COVID

Report Examines Utilization, Spending Growth of U.S. Health Care Services

By the end of the third year of the COVID-19 pandemic, health services utilization had returned to their pre-pandemic levels overall, but some shifts have occurred. That’s just one of the findings of the IQVIA Institute for Human Data Science’s The Use of Medicines in the U.S. 2023: Usage and Spending Trends and Outlook to 2027 recently released report. And while spending on medications will continue to grow, driven by new oncology drugs, traditional areas of growth such as immunology and diabetes will instead help to slow that growth.

Since the beginning of the COVID-19 pandemic, the institute has tracked patient visits, including both telehealth and in-person ones; screening and diagnostic tests; elective procedures; and new prescriptions for its IQVIA Health Services Utilization Index. Speaking at a May 18 webinar on the report’s findings, Michael Kleinrock, research director for the IQVIA Institute for Human Data Science, explained that overall, those services have returned to 100% of pre-pandemic levels as of the fourth quarter of 2022. However, some shifts among the four elements have occurred.

0 Comments
© 2024 MMIT

Retail Clinic Volume Boomed During Pandemic — and Could Stay High

According to a new report, retail clinic claims have boomed since the onset of the COVID-19 pandemic — and heavy utilization seems like it’s here to stay. Experts tell AIS Health, a division of MMIT, that retail clinics can help improve access and convenience for patients, but they also caution that retail clinics aren’t a substitute for high-quality primary care and could induce demand for low-value encounters.

The report, prepared by health care consultancy Definitive Healthcare LLC, found that retail clinic claim volume increased by 200% between 2017 and 2022, according to information sourced from the firm’s proprietary all-payer claims database. During the same period, urgent care claims increased by 70%, emergency room claims decreased by 1%, and primary care physician claims decreased by 13%.

0 Comments
© 2024 MMIT

News Briefs: Senate Panel Advances PBM Reform Bill

Following a hearing on insulin costs in which senators from both political parties grilled PBM executives, the Senate Health, Education, Labor and Pensions (HELP) Committee approved the Pharmacy Benefit Manager Reform Act of 2023 (S. 1339). The legislation would ban spread pricing, introduce a host of transparency requirements, and compel PBMs to pass on rebates and fees they collect to their health plan clients, Pink Sheet reported. However, HELP Committee Chairman Bernie Sanders (I-Vt.) would not allow a vote on an amendment that would prohibit PBMs from charging administrative fees based on a percentage of a drug’s list price, as that amendment did not yet have a Congressional Budget Office score. The measure passed on an 18-3 vote with Sen. Rand Paul (R-Ky.), Sen. Mitt Romney (R-Utah) and Sen. Tommy Tuberville (R-Ala.) voting no.

0 Comments
© 2024 MMIT

MA Insurers Tap Into ‘Tech-Savvy’ Seniors for Marketing, Wellness and More

As marketing experts from regional Medicare Advantage plans and their strategic partners shared success stories from the recent Medicare Annual Election Period and their year-round member engagement campaigns at the 14th Annual Medicare Market Innovations Forum, there was one commonly recurring theme: Today’s MA beneficiaries are increasingly embracing technology for everything from conducting AEP research to maintaining a healthy lifestyle.

In his experience working with digital marketing agency Amsive, Dan Paladino noted that Medicare consumers are relying on digital tools to research their coverage options “early and often” and that clients have experienced a surge in digital use “across many channels” this past AEP.

0 Comments
© 2024 MMIT

2023 AEP May Dictate Post-COVID Marketing, Benefit Design Strategies

Since the conclusion of the 2023 Medicare Annual Election Period (AEP), several common threads have emerged from industry reports, Medicare Advantage insurers and marketing experts. These include a slow start to the AEP, a higher rate of switching among MA enrollees, increased use of digital channels, and member confusion or frustration with certain benefits. These observations and other data may help MA insurers and their marketing partners predict future member movement and influence strategy when it comes to both marketing and benefit design.

While the midterm elections certainly created a distraction, inflation and economic concerns may have created a drag in signups, suggested Dan Paladino, vice president of healthcare client experience with Amsive, while speaking at the 14th Annual Medicare Market Innovations Forum, held March 27-29 in Orlando. At the same time, the digital marketing agency observed more people using digital tools to conduct their research about coverage, such as online educational videos and Google search. “When that happens, they’re not picking up the phone and calling as early as we would probably like and I think some of our clients would like,” said Paladino, during a panel discussion moderated by AIS Health.

