HealthCare Roundtable e-News – February 9, 2022

Latest CMS Projections Anticipate Nearly 8% Revenue Increase for MA Plans

Last week, CMS published new projections showing an increase in revenue in Medicare Advantage plans in 2023, a pay bump of 7.98%. The agency is currently eyeing changes to its risk adjustment model after it recently requested feedback on whether plan adjustments and star ratings could address the impacts of social determinants of health and health equity. According to the agency fact sheet, CMS projects a 3.5% revenue increase tied to the MA risk score assessment.

The news also comes as Sen. Elizabeth Warren (D-Mass.) called for reforms during a hearing on Wednesday (Feb. 2) of the Senate Finance Committee to risk adjustment practices she said Medicare Advantage plans are using to get overpayments from Medicare. Warren called for reining in private insurers, which she alleged were taking advantage of the MA program. (InsideHealthPolicy)

“It is completely baffling to me that the Biden administration wants to give the same bad actors in Medicare Advantage free rein in traditional Medicare,” Warren said during the hearing. “President Biden should not permit Medicare to be handed over to corporate profiteers. Doing so is going to increase costs and put more strain on the hospital insurance trust fund.”

CMS said that it would accept comments on the CY 2023 Advance Notice through Friday, March 4, 2022, before publishing the final Rate Announcement by April 4, 2022.

ICER Draft Drug Pricing Report Claims COVID-19 Drugs “Reasonably” Priced

Four drugs that have recently been authorized to help treat and prevent the coronavirus are said to be worth their prices. According to a draft report from the Institute for Clinical and Economic Review (ICER), the cost of the drugs is “reasonably aligned” with how much they help patients and how quickly they can get back to work after infection.

The report assessed Pfizer’s Paxlovid and Merck’s molnupiravir, as well as sotrovimab, an intravenous monoclonal antibody drug developed by GlaxoSmithKline and Vir Biotechnology, and fluvoxamine, a Selective Serotonin Reuptake Inhibitor (SSRI). The assessment of the drugs was based on information around when clinical evidence is expected to be available, the expected timing of FDA approval, and input from clinical experts on which treatments are likely to be the most relevant for patients and clinicians.

The treatments reduce and shorten hospitalizations, which saves the health care system a lot of money and reduces the workload on hospitals, ICER says. ICER President Steven Pearson says that the drugs’ impact on “reducing the likelihood of mild COVID-19 becoming severe improved the quality of life for patients and it also helped save costs of hospitalization and ICU stays.”

Lawmakers Push for Different Paths to Post-Pandemic Telehealth Expansion

Lawmakers in the House and Senate are eager to build on telehealth expansion, though committees have disagreed on how to go about formalizing policies. Congressional leaders have yet to determine whether to go about permanently extending a few of the pandemic-era telehealth waivers or, instead, temporarily extending the waivers and continue to collect data to determine the form that longer-lasting policies can take.

Sens. Catherine Cortez Masto (D-Nev.) and Todd Young (R-Ind.) unveiled legislation, known as the “Telehealth Extension and Evaluation Act,” that would extend telehealth waivers for two years. The plan follows the House Ways & Means Committee plan headed by House Ways & Means health subcommittee Chair Lloyd Doggett (D-TX), who expressed his interest in marking up his “Telehealth Extension Act.” The House bill differs from the Senate bill in that it would include a mix of temporary and permanent extensions, along with some permanent guardrails.

“The pragmatic approach we take permanently removes onerous site-based and geographic restrictions that have a disproportionate impact on patients with disabilities,” Doggett said during a subcommittee health equity hearing. “We also provide a temporary two-year extension of the broad range of services permitted via telehealth under the emergency waivers—providing time for further study of quality of care and what additional policies are needed to ensure platforms do not exacerbate or create new disparities.” (InsideHealthPolicy)

The Senate’s proposed bill would enable telehealth expansion to last for two years, allowing for additional data collection on telehealth services and for lawmakers to review the collected information before voting on permanent legislation. Kyle Zebley, executive director of ATA Action, notes that the bill is largely along the lines of what over 300 stakeholders called on Congress to do in a letter sent early last week. (InsideHealthPolicy)

Mental Health Experts Push Congress for Legislative Solutions on Mental Health and Substance Abuse Crisis

Mental health advocates spoke at two congressional hearings last week pushing lawmakers to consider the creation of an integrated health system to combat mental health and substance abuse in the U.S. The Senate hosted a hearing on Tuesday (Feb. 1), the House Ways and Means Committee held their hearing on Wednesday (Feb. 2), and Surgeon General Vivek Murthy testified at a deep dive hearing on youth mental health on February 8th.

According to experts, the number of Americans reporting anxiety or depression has nearly quadrupled since the start of the COVID-19 pandemic, yet more than 56% of adults did not receive any mental health treatment in the past year. Deepa Avula, one of the mental health advocates who spoke during the hearings and is director of the North Carolina Division on Mental Health, Developmental Disabilities, and Substance Abuse Services, wants to see Congress invest in recruitment incentives that draw people into the behavioral health field, like via loan repayment or better wages.

“I truly believe we are—in the behavioral health field—we are at a very unique moment in time. And I think all of us need to recognize it is a sad moment but it’s a moment of great opportunity, and I think with collective action at the federal, state, and local levels, we can really improve the lives of millions of Americans,” said Avula during the House hearing. (InsideHealthPolicy)

Mitch Prinstein, American Psychological Association’s chief science officer and an advocate who spoke at the hearings, said it’s important to engage primary care providers on how to best integrate behavioral health providers into their offices and suggested that potential solutions are “about the time and the funding that’s required for cross training so that way physicians and mental health care providers can speak each other’s language.” (InsideHealthPolicy)