News Briefs: Trump Revives ACA Repeal Talk

Former President and current Republican presidential candidate Donald Trump posted on TruthSocial on Nov. 25 that he is “seriously looking at alternatives” to the Affordable Care Act. He added that the failure to overturn the ACA during his presidency “was a low point for the Republican Party, but we should never give up!” Following Trump’s comments, Citi analyst Jason Cassorla wrote in a note to clients that “we got the sense that the Trump headline didn’t have as much of a dampening impact in comparison to the headlines from back in 2017 when the repeal/replace rhetoric was in full swing and Republicans offered alternative such as block grants and other considerations.” Cassorla added that “as the 2024 election rhetoric heats up, we remain watchful of any momentum change on this front.”

CVS Health Corp.-owned Aetna has reversed course on a previously announced telehealth coverage change, Politico reported. The insurer had planned on ending virtual coverage for intensive outpatient and partial hospitalization program care on Dec. 1, but an Aetna spokesperson told Politico that Aetna would no longer go through with that decision. Groups such as the American Society of Addiction Medicine and the Consortium Representing Eating Disorders Care raised concerns about the proposed change.


Nurse Practitioners, Urgent Care Take Center Stage as Patient Trends Shift

Fewer people with employment-based health plans visited primary care practices, while more have turned to telemedicine and urgent care clinics since the COVID-19 pandemic, according to a report published by the Employee Benefit Research Institute.

Using claims data from 2013 to 2021, researchers found that primary care office visits at a family/general practice, internal medicine practice or with a medical doctor dropped during that time. The share of visits with a nurse practitioner, however, increased significantly, from 4% in 2013 to 16% in 2021.


Decline in Primary Care Use Presents Challenge for Payers

A new report from the Employee Benefit Research Institute (EBRI) confirms that primary care for commercially insured patients is in the midst of a significant transformation. In a study of claims data from 2013 to 2021, EBRI found that fewer patients have a primary care practitioner (PCP), more non-physician practitioners deliver primary care than ever, and sites of care are changing. And the author of the report says he believes the COVID-19 pandemic accelerated the shift.

EBRI’s findings are a mixed bag for payers. On the one hand, the report confirms that the size of the workforce able to deliver primary care is likely growing, and more patients may have better access to a variety of primary care options: 95-97% of all primary care visits were in an office setting prior to 2020, but that share declined to 86% in 2020. Seven to eight percent of primary care visits went to telemedicine that year and 3-4% went to urgent care clinics. However, the report also found that primary care costs have not gone down despite broader access.


Senate Could Make Medicare Telehealth Rules Permanent

The U.S. Senate Finance Committee seems poised to take up legislation that would make permanent the significant, pandemic-era reforms to Medicare telehealth rules, including rules governing site of care origination and audio-only telehealth encounters, which are otherwise set to expire at the end of next year. Medicare Advantage plan and provider trade groups back the legislation and have pushed for telehealth reforms to be permanent when they were up for renewal in previous legislative cycles.

Emergency reforms to Medicare reimbursement rules were a key reason that the telehealth industry boomed in recent years. Telehealth was the only option for many types of outpatient care during the early parts of the COVID-19 pandemic, and patients, plans and providers became accustomed to using telehealth modalities for a wide variety of low-acuity encounters. Those encounters wouldn’t have been reimbursable if it weren’t for temporary, emergency reforms of Medicare telehealth billing rules passed as parts of COVID relief bills and executive orders by Presidents Donald Trump and Joe Biden.


Surveys Show Plan Sponsors Are More Hesitant to Shift Costs to Employees

Two recent surveys from KFF and WTW indicate employer-sponsored health plans are concerned with rising health care costs, driven by factors such as inflation, increased utilization and rising prescription drug expenditures. However, the results suggest that employers are becoming more hesitant to raise health insurance costs for workers at a higher rate than their salary increases.

While the average annual family premiums for employer-sponsored coverage increased 7% this year to $23,968 after not increasing a year ago, according to the KFF Employer Health Benefits Survey, workers’ average wages increased 5.2% and inflation was up by 5.8%. During the past five years, premiums increased 22%, while wages rose by 27% and inflation increased 21%.


