HealthCare Roundtable e-News – May 20, 2024


Congressional Forum – June 5-6, 2024

Register NOW to attend the Roundtable’s 2024 Congressional Forum

The Phoenix Park Hotel, Washington, DC

Whether you actively advocate with the Administration or your Members of Congress or not, you should plan to participate in the Roundtable’s Congressional Forum. You’ll learn first hand from industry leaders, DC allies, and key friends in Congress about the issues which impact health care purchasers today.

The Forum will begin with a networking reception on Wednesday, June 5th and continue with a series of educational presentations on Thursday morning, June 6th. For those who are able, the Roundtable will provide information to support meetings on Capitol Hill as health plan representatives reach out to educate their Members of Congress on Roundtable priorities.

Register Here

We look forward to welcoming you to Washington!

The following are links to hotels that are convenient to our Welcome Reception at the Healthsperien Office and the Phoenix Park Hotel:

Top News

Senators Introduce Legislation and Release RFI on Provider Payment Reform

U.S. Senators Sheldon Whitehouse (D-RI) and Bill Cassidy, M.D. (R-LA) released a request for information (RFI) to accompany the introduction of the senators’ Pay PCPs Act, which aims to better support and improve pay for high-quality primary care providers. The Pay PCPs Act would task the Centers for Medicare & Medicaid Services (CMS) with establishing hybrid payments to reward primary care providers who provide care that reduces patients’ emergency visits, hospitalizations, excess specialist services, and other big cost drivers and reward patients with better health outcomes. The bill would provide Medicare beneficiaries with reduced cost-sharing for certain primary care activities and services and would also create a new technical advisory committee to help CMS more accurately determine Fee Schedule rates. The senators’ accompanying RFI provides stakeholders the opportunity to comment on the bill. Feedback can be submitted to until July 15, 2024.


New Study Examines the Lack of Transparency in Health Care Pricing in Employer-Sponsored Insurance Plans

A recent study published in RAND, analyzed the lack of transparency in health care pricing within employer-sponsored insurance plans, highlighting the significant role employers play in financing the U.S. health care system. The study utilized claims data from self-insured employers, state-based all-payer claims databases, and health plans spanning 2020 to 2022 to analyze pricing differentials between private insurer payments and Medicare rates for both inpatient and outpatient services. The study also examining price discrepancies for outpatient surgeries between ambulatory surgical centers and hospital outpatient departments, as well as specialty prescription drugs administered in hospital settings versus physician offices. Key findings indicate substantial price variation across states, with some averaging below 200 percent of Medicare prices and others exceeding 300 percent. Additionally, it revealed that employers and private insurers paid on average 254 percent of what Medicare would for the same services, suggesting potential opportunities for cost-saving measures and value-based purchasing decisions. The study suggests using this data to inform negotiations with providers and potentially reformulating contract agreements to achieve better value for employers and employees alike. However, it emphasizes that while price transparency is essential, it may require complementary policy interventions to drive significant changes in the health care landscape.

Administrative Action

  • The Biden-Harris administration released a Fact Sheet on worker protection from risks related to Artificial Intelligence (AI). In October of 2023, President Biden issued an Executive Order directing the Department of Labor to create principles for worker protections that should be considered throughout the lifecycle of AI development. The principles include worker empowerment, ethical development of AI, AL governance and human oversight, transparency in AI use, protecting labor and employment rights, using AI to enable workers, supporting workers impacted by AI, and ensuring responsible use of worker data.


  • The U.S. Department of Health and Human Services (HHS) released data on the growth and investments into mental health care over the past few years. Notably, HHS invested $1.5 billion into launching 988 with over 9.5 million calls recorded since June 2022, Medicare launched mental health crisis codes for more than 65 million Medicare seniors, and Medicaid, Child Health Insurance Program, and Marketplace plans instituted nationwide mandatory appointment wait time standards for outpatient behavioral health. In addition, Medicare increased payment rates for crisis psychotherapy outside outpatient clinics by 150% the usual Physician Fee Schedule rate, the Health Resources and Services Administration (HRSA) awarded $55 million to 229 HRSA-funded health centers to expand behavioral health screening and treatment for children, the Indian Health Service through partnerships reduced opioid prescribing by over 70% and increased the availability of naloxone, and the Centers for Disease Control and Prevention (CDC) released a Mental Health Action Guide to help schools promote student mental health.


  • The Office of the Assistant Secretary for Planning and Evaluation (ASPE) published a report on telehealth use among people and Medicare beneficiaries with disabilities, focusing on the use of audio-only telehealth during the second and third years of the COVID-19 pandemic. The study draws on data from the Medicare Current Beneficiary Survey (MCBS) COVID-19 2021 Winter Supplement and 2022 surveys, ASPE’s Medicare Telehealth Trends Dashboard, and the Census Bureau’s Household Pulse Survey (HPS). Across the surveyed and claims data analyzed, individuals with disabilities were more likely to use telehealth than those without disabilities. Further, people with multiple disabilities, and mobility disabilities were the most likely to use telehealth as a service delivery option. Audio-only telehealth accounted for the majority of telehealth interactions among people with disabilities and older adults, which suggests this telehealth modality is essential for maintaining access to care among these populations.

Congressional Action

  • The Bipartisan Senate AI Working Group released A Roadmap for Artificial Intelligence Policy in the United States Senate based on 9 Insight Forums and testimony from over 150 experts. The roadmap includes directives Senate committees, AI companies, and AI users to explore how current legislation may or may not apply to AI in multiple contexts including workforce development, risk management, liability, biosecurity, data protection, drug crackdown, and research.


  • U.S. Senators John Fetterman (D-PA) and Tina Smith (D-MN) introduced the United States Senate Commission on Mental Health Act of 2024, which would establish a U.S. Senate Commission on Mental Health tasked with providing Congress and the President policy recommendations to improve access to and affordability of mental health care services. The Commission’s first year of study would focus on the coverage of mental health care services, including mental health parity requirements, under federal health plans, reimbursement rates for mental health care services with regard to mental health care providers, and workforce challenges, including barriers to entering this field and challenges faced by mental health care providers, including factors that contribute to burnout. The Commission would submit to Congress, the Secretary of Health and Human Services, and, as appropriate, the heads of other relevant federal agencies, an annual report based on studies carried out that year.


  • On Wednesday, May 8th, the U.S. House Committee on Ways and Means held a markup of six bills crucial for rural health, telehealth, hospitals, and the physician workforce which collectively aim to safeguard telehealth access, prevent rural hospital closures, enhance ambulance services, and bolster healthcare workforce availability in rural communities. Healthsperien covered the markup, and a detailed summary can be found here.

Mark your calendar:

Roundtable’s Congressional Forum

June 5-6, 2024

Phoenix Park Hotel, Washington, DC

Register Here

Roundtable’s 20th Annual Conference

November 6-8, 2024

The Mayflower Hotel, Washington, DC

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