COVID

Open enrollment for 2023 Affordable Care Act exchange plans starts on November 1, with the Biden administration hoping to continue the enrollment growth seen over the past few years. As of early 2022, about 16.9 million people were enrolled in the individual market, a 20% increase from early 2020, according to a recent Kaiser Family Foundation analysis.

The growth is largely driven by enhanced subsidies enacted by American Rescue Plan Act (ARPA) and extended through 2025 by the Inflation Reduction Act. Overall, about 75% of individual market enrollees are now subsidized. The study estimated that about 3 million people will buy unsubsidized coverage off- marketplace during 2023 open enrollment, a decrease compared to prior years.

At some point in the next year, it’s likely that Medicaid eligibility redeterminations will resume — a process that will be kicked off when the Biden administration declares an end to the COVID-19 public health emergency (PHE). Medicaid has hit record-high enrollment this year, meaning states and managed care organizations will have to contact more people than they ever have before in a short period of time; meanwhile, MCOs will also have to deal with looming cuts to reimbursement and rising provider rates.

Margins for MCOs seem likely to shrink. Provider rate increases are coming soon, though it’s likely that they will vary in timing and scope depending on market and contract cycles. However, the pricing effects of workforce shortages and inflation will impact every plan and provider, sources previously told AIS Health.

Since the COVID-19 pandemic began, the federal government has spent tens of billions of dollars purchasing vaccines, treatments and tests and providing them for free to the public. Congress has also passed legislation ensuring private and public payers cover those countermeasures for as long as the public health emergency (PHE) is in place.

However, that may soon be ending as Congress has yet to authorize additional COVID-specific funding and the PHE is likely to expire sometime next year. That could lead to questions about access, pricing and insurance coverage, according to panelists who spoke during a Kaiser Family Foundation (KFF) webinar on Oct. 19.

Amid a global pandemic and inflation challenges, CEOs surveyed for a recent report expressed confidence in the three-year outlook for their companies and the economy. While many respondents from the life sciences sector said they expect a recession will occur within the next year, almost the same amount said their growth prospects are strong, according to the KPMG 2022 CEO Outlook. Those CEOs also expressed a growing interest in environmental, social, and governance (ESG); and diversity, equity and inclusion (DEI) initiatives.

For the eighth edition of the report, KPMG spoke with 1,325 CEOs from 11 markets around the globe and 11 key industry sectors, including life sciences, between July 12 and Aug. 24. The company shared the responses from the life sciences CEOs on their three-year outlook with AIS Health, a division of MMIT.

With the updated bivalent COVID-19 boosters available, federal investment in vaccination campaigns could save thousands of people from hospitalizations and deaths and avert billions of dollars in medical costs, The Commonwealth Fund predicted.

The study projected three scenarios: a baseline scenario where vaccination rates remain at the average rate in August 2022 — about 28 doses per 100,000 people per day — from September 2022 to March 2023. In the first vaccination campaign scenario, COVID booster uptake by the end of 2022 reaches the same level as influenza vaccination coverage seen in 2020–2021, and then remains at the baseline rate until the end of March 2023. This could prevent more than 75,000 deaths and generate $44 billion in medical cost savings over the course of the next six months, compared with the baseline scenario.

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.

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. 

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.

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.

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.