HealthCare Roundtable e-News – April 22, 2024

 

 

Webinar Delayed – Medicare Prescription Payment Plan (MP3) Program

The Impact on Public Sector Health Plans

Webinar | New Date Pending

NOTICE: If you have already registered for this Webinar, we will contact you directly with the new date and time. When we announce the new date, we will re-open the registration. We have delayed the webinar to better prepare for a thorough discussion of this important topic.

Join us for an insightful webinar hosted by the Public Sector HealthCare Roundtable, where we’ll delve into the intricacies of the upcoming Medicare Prescription Payment Plan (MP3) Program. Set to roll out in 2025 under the Inflation Reduction Act, this program promises significant changes in healthcare accessibility and affordability. We’ll explore the fundamental aspects of MP3, including its impact on public sector purchasers with the introduction of the $2000 maximum cap on out-of-pocket costs for prescription drugs.

Top News

House E & C Health Subcommittee Holds Hearing on Legislative Proposals to Support Patient Access to Telehealth Services

The U.S. House of Representatives Energy and Commerce Health Subcommittee held a hearing to discuss legislative proposals to support and improve access to telehealth. Congress extended telehealth flexibilities for Medicare that expire in December, and Committee members discussed benefits and concerns related to further extending or making permanent these flexibilities. In his opening remarks, subcommittee Chairman Brett Guthrie (R-KY) discussed long-term solutions to ensure individuals maintain access to telemedicine services and bills such as H.R.7623, the Telehealth Modernization Act, and H.R. 7858, the Telehealth Enhancement for Mental Health Act. The Subcommittee is considering 15 bills to expand telehealth access. Members of Congress emphasized the need to better assess quality of care delivered via telemedicine and the need to increase monitoring of telehealth. Committee members also emphasized how any telehealth expansions must focus on patient choice and the advantages of telehealth for rural communities. Witnesses recommended that Congress prioritize telehealth policies that increase access, promote equity, provide consumer protections, and drive high-quality care. Healthsperien covered the hearing and detailed notes are provided here.

 

Representatives Scott and DeSaulnier Author Letter Urging the DOL to Ensure Parity in Long-Term Disability Benefits

Representatives Bobby Scott (D-VA), Ranking Member of the Committee on Education and the Workforce and Mark Desaulnier (D-CA), Ranking Member of the Subcommittee on Health, Employment, Labor, and Pensions co-authored a letter to the Department of Labor (the Department) Acting Secretary, Julie Su, and Assistant Secretary of the Employee Benefits Security Administration (EBSA), Lisa Gomez. The letter aims to bring attention to the December 2023 report from the Advisory Council on Employee Welfare and Pension Benefit Plans (ERISA Advisory Council) regarding Long-Term Disability Benefits and Mental Health Disparity. The report highlights the barriers imposed upon workers experiencing mental health and substance use disorder conditions. The letter notes that the majority of long-term disability (LTD) plans treat disability arising from behavioral health conditions differently than disability arising from physical health conditions. Approximately 99 percent of all LTD plans offer a shorter coverage period, often just 24 months, for mental health and substance use disorder conditions. Moreover, the letter characterizes the treatment of behavioral health conditions in LTD plans as discriminatory, citing inconsistencies with the Mental Health Parity and Addiction Equity Act (MHPAEA). The Representatives encouraged the Department to give full consideration to the ERISA Advisory Council’s report and the recommendations within it to bring equitable coverage to LTD benefits.

Administrative Action

The Biden-Harris Administration hosted an event to announce new actions and highlight previous accomplishments to support caregivers and increase access to high-quality care. The event marks the one year anniversary of the President’s Executive Order on Increasing Access to High-Quality Care and Supporting Caregivers (Care EO), which directed all cabinet-level agencies to determine how they could encourage their own federal funding applicants to provide supportive services for workers. One of the recent actions that followed the Care EO is the Department of Labor (DOL) awarded a total of $65 million in Strengthening Community Colleges grants to 16 community colleges and their partners nationwide, helping to expand access to high-quality, equitable training for in-demand industries. Several new actions were announced, some of which include the Department of Commerce will cohost, in collaboration with the U.S. Chamber of Commerce and the U.S. Chamber of Commerce Foundation, the first National Child Care Innovation Summit this summer, and the Department of Treasury, which published a fact sheet highlighting that employer-provided “work-life referral services” are generally considered a de minimis fringe benefit and therefore excluded from an employee’s taxable income.