Payment Parity Between In-Person Care, Telehealth Persisted in 2021

Private insurers paid providers a similar amount for both evaluation and management and mental health therapy services regardless of whether the care was delivered in person or via telehealth in 2021, according to KFF-Peterson Health System Tracker. The analysis noted that while private insurers and employers were paying about the same amounts for in-person and telehealth in 2020, it was initially unclear whether they would continue to do so in 2021.

Telehealth use for mental health therapy surged with the COVID-19 pandemic: In 2021, more than half of mental health services were delivered via telemedicine, compared to only 1% in 2019. Common mental health therapy claims were paid at similar rates for in-person and telehealth care.


Q&A: How UnitedHealth Got Top Scores in Telehealth Satisfaction

J.D. Power & Co., in the latest edition of its annual survey of consumer satisfaction with telehealth brands, gave UnitedHealthcare, the managed care arm of UnitedHealth Group, the highest marks of any insurer. The company beat out second place Kaiser Permanente and third place Humana Inc. for the top spot.

Insurers have invested heavily in telehealth since the beginning of the COVID-19 pandemic. Starting in 2020, due to pandemic lockdown orders, telehealth became a key care modality in a way that it never had been before. UnitedHealthcare, according to a press release touting the J.D. Power results, offers telehealth products such as 24-hour virtual urgent care without cost sharing and virtual primary care. The health care giant in June made 24-hour virtual care available to 5 million of its fully insured members without cost sharing.


News Briefs: Cigna Tucks In a New Telehealth Asset

The Cigna Group’s Evernorth division said on Oct. 10 that it acquired, which provides “asynchronous care, triage, and health care navigation services.” The new acquisition’s capabilities will be added to Evernorth’s existing telehealth platform, MDLIVE, starting in 2024, the company said. Once the two telehealth offerings are combined, patients seeking care will be guided through a “digital clinical interview” that is then converted into a comprehensive chart note — rather than going immediately to a real-time clinician interaction. A clinician then will review the patient’s responses and offer a diagnosis, care plan or prescription, or the patient will be connected “to a different modality or setting for care when clinically appropriate.” Evernorth noted that “this asynchronous care experience is not based on artificial intelligence or machine learning, and all care decisions are made by clinicians.” Additionally, MDLIVE will expand its chronic care management to include health coaching.


News Briefs: Wyden, Pallone Probe Medicaid Prior Authorization Denials

Prominent Democratic lawmakers have launched an investigation following an HHS Office of Inspector General (OIG) report citing high rates of prior authorization denials by Medicaid managed care organizations. That report, which reviewed 2019 claims data from seven multistate MCOs, found that those insurers denied 12.5% of all prior authorization requests — more than double the denial rate of Medicare Advantage plans that same year. Alarmed by the report, House Energy and Commerce Committee Ranking Member Frank Pallone, Jr. (D-N.J.) and Senate Finance Committee Chair Ron Wyden (D-Ore.) said they sent letters seeking information about prior authorization practices to CVS Health Corp.’s Aetna, AmeriHealth Caritas, CareSource, Centene Corp., Elevance Health, Inc., Molina Healthcare, Inc., and UnitedHealthcare. Among other questions, the lawmakers want “a description of all algorithms, including machine learning and artificial intelligence algorithms” that the companies use when considering prior authorization requests.


Researchers Take Closer Look at Virtual Mental Health Care Boom

Now that the COVID-19 public health emergency has ended, the health care system — including insurers — are grappling with how to proceed in the “new normal” amid shifted habits and utilization patterns. To that end, two new studies offer insights into the implications of patients’ growing use of telehealth for mental health care services.

“The COVID-19 pandemic has caused massive amounts of changes in health care delivery, but then also in terms of how individuals are dealing with the pandemic. There’s been extensive research about how anxiety has increased or [how] other mental health disorders have increased,” observes Jonathan Cantor, Ph.D., a policy researcher at RAND Corp. With that in mind, Cantor and his fellow researchers sought to build on a previous study and measure how both telehealth and in-person mental health utilization and spending has changed from 2019 to 2022.