Data & Analytics

Insurers Applaud New CMMI Push for Risk-Based Contracting

The Biden administration has revamped the strategy of the Center for Medicare and Medicaid Innovation: In the coming years, CMMI will focus on consolidating models, increasing insurer and provider participation in models, and advancing equity — and it aims to have most Medicare and Medicaid members served by value-based payment models by the end of the decade. Health care insiders applauded the new direction, saying the “strategy refresh” should bring the agency closer to its original mission and make its budget go further.

CMMI has tested more than 50 models since its creation in 2010 as part of the Affordable Care Act. Experts outside the agency have criticized the proliferation of models: The Medicare Payment Advisory Commission (MedPAC) recommended in June that HHS “should implement a more harmonized portfolio of fewer alternative payment models that are designed to work together to support the strategic objectives of reducing spending and improving quality.”

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MCO Stock Performance, October 2021

MCO stock performance in October 2021

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Executive Compensation Data for Blue Cross and Blue Shield Affiliates, 2020

See a full list of director compensation for Presidents and/or CEOs of Blue Cross and Blue Shield Affiliates at https://bit.ly/3oTfcAn, compiled by AIS Health.

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MMIT Reality Check on Type 2 Diabetes (DPP4 and Combo)

A review of market access for type 2 diabetes (DPP4 and combo) treatments shows that under the pharmacy benefit, about 39% of the lives under commercial formularies are covered with utilization management restrictions. Around 21% of the lives under Medicare formularies are not covered for at least one of the drugs.

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SCAN Health Opts to Invest in Medication Adherence Tool

SCAN Health Plan, a California-based Medicare Advantage insurer, is pushing further into the world of virtual drug management with an investment in Arine, a software vendor with a focus on artificial intelligence-backed medical management solutions.

On Oct. 19, SCAN Group, the carrier’s parent company, announced it had taken a minority stake in the vendor, with whom it had a previously established client relationship. The investment in Arine, whose software platform relies on predictive analytics to drive medication adherence, gives SCAN the ability to target specific populations and tailor messages individually to members, including to traditionally underserved populations, according to Binoy Bhansali, corporate vice president of corporate development for SCAN Group.

Smaller PBMs Beat Big Firms in Customer Satisfaction

Plan sponsors’ overall satisfaction with their PBMs increased from 8.0 on a 1-10 scale in 2020 to 8.2 in 2021, according to Pharmaceutical Strategies Group’s 2021 Pharmacy Benefit Manager Customer Satisfaction Report. Based on surveys completed by 291 plan sponsors who provide pharmacy benefits to their employees, the report found that PBMs with 20 million or fewer members tend to have higher satisfaction ratings than larger PBMs. Average satisfaction was highest for PBMs’ opioid management programs, while gene therapy financial protection programs rated the lowest and only 13% of the respondents used such programs. Among PBMs with more than 20 million members, MedImpact scored the highest overall satisfaction rate (8.5).

MMIT Reality Check on Colorectal Cancer

A review of market access for colorectal cancer treatments shows that under the pharmacy benefit, about 53% of the lives under commercial formularies are covered with utilization management restrictions. Around 28% of the lives under Medicare formularies are not covered for at least one of the drugs.

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Employer Plans in 2021: Premiums, Telemedicine Coverage Rise

The average annual premium for employer-sponsored health insurance increased 4% to $7,739 for single coverage and $22,221 for family coverage, respectively, this year, according to the Kaiser Family Foundation 2021 Employer Health Benefits Survey. In recent years, high-deductible plans with a savings option have been gaining popularity. About 22% of firms offered an HDHP/SO and 28% of covered workers were enrolled in such a plan in 2021, representing slight declines compared with previous years. Meanwhile, the COVID-19 pandemic has increased the use of telemedicine, as 95% of firms with 50 or more workers offered telemedicine coverage in their largest health plan, up from 85% last year. In addition, about 65% of firms with 50 or more workers made changes to enhance their telemedicine benefits after the beginning of the pandemic.

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MMIT Reality Check on Cystic Fibrosis

A review of market access for cystic fibrosis treatments shows that under the pharmacy benefit, about 65% of the lives under commercial formularies are covered with utilization management restrictions. Around 32% of the lives under Medicare formularies are not covered for at least one of the drugs.

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