AHIP Experts Turn an Eye to the Post-Pandemic World – Managed Healthcare Executive

In 2022, AHIP is looking ahead to a post-pandemic world and the policies and solutions that will improve affordable access to care, explained Matt Eyles, president and CEO of AHIP, during a webinar on the state of the industry.

The key priorities of AHIP, the national trade association of the health insurance industry, include addressing the underlying cost drivers of care, ending pharmaceutical monopolies and patent gaming, improving health equity, developing a clear vision of a post-pandemic world that maintains coverage gains and supporting a competitive, free market, Eyles said.

Eyles was joined by a panel of AHIP experts: Kate Berry, senior vice president of clinical innovation; Mark Hamelburg, senior vice president of federal programs; and Danielle Lloyd, senior vice president of private market innovations and quality initiatives.

According to Berry, chief medical officers (CMOs) are focused on 3 things when looking forward to the post-pandemic world. The first is the use of telehealth, which has seen tremendous growth during the pandemic because of new flexibilities.

“The CMOs are really thinking about how do we integrate telehealth with the healthcare system more broadly so that people get the right care at the right time in the best setting, whether that’s virtual or in person,” she said. “And actually, the ability to integrate telehealth with the overall system is much more likely to happen in value-based payment arrangements.”

The second focus is on value-based care because the providers who were operating in fee for service had a harder time adapting during the pandemic. These providers didn’t have enough revenue to leverage telehealth, Berry explained.

Finally, CMOs are focused on getting people caught up on the preventive services and vaccinations they may have missed during the pandemic. Berry said that 37 million vaccines weren’t delivered to adults and adolescents since the start of the pandemic. In addition to vaccinations, they are looking to encourage more use of cancer screenings, which also declined significantly during the first year of the pandemic.

In the Medicaid and Medicare space, there are concerns that when the public health emergency (PHE) ends, it could trigger significant benefit changes in both programs that were enacted due to COVID-19 relief laws and regulatory flexibility.

For instance, in Medicare, enrollees have paid no cost sharing for COVID-19 testing and related services, Hamelburg explained. Medicaid had a similar requirement ensuring that all states provide coverage without cost sharing for the COVID-19 vaccine, testing and treatment. However, these sorts of waivers are tied to the end of the PHE.

Also, early relief legislation increased federal Medicaid matching funds for states as long as the states maintained Medicaid eligibility for beneficiaries through the end of the PHE. During the pandemic, states have not done their regular eligibility reviews, nor have the rolled off people who no longer qualify.

“So now we’ve gone through almost two years, and incomes and other conditions have changed, and some people are no longer going to be eligible,” Hamelburg said. “In fact, we now have more than 80 million people on Medicaid and CHIP. And there have been estimates that millions could end up losing coverage when this process kicks in.”

As telehealth has exploded during the pandemic, so has general use of technology, said Lloyd. In addition to generating huge amounts of data that data is being shared more commonly with partners to develop solutions that improve quality, make care more equitable, and made care more affordable. However, there are still bad actors out there and they are getting more sophisticated.

While AHIP is calling for consumers to have easier access to their information, there is also the need to tighten security. Right now, the Health Insurance Portability and Accountability Act only applies to plans, providers and some of their business partners, but when the information moves outside of those organizations, it is largely ungoverned.

“… consumers shouldn’t have to make a choice between easy access to the information and it being held private and secure,” Lloyd said.

In addition to access and security, another change related to data that needs to be made is greater collection of demographic data for things like race, ethnicity, and disability status. Collecting this data can improve quality ensure that health insurance providers are working to reduce disparities in care, she said.

In the last year, there have been a handful of innovative drugs including the COVID-19 vaccines and Aduhelm (aducanumab), the controversial Alzheimer’s disease drug. The panelists noted that in the case of Aduhelm, the evidence of efficacy was minimal, the adverse effects were large and the costs were substantial, all of which were considered by health plan CMOs and CMS.

Hamelburg added that, prior to coverage decisions, CMS actuaries had initially estimated that Part B premiums for 2022 would have the largest increase in the program’s history because of the contingent costs of Aduhelm.

The approval decision of Aduhelm has “flow-through implications not just for people with this horrible disease, but for all Medicare beneficiaries,” he said.