients grappling with mental health conditions since 2020, Centene Corp.’s WellCare of Kentucky launched a pilot program to address two conditions — panic attacks and post-traumatic stress disorder (PTSD) — that are often overlooked.

Working with digital therapeutics company Freespira Inc., the pilot program takes an innovative approach to managing conditions at home with supportive technology and personalized coaching. AIS Health, a division of MMIT, connected with leaders of the two organizations, Timothy Houchin, M.D., a board-certified adult, child and forensic psychiatrist and senior medical director for WellCare Kentucky, and Joseph Perekupka, CEO of Freespira, to discuss the collaboration and learn about the early outcomes.

Emerging technologies such as artificial intelligence (AI) are being incorporated into numerous processes within the health care system with an eye on improving a wide range of results. But rather than applying them across the board, a balance must be struck between what tasks are best suited for automation and what work best when provided with a human touch.

When it comes to patient onboarding, for instance, automated solutions may help fulfill certain requirements quickly, allowing patients to start needed therapies soon. But adherence to those treatments may be better achieved with a human touch that can help personalize approaches.

Taking a look at the overall state of Medicaid managed care, KFF earlier this month compiled data from prior years of its surveys and analyses to identify notable trends. About 75% of all Medicaid beneficiaries are enrolled in risk-based managed care — with that percentage set to grow as Oklahoma transitions away from fee-for-service (FFS) Medicaid — and most states spend at least 40% of total Medicaid dollars on payments to MCOs. KFF noted that spending could increase as states shift higher-cost, higher-need beneficiaries, such as disabled individuals and adults aged 65 and older, into managed care. Moreover, most states (32 states including Washington, D.C.) with managed care carve in their pharmacy benefits to MCO contracts, observed KFF.

As CMS continues efforts to advance health equity, the agency on May 2 released its annual report on disparities in the Medicare Advantage program based on race, ethnicity and sex. Racial and ethnic minorities are consistently more likely to enroll in Medicare Advantage versus the traditional, fee-for-service Medicare program. The 2024 report, released by the CMS Office of Minority Health in partnership with The RAND Corp., examined patient experience measures based on responses to the 2023 Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey, as well as clinical care measures based on the Healthcare Effectiveness Data and Information Set (HEDIS) that is collected from administrative data and patients’ medical records, reflecting care received in 2022.

Amgen Inc. will discontinue the Repatha (evolocumab) Pushtronex system, an on-body infusor, on June 30, the company said April 12. Certain patients, however, may need to remain on that system, and the manufacturer says it will maintain inventory of it to meet their needs.

In addition to the 420 mg/3.5 mL single-dose Pushtronex, Repatha is available as a 140 mg/mL single-dose SureClick autoinjector and a 140 mg/mL single-dose prefilled syringe. The company is urging users to transition to the SureClick because it plans to discontinue the prefilled syringe in mid-2025.

PBMs and health plans are increasingly relying on pharmacists to manage their members’ medication costs and improve adherence, particularly among marginalized groups who have often been overlooked, according to speakers at the third annual Pharmacoequity Conference, held May 3 at the University of Pittsburgh. The panelists also said pharmacists adopting a so-called “cost-plus” model can help bring more transparency to drug pricing, make medications more affordable, and help people become healthier and save payers money.

The term “pharmacoequity” was popularized in 2021 by Utibe Essien, M.D., an internal medicine physician and former professor at the University of Pittsburgh who is now at the University of California, Los Angeles. Essien has defined pharmacoequity as “equity in access to pharmacotherapies or ensuring that all patients, regardless of race and ethnicity, socioeconomic status, or availability of resources, have access to the highest quality of pharmacotherapy required to manage their health conditions.”

Chorus Community Health Plans (CCHP) saw significant savings after partnering with telenutrition company Foodsmart, according to a study released by the insurer and company on April 25. CCHP president Mark Rakowski tells AIS Health, a division of MMIT, that the results indicate payers can benefit financially by providing members access to dietitians and tips to improve their eating habits.

The study matched more than 3,000 CCHP members who used Foodsmart with a control group. After one year of enrollment in the program, the Foodsmart cohort achieved an average $33 per member per month (PMPM) in net savings. CCHP, a Wisconsin-based insurer, saw $32 PMPM savings among the 2,986 Medicaid beneficiaries in the study and $45 PMPM among the 176 Affordable Care Act exchange enrollees who used Foodsmart.

States and the federal government have taken steps in recent years to increase access to medications to treat opioid use disorder (OUD), such as allowing prescribing via telehealth and easing other restrictions for providers. However, some of those policies are set to expire in the coming months and more needs to be done to ensure patients receive the much-needed treatments, health policy experts tell AIS Health, a division of MMIT.

A KFF analysis found a 24% increase from 2019 to 2022 in the dispensing of buprenorphine, one of three FDA-approved medications for OUD. A separate KFF report published last month showed that 63% of Medicaid enrollees with an OUD diagnosis received medication treatment in 2020.

Data sharing and staff contacts are the keys to improving collaboration between Medicaid managed care organizations and public health departments, according to California officials and plan staffers. Leaders from managed care plans say that close collaboration improves outcomes for high-needs populations who struggle with one or more social barriers to health.

“When you're looking at claims data, we're obviously not going to see a claim for homelessness. We’re not going to be able to capture that. But when we take our data and bump it against data that's available to some of the public health jurisdictions, and we find out that some of our members are facing housing instability, then that also gives us the ability to understand that maybe their health outcomes are directly being affected by these social determinants of health,” said Nishtha Patel, manager of care transformation at Inland Empire Health Plan (IEHP), during a March 21 Manatt LLP webinar. “No matter what we do intervention-wise, if we're not addressing those, their health outcomes are not ever going to improve.”