Congressional Action

  • The United States Senate Committee on Finance held a hearing to discuss changes to the Medicare system and the burdens associated with administrative tasks, cost-sharing, practicing as a primary care provider, and other areas for improvement. Members of the committee showed bipartisan support for creating a system that provides patient-centered care and reduces complexity. Healthsperien’s comprehensive coverage of the hearing can be found here.

 

  • Senator Bob Casey (D-PA), Chairman of the Senate Special Committee on Aging, as well as Senators Tim Kaine (D-VA), and Tammy Baldwin (D-WI) recently introduced the Long-Term Care Workforce Support Act to mitigate the caregiving crisis by supporting long-term caregivers and their efforts to help families nationwide. In the U.S. House of Representatives, Congresswoman Debbie Dingell (D-MI-6) introduced a companion bill. Many caregivers provide long hours of support for aging loved ones or individuals with disabilities for low or no pay. Caregivers earn a median wage of $15.43 an hour and a majority are living in poverty. There exists a widespread worker shortage for individuals needing essential long-term care. This legislation aims to establish caregiving as a lifelong profession by allocating significant new funds to support workers across all sectors of the long-term care industry, including nursing homes, home care, and assisted living facilities. The bill improves caregiver compensation to benefit workers who care for older adults and individuals with disabilities.

Research

  • A recent Congressional Budget Office (CBO) report presents recent research findings focused on Medicare accountable care organizations (ACOs). The report dives into aspects that have improved or limited the capacity of ACOs to attain net budgetary savings for the Medicare program. According to the findings of CBO, specific kinds of ACOs demonstrate greater cost savings, notably those led by independent physician groups, ACOs with a greater proportion of primary care providers (PCPs), and ACOs with initial baseline spending exceeding the regional average. It also found that factors may limit the potential savings from Medicare ACOs. These include weak incentives for ACOs to reduce spending, insufficient resources for providers to engage in ACO models, and providers’ capacity to join or withdraw from the program based on financial outcomes. There are various policy suggestions about how to increase the savings that ACOs generate for the Medicare program such as increasing providers’ incentives to engage in ACO models. Other approaches include boosting provider incentives to reduce spending and increasing beneficiary engagement with ACO models. CBO has not evaluated the effects of these policy approaches.

 

  • The Commonwealth Fund released its “Advancing Racial Equity in U.S. Health Care” report that examines disparities in health outcomes and health care across racial and ethnic groups, both within states and between states, driven by inequities in access to care. The Commonwealth Fund examined data for 25 indicators of health system performance with an emphasis on outcomes, access to health care, and quality and use of health care services for Black, white, Hispanic, American Indian and Alaska Native (AIAN), and Asian American, Native Hawaiian, and Pacific Islander (AANHPI) populations. They calculated a health system performance “score” for each of the five racial and ethnic groups in every state where direct comparisons were feasible among these groups and with counterparts in other states. The report concluded that in every state, racial and ethnic disparities are widespread and that there are notable differences in mortality rates and the prevalence of health issues across various racial and ethnic groups. It also found that limited insurance coverage and unequal access to high-quality health care perpetuate disparities in health outcomes among racial and ethnic groups. It pointed to how unequal access to primary care services contributes to racial and ethnic disparities in care quality. The goal of the report is to highlight these issues for policymakers, healthcare administrators, and community stakeholders. This resource enables these stakeholders to investigate the effects of current and historical health policies on different racial and ethnic groups and implement measures to establish a more equitable health care system. The report draws attention to the need for policymakers to establish and use standardized, equity-focused measures across agencies and institutions to track if states, health systems, and health plans are reducing racial disparities in health-related areas such as clinical outcomes and insurance coverage.

 

  • In a recent study, published in HealthAffairs, the greater use of telemedicine was analyzed across health systems based on utilization, spending and quality. During the COVID-19 pandemic, telemedicine was adopted through several reimbursement expansions and regulatory wavers from a variety of payers including Medicare, Medicaid, and commercial insurers. Congress has temporarily extended Medicare’s coverage of telemedicine through December of 2024, but without congressional intervention, the coverage of telemedicine will expire. The study, aiming to better understand utilization rates post-pandemic, compared patients use of telemedicine during the pandemic to use in the years of 2021-22. It found that in 2020, patients at health systems with high telemedicine use had 2.5 telemedicine visits per person, while those at low-telemedicine systems had 0.7 visits. In 2021-22, patients at high-telemedicine systems saw a slight increase of 0.21 total outpatient visits per patient per year (2.2% relative increase), a decrease of 14.4 annual non-COVID-19 emergency department visits per 1,000 patients per year (2.7% relative decrease), and a $248 rise in per-patient-per-year spending (1.6% relative increase). Notably, there were no significant changes in hospitalizations or receipt of preventive care.

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