AHIP's State of Industry addresses need for MA and Medicaid stability

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During its annual State of the Industry briefing on Wednesday, insurer trade group AHIP outlined its vision for the year ahead, advocating for policies and industry changes that result in more equitable healthcare, with a particular focus on protecting telehealth, ending surprise billing and promoting the increasingly popular Medicare Advantage. 

AHIP President and CEO Matt Eyles emphasized equity in his opening remarks and praised the No Surprises Act for working to protect Americans from surprise medical bills, and for protecting patients from being charged for care they didn't choose.

"We know this practice has bankrupted too many working families," said Eyles, adding that the No Surprises Act is a "crucial step to relegating surprise billing to the past.

"But private equity-backed organizations are fighting that in court," he said. "AHIP continues to fight and protect the law. Patients deserve these protections, they deserve access to affordable care, and they deserve access to competitive healthcare markets."

AHIP also extolled the virtues of Medicare Advantage and highlighted the continued expansion of its services, from dental and vision to meal and transportation benefits and wellness programs – which have all factored in the program's bipartisan support in Congress.

As popular as MA has been, though, AHIP Senior Vice President, Federal Programs Mark Hamelburg warned that as the COVID-19 pandemic winds down and federal flexibilities regarding MA end, there could be a significant shift that may cause people to temporarily or permanently lose coverage. And this extends to Medicaid and CHIP as well, which have their own flexibilities that are set to expire.

"MA and Part D sponsors can waive or reduce premiums to make midyear benefit enhancements," said Hamelburg. "Some of those flexibilities are going to end. In Medicaid, some benefit provisions are tied to the end of the public health emergency, like a requirement that all states provide care without cost sharing. Eight million people are on Medicaid and CHIP; millions could lose coverage when the shift happens. Some may end up in the individual marketplace or in employer coverage. Both the people who lose coverage and the people who remain eligible could temporarily run into barriers in the process, due to delays, lack of updated addresses. It could result in a lot of people losing coverage just because the process has at least temporarily kicked them out of coverage. That's something we're tremendously focused on."

Kate Berry, senior vice president of clinical innovation at AHIP, said chief medical officers in particular have been focused on the significant growth of telehealth during the pandemic. Use of remote care technologies skyrocketed during months when many Americans were forced into isolation, and in the months ahead, CMOs will contemplate how to integrate telehealth into the healthcare system in a broader and more sustained fashion.

"That's more likely to happen in value-based arrangements," said Berry. "For providers operating in fee-for-service, it was harder for them to adapt when the world changed. Because of the lack of volume they didn't have enough revenue to help them move forward to fully leveraging telehealth. In a value-based arrangement, telehealth can become a regular part of the routine. So the CMOs are continuing to work with providers to implement those value-based arrangements, which is a really important way to align incentives around quality outcomes."

AHIP Senior Vice President of Private Market Innovations and Quality Danielle Lloyd highlighted the explosion in the use of technologies that are now to operate effectively in the healthcare industry, enabling things like interacting with patients and transferring sensitive patient data. But moving forward, Lloyd said patients deserve to know their data is private and secure, which will necessitate developing solutions that ensure care is more equitable and improves costs.

"Things are changing very dramatically, and at the same time, we've seen during the pandemic there are bad actors out there, and they're getting more determined to create trouble," she said. "Technology like apps and digital platforms need to ensure they have built-in protections. The commercial sale of individual health information should be prohibited unless there's express agreement from the consumer."

Aside from achieving health equity, Eyles said AHIP's commitments in 2022 include ensuring more Americans have access to affordable coverage; addressing underlying cost drivers of care; ending pharmaceutical monopolies; highlighting hospital and physician consolidation, which he said raises costs and limits patient choice; ensuring limites on telehealth and other technologies are removed; adopting solutions that promote efficiency and eliminate waste; and moving toward a more consumer-centric healthcare system.

"Our focus is squarely going to be on the health and wellbeing of Americans," said Eyles. "Our reason for being is ensuring Americans can live their lives to the fullest. Everything we do is in service to guiding greater health."
 

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Email the writer: jeff.lagasse@himssmedia.com