0 Comments
© 2024 MMIT

Though Remote Patient Monitoring Use Spikes, Barriers to Uptake Still Exist

The use of remote patient monitoring skyrocketed during the COVID-19 public health emergency, with RPM claims volume jumping by 1,294% from January 2019 to November 2022, according to a report released by Definitive Healthcare.

Since 2018, CMS added five new reimbursement codes for RPM services, and introduced five codes related to remote therapeutic monitoring in 2022. By November 2022, RPM claims volumes were already 27% higher than they were during 2021.

Internal medicine physicians were more likely to use RPM, with 28.7% of their procedure claims related to RPM. Cardiological and family practice providers ranked second and third at 21.3% and 19.4%. An analysis of diagnosis categories suggested similar trends. Essential hypertension saw the highest share of RPM-related claims at 51.0%, followed by diabetes mellitus with complications (10.4%) and diabetes mellitus without complications (6.4%).

0 Comments
© 2024 MMIT

Remote Monitoring Faces Coding Challenges After Public Health Emergency Ends

Federal remote monitoring regulations tied to the COVID public health emergency (PHE) are expiring soon, and insurers and providers must make sure that remote monitoring is being used effectively and in compliance with permanent regulations. Health care experts say that payers and providers have an opportunity to improve clinical outcomes and increase value by applying pandemic-era lessons learned and best practices to ongoing remote monitoring-assisted care. 

Remote patient monitoring became a vital tool for practitioners during the COVID-19 pandemic’s darkest days. Hospitals were overwhelmed and, in many places, barred from providing elective services, creating an urgent need for “hospital-at-home” care. The Biden and Trump administrations facilitated expanded use of remote monitoring technologies through emergency regulations tied to the duration of the PHE, but it is set to end on May 11. In particular, hundreds of emergency use authorizations (EUAs) from the FDA will expire unless they have undergone a review process. Going forward, some reimbursement codes set up by CMS during the pandemic will be phased out, and others will carry on until the agency can set up permanent protocols.  

0 Comments
© 2024 MMIT

Hospital Finances Begin to Stabilize

Hospital margins are beginning to stabilize, with razor-thin margins likely becoming the new normal in the near future, according to Kaufman Hall’s latest National Flash Hospital Report. Based on data from more than 900 hospitals, the report found that hospitals’ median operating margins in February went down slightly at -1.1% from the previous month. Outpatient care is driving revenues, as patients continued to seek care away from inpatient settings due to the pandemic. Meanwhile, inflation and pricing pressures are leading to significant cost growth in supplies and services. Labor expenses, which shot up over the last three years, appeared to be holding steady.

0 Comments
© 2024 MMIT

Highmark Pilots Disease-Tracking Tech Program to Help Members Avoid Illness

Although spring is just around the corner, many families are still reeling from an autumn and winter season that served up a severe onslaught of respiratory syncytial virus (RSV) and influenza cases. But also starting last fall, select members of Highmark Inc. health plans have been given access to a tool that helps them mitigate their risk: a “local illness alert” program that offers regular, data-driven reports about what’s going around in their area.

The insurer and the company Kinsa, which developed the tool, tell AIS Health, a division of MMIT, that there is already evidence that the pilot program is driving behavioral changes among members, such as avoiding crowded indoor spaces when illness levels are high. And if final results from the pilot also look promising, Highmark will expand the program to more members — possibly spurring other insurers to do the same.

0 Comments
© 2024 MMIT

Specialty Pharmacies Can Provide Support for Synagis Treatment

Following a severe season of respiratory syncytial virus (RSV) in the U.S., several companies have revealed that they have promising vaccine candidates for various patient populations in the late-stage clinical trial pipeline. The FDA could approve some of them as early as this year, for what is estimated to be a market worth more than $10 billion. Currently, only one agent has FDA approval for RSV prevention, and one specialty pharmacy recently shared with AIS Health, a division of MMIT, how it manages that treatment and members taking it.

The CDC estimates that children younger than 5 years old account for more than 57,000 hospitalizations and about 100 to 500 deaths per year. Older adults experience approximately 177,000 hospitalizations and 14,000 deaths annually, but no FDA-approved treatments indicated for this population are available.

0 Comments
© 2024 MMIT