Highmark Tailors ‘Big Blue Box’ to Meet MA Members’ Evolving Needs

In the first year of the COVID-19 pandemic, when many people were having trouble accessing basic personal protective equipment, Highmark Blue Cross Blue Shield began sending out care kits including PPE and other items to support seniors at home. The response from Medicare Advantage members was so positive that what started out as a feel-good gesture has become a full-blown supplemental benefit, and the insurer continues to refine the kits to meet members’ evolving needs and ensure continued satisfaction with the plan.

Starting with plan year 2022, eligible Highmark members were given the option to receive one of 17 condition care kits. Commonly referred to as the “big blue box,” each kit is filled with a variety of items tailored to a specific condition, with a focus on member choice and high quality, speakers from Highmark and its strategic partner RR Donnelley explained during the 14th Annual Medicare Market Innovations Forum, held on March 28 and 29 in Orlando. RR Donnelley, a firm that provides marketing and business communications, commercial printing, and related services, has assisted CVS Health Corp.'s Aetna and Humana Inc. with similar initiatives.


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%).


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.  


Employers’ Desire to Shake Up Benefits Vendors Can Be Opportunity for Insurers

Although U.S. employers already contract with a bevy of health and wellbeing vendors, a recent survey found that nearly nine in 10 are planning to make changes to their vendor partnerships in the next two years — chiefly by adding or enhancing current offerings. As companies do so, health insurers have a critical role to play when it comes to integrating various solutions and helping employees find them, an employee benefits expert says.

Employers’ desire to add and enhance health/wellbeing offerings “doesn’t look like it’s going to stop anytime soon,” says Regina Ihrke, senior director and health, equity and wellbeing leader at WTW. Therefore, large medical benefits carriers “are going to have to continue to be nimble and flexible in who they partner with, and then how they also integrate with other carveout solutions that are out there,” she tells AIS Health, a division of MMIT.


UnitedHealth, Blues Spinoff Lucet Proffer Behavioral Health Care Access Solutions

With two recently debuted product offerings, a pair of health care companies aim to solve a problem that has been thrown into sharp relief during the ongoing pandemic: highly variable — and often inadequate — access to behavioral health care services. Industry observers say that both solutions are likely a response to employer clients seeking increased care access points for their covered workers.

One of the announcements comes from UnitedHealth Group, which in January rolled out a virtual behavioral health coaching program that’s available to UnitedHealthcare commercial plan members with mild depression, stress and anxiety. Through the Optum-administered program, 5 million eligible fully insured plan members can access support “through digital modules and 1:1 video or telephonic conferencing and messaging with trained coaches” at no additional cost. Self-insured employers may also purchase the virtual behavioral health coaching program for their employees, UnitedHealth said.


Even With Split Congress, Some Experts Predict Heightened Health Care Oversight

Although there’s a divided Congress this year — with Republicans controlling the House and Democrats in charge of the Senate — there are still a variety of health care policy issues that federal and state legislators alike have in their crosshairs, experts said during a recent webinar hosted by the Alliance for Health Policy. And some of those agenda items could be of considerable interest to health insurance companies.

Paul Edattel, principal of Todd Strategy Group, LLC, a federal government affairs firm, said he expects the newly Republican-controlled House to zero in on budgetary issues. “Budgetary issues are top-of-mind for House Republicans and some Senate Republicans,” he remarked during the Jan. 25 webinar. “Things like the operating budget for the Department of Health and Human Services...will be under really heightened scrutiny relative to prior Congresses.”


Federal Funding Law Introduces New Compliance Challenges in Telehealth, Mental Health, Medicaid

The Consolidated Appropriations Act, 2023 (2023 CAA) — the latest edition of the annual bill that funds the federal government — includes notable new policies that will touch on telehealth, behavioral health and Medicaid enrollment, among other areas. According to policy experts, because of the law, health plans have a great deal of new compliance requirements to manage in plan year 2023 and beyond.

Congress discussed notable reforms to telehealth and mental health care over the course of 2022, and the 2023 CAA includes permanent changes to the latter — and temporary extensions of pandemic-era policies for the former. Meanwhile, the law sets out requirements for states and managed care organizations disenrolling Medicaid members as part of the return of Medicaid eligibility redeterminations.


Becerra Touts Mental Health, Addiction Treatment Funding; Calls for Telehealth Reform

In remarks at a Dec. 13 Brookings Institution event, HHS Secretary Xavier Becerra touted the rollout of the 988 mental health assistance line and the Biden administration’s push for more mental health funding. In addition to promoting the administration’s victories, Becerra also reiterated the urgent need to recruit and retain burnt out practitioners. And he called on Congress to make pandemic-related emergency telehealth flexibilities permanent.

The relatively low amount of available mental health care providers, particularly for youth and in rural areas, is a stubborn barrier to care that has frustrated health insurers that need to meet network adequacy requirements.


Federal Watchdogs Raise Telehealth Fraud Concerns

The pandemic-induced telehealth revolution expanded access to an exciting new modality of care delivery, but a new report from federal watchdogs found that federal payers face new, telehealth-derived challenges in stopping waste, fraud and abuse. Those findings mean the commercial carriers that administer certain federally underwritten health insurance plans have a new auditing and accountability challenge as telehealth settles in as a permanent part of the care delivery landscape.

The report, prepared by six Offices of Inspectors General (OIGs) from HHS, the Dept. of Justice, Dept. of Defense, Dept. of Veterans Affairs (VA), Dept. of Labor and Office of Personnel Management (OPM), found that “while the expansion of telehealth has been essential to maintaining individuals’ access to care, there have been concerns about the potential for fraud, waste, and abuse associated with expanded telehealth services.”


Telehealth, Mental Health Care Provisions Could Pass Congress in Lame Duck Session

With midterm elections over, the soon-to-end 117th Congress will turn its attention to the biannual lame-duck session, and D.C. insiders say that health care items like reforms to telehealth and behavioral health care policies could be on the agenda. Meanwhile, the new Republican majority in the House of Representatives will soon hold inter-caucus votes on leadership roles, including Speaker of the House chairs — and those polls could dictate what is possible in health care policy when the 118th Congress begins work.

The lame-duck session is the final gathering of an outgoing Congress, a last hurrah for members who have been voted out or will retire. Such sessions revolve mainly around prosaic government funding bills, which must be passed in order to keep agencies running in the new year. They also offer a chance for urgent policy considerations to advance; additional COVID-19 funding and pandemic preparedness legislation could get a hearing during this year's lame duck, D.C. insiders tell AIS Health, a division of MMIT. A lame duck session will typically pass an omnibus spending bill, which D.C. wags joke is a "Christmas tree" — in many years, nearly every member gets to decorate the end-of-year package with their own pet amendment.