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Radar On Market Access: Anthem Warns of Greater Commercial Enrollment Drop in Second Half

Posted by Leslie Small on Aug 6, 2020

While Anthem, Inc. has seen less of an enrollment dip in its commercial business than it originally feared when the COVID-19 pandemic and economic recession first took hold, the insurer's executives said during a July 29 earnings conference call that they expect that attrition to accelerate in the coming months as some furloughs become permanent job losses, AIS Health reported.

From March 31 to June 30, Anthem saw enrollment in its commercial and specialty business lines drop by 290,000. "But as you think about unemployment, that was fairly muted," especially when it comes to Anthem’s risk-based business, President and CEO Gail Boudreaux said during the earnings call. She and other Anthem executives attributed that effect to the fact that many companies have thus far furloughed rather than laid off workers, thanks in part to federal stimulus funding.

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Topics: Industry Trends, Data & Analytics, Payer

Trends That Matter for Medicaid MCOs

Posted by Peter Johnson on Jul 30, 2020

Two recent reports found that Medicaid managed care plans now enroll most Medicaid members, help keep costs and premiums low in the markets where they participate, and are competitive with commercial plans at the low end of the individual market in areas including network quality and benefit design, AIS Health reported.

One white paper was prepared by consultancy The Menges Group for America's Health Insurance Plans (AHIP), and the other was authored by researchers at the Robert Wood Johnson Foundation (RWJF) and Urban Institute.
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Topics: Industry Trends, Data & Analytics, Payer

Radar On Market Access: UnitedHealth, Humana Launch Programs for Chronic Conditions

Posted by Jane Anderson on Jul 30, 2020

Both UnitedHealthcare and Humana Inc. are rolling out new disease-specific care management programs aimed at providing patients with the tools they need to help control their chronic conditions, AIS Health reported.

The new initiatives highlight new digital and time-tested interpersonal ways of managing chronic conditions, observers say.

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Topics: Data & Analytics, Payer

Radar On Market Access: Manufacturers, Payers Wait on Federal COVID-19 Vaccine Distribution Plan

Posted by Peter Johnson on Jul 28, 2020

As the many COVID-19 vaccines under development barrel toward clinical trials for safety and efficacy, questions remain about how they will be distributed when they become available, AIS Health reported.

In a hearing held by a subcommittee of the House Energy & Commerce committee, pharmaceutical executives said they would rely on guidance from the Trump administration and the Centers for Disease Control and Prevention (CDC) to distribute vaccine doses.

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Topics: Market Access, Data & Analytics, Provider, Payer

Radar On Market Access: Despite Coronavirus Surge, UnitedHealth Expects Care Utilization to Rebound This Year

Posted by Leslie Small on Jul 23, 2020

With COVID-19 cases and deaths surging in some U.S. states, it has become clear that the nation won't be back to normal anytime soon. Still, the country's largest health insurer is betting that health care utilization, and the costs associated with it, will return to something close to typical levels in the second half of the year, AIS Health reported.

At its lowest point in April, inpatient care volume — including care for COVID-19 patients — was about three quarters less than normal, UnitedHealth Group Chief Financial Officer John Rex said during a July 15 conference call to discuss the company's second-quarter earnings. At that same low point, utilization of outpatient and physician services fell to roughly 60% of normal levels. But in June, UnitedHealth saw inpatient volume recover to nearly 95% of baseline, and as June turned to July, outpatient and physician services were "tracking above 90%," Rex said. "These national trends have continued thus far in July, even as certain states are seeing short-term deferral of services where there are elevated levels of infection and hospitalization," he added.

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Topics: Industry Trends, Data & Analytics, Payer

Radar On Market Access: Trump Admin's COVID-19 Testing Payment Guidance Stirs Debate

Posted by Leslie Small on Jul 21, 2020

Weeks after the Trump administration released guidance saying private health insurers don't have to pay for COVID-19 testing conducted for the purposes of workplace safety or public health surveillance, questions and controversy are still simmering about the implications of that edict, AIS Health reported.

"With COVID-19 cases skyrocketing and our testing capacity nowhere near where it needs to be, it is unacceptable that this Administration's priority seems to be giving insurance companies loopholes instead of getting people the free testing they need," wrote Frank Pallone Jr. (D-N.Y.), Bobby Scott (D-Va.), Richard Neal (D-Mass.), Patty Murray (D-Wash.) and Ron Wyden (D-Ore.) in a recent letter to HHS, the Dept. of Labor and the Treasury Dept.

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Topics: Industry Trends, Data & Analytics, Provider, Payer

Trends That Matter for Racial Disparities in MA Plans

Posted by Lauren Flynn Kelly on Jul 16, 2020

As protests erupt across the U.S. calling for racial justice and police reforms, the COVID-19 pandemic continues to bring to light many of the racial disparities in health care, putting pressure on policymakers and the industry to take a hard look at health and access inequities, AIS Health reported.

Meanwhile, CMS's Office of Minority Research in April released a stratified report highlighting the racial and ethnic differences in health care experiences and care of Medicare Advantage (MA) enrollees. The data showed that black members enrolled in MA plans in 2018 received worse clinical care than white enrollees on 20 out of 44 measures, similar care for 20 and better care for four. And all minority populations reported experiences with care that were either worse than or similar to the experiences reported by white enrollees, including the experience measure for getting appointments and care quickly.
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Topics: Industry Trends, Data & Analytics, Payer

Radar On Market Access: Remdesivir's $3,120 Price Tag Stirs Debate

Posted by Leslie Small on Jul 14, 2020

Gilead Sciences, Inc. recently revealed that for promising COVID-19 treatment remdesivir, it will charge $2,340 for a typical five-day, six-vial treatment course for people covered by U.S. government health programs and $3,120 for those covered by private insurance, AIS Health reported.

In an open letter, Gilead CEO Daniel O'Day argued that Gilead priced remdesivir "well below" its estimated value, considering it can save the U.S. health care system approximately $12,000 per patient by reducing the length of COVID-19 patients’ hospital stays.

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Topics: Market Access, Data & Analytics, Provider, Payer

Radar On Market Access: Reports Show Medicaid MCOs Are 'Dominant,' Increase Affordability

Posted by Peter Johnson on Jul 7, 2020

Two recent reports found that Medicaid managed care plans now enroll most Medicaid members, help keep costs and premiums low in the markets where they participate, and are competitive with commercial plans at the low end of the individual market in areas including network quality and benefit design, AIS Health reported.

One white paper was prepared by consultancy The Menges Group for America's Health Insurance Plans (AHIP), and the other was authored by researchers at the Robert Wood Johnson Foundation (RWJF) and Urban Institute.

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Topics: Industry Trends, Data & Analytics, Payer

Trends That Matter for DMD Therapies

Posted by Angela Maas on Jul 2, 2020

Since 2016, the FDA has approved a handful of therapies to treat Duchenne muscular dystrophy (DMD). But some uncertainty exists over their effectiveness, in addition to concerns about their costs.

When DMD is suspected, a blood test that measures creatine kinase (CK) levels is performed. "CK is an enzyme found in abnormally high levels when muscle is damaged," Mesfin Tegenu, R.Ph., president of PerformRx, LLC., tells AIS Health. "The detection of an elevated CK level leads to molecular genetic testing to confirm a definitive diagnosis of DMD."
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Topics: Industry Trends, Market Access, Data & Analytics