COVID

Spike in Remote Patient Monitoring During Pandemic Is Driven by a Fraction of Providers

Billing for remote patient monitoring (RPM) jumped by more than four times during the first year of the pandemic, according to a recent Health Affairs study. The increase was mostly driven by a handful of primary care providers. Using medical claims data from the OptumLabs Data Warehouse collected between Jan. 1, 2019 to March 31, 2021, the researchers found that there were 19,762 general RPM claims in March 2021, compared with 4,355 claims in February 2020. Continuous glucose monitoring, however, only saw a slight increase over the same period of time.

In addition, RPM claims were highly concentrated. The top 0.1% of primary care providers — identified by the researchers as “high-volume provider group” — accounted for 69% of all general RPM claims.

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Interstate Telehealth Licensure Improved Access to Care During Pandemic 

During the early stages of the COVID-19 pandemic, states moved to temporarily allow health care providers licensed in other states to practice in their own jurisdictions with the goal of addressing staffing shortages and increasing access to telehealth. Many in the managed care industry have hoped that these short-term reforms would become permanent, with the goal of cutting costs and preserving telehealth access, but health policy experts are just beginning to make sense of the impact interstate licensure had during the early pandemic. 

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Health Spending Per Capita Is Expected to Grow Moderately Over Time

The COVID-19 pandemic significantly impacted health spending in 2020 and its long-term health effects are adding more uncertainties looking ahead, according to the Peterson-Kaiser Family Foundation.

Health spending per capita jumped at a rate of 9.3% in 2020 from the prior year, mainly caused by the COVID-related public health activities. Meanwhile, out-of-pocket health spending declined 4.0% per capita in 2020, as a result of delayed or forgone routine care during the early months of the pandemic. Looking forward, CMS expects health spending and prescription drug spending to grow moderately through 2030, but the new COVID variants and treatments add a great deal of uncertainties to the coming years. Out-of-pocket health spending growth was expected to rebound starting in 2021 and average at a rate of 3.5% for the following seven years.

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Insurance, Retail Segments Help CVS Beat Expectations in Second Quarter

Although many people still associate CVS Health Corp. with its ubiquitous retail pharmacy locations, executives during the company’s second-quarter 2022 earnings call highlighted the Health Care Benefits segment — which houses legacy health insurer Aetna — as one of the firm’s strongest business assets. Meanwhile, the Rhode Island-based company said it’s planning to acquire more care-delivery assets by the end of the year.

During an Aug. 3 conference call to discuss quarterly financial results, CEO Karen Lynch touted the Health Care Benefits segment’s “strong quarter,” noting that the business line saw revenue growth of nearly 11% compared to the prior-year period. The firm’s medical loss ratio (MLR) of 82.9% also improved by 120 basis points year over year, “reflecting medical cost trends that remain modestly favorable to our pricing assumptions,” according to Chief Financial Officer Shawn Guertin.

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New Drug Benefit Design Report Shows Increasing Emphasis on Member Experience

In 2022, the majority of plan sponsors used a drug benefit consultant while designing their drug benefit programs, according to Pharmaceutical Strategies Group’s 2022 “Trends in Drug Benefit Design Report,” sponsored by Rx Savings Solutions. The report, which is based on surveys of 153 individuals representing employers, union/Taft-Hartley plans and health plans that covered an estimated 35.1 million lives, also revealed an increasing focus on member satisfaction.

News Briefs: MCS Advantage Will Pay $4.2M to Settle Kickback Allegations Involving Gift Cards

Medicare Advantage plan operator MCS Advantage, Inc. agreed to pay $4.2 million to resolve False Claims Act allegations that it violated the federal Anti-Kickback Statute (AKS) by offering kickbacks to health care professionals in the form of gift cards. According to the July 1 press release from the U.S. Dept. of Justice, MCS allegedly implemented a gift card incentive program between November 2019 and December 2020, when it distributed 1,703 gift cards to administrative assistants of providers in the aggregate amount of $42,575 to induce them to refer, recommend or arrange for enrollment of 1,646 new Medicare beneficiaries into an MCS plan. The Puerto Rico insurer did not admit liability as part of the settlement agreement. The company voluntarily closed the gift card program in December 2020, which the DOJ and HHS Office of Inspector General took into consideration, according to the press release. “The Settlement highlights the breadth of the AKS, as well as the flexibility that enforcement authorities have in utilizing the AKS as a vehicle to deter behavior deemed to be problematic” and suggest that remuneration to induce referrals of beneficiaries to specific federal health care program plans, along with to specific item or service, may be within the confines of the AKS, the law firm Holland & Knight suggested in a July 11 blog post.

Employers Focus on Affordability, Access in 2023 Benefit Design, Mercer Reports

Over 70% of employers with 500 or more employees are planning to enhance their benefit programs in 2023, with increasing emphasis on health care affordability, work and life balance and women’s reproductive health, according to Mercer’s “Health & Benefit Strategies for 2023 Report.” The report, which is based on surveys of 708 organizations with a focus on the 451 large employers, also found that health benefit strategies are becoming less about reducing health care costs but more about supporting the emotional, physical, social and financial well-being of employees.

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Pandemic’s Long Tail Will Shape 2023 Premiums

Researchers from the American Academy of Actuaries expect the most notable factors in 2023’s health insurance premium rate-setting will be COVID-19 variants, the expiration of enhanced premium subsidies in the individual marketplace, the resumption of Medicaid eligibility redeterminations, inflation and provider labor shortages — a combination of public health, policy and economic factors that represent the long tail of the COVID-19 pandemic.

The impact of COVID-19 is still difficult to model. New variants to the virus and regional outbreaks mean that plan-level analysis is fraught. But the cost of hospitalization and a consistent standard of care mean that plans have a useful base for modeling.

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Plans Are Likely to Treat Paxlovid Like Other Drugs if U.S. Isn’t Paying

With COVID-19 infections surging once again, the Biden administration has stepped up efforts to increase the supply of Paxlovid, the Pfizer Inc. antiviral that garnered emergency use authorization as a therapeutic treatment for the coronavirus. However, increased availability for Paxlovid might end in coming months — Congress has stalled on providing the increased COVID-19 response funding that the administration requested, and experts say health plans are likely to treat the drug like any other if the federal government isn’t picking up the tab for treatments.

The Biden administration has pushed in recent weeks to increase the availability of Paxlovid, free of charge, to COVID-19 patients. On May 26, the White House released a statement touting the rollout of more than 2,500 “test-to-treat” sites where free testing and Paxlovid courses are available, along with 40,000 locations where antivirals are available for patients. The administration also noted that it had “increased the number of people benefiting from oral antivirals in the last seven weeks, from about 27,000 prescriptions filled each week to more than 182,000 last week.”

Plans Are Likely to Treat Paxlovid Like Other Drugs if U.S. Isn’t Paying

With COVID-19 infections surging once again, the Biden administration has stepped up efforts to increase the supply of Paxlovid, the Pfizer Inc. antiviral that garnered emergency use authorization as a therapeutic treatment for the coronavirus. However, increased availability for Paxlovid might end in coming months — Congress has stalled on providing the increased COVID-19 response funding that the administration requested, and experts say health plans are likely to treat the drug like any other if the federal government isn’t picking up the tab for treatments.

The Biden administration has pushed in recent weeks to increase the availability of Paxlovid, free of charge, to COVID-19 patients. On May 26, the White House released a statement touting the rollout of more than 2,500 “test-to-treat” sites where free testing and Paxlovid courses are available, along with 40,000 locations where antivirals are available for patients. The administration also noted that it had “increased the number of people benefiting from oral antivirals in the last seven weeks, from about 27,000 prescriptions filled each week to more than 182,000 last week.”