Telehealth, Medicare Advantage Top-of-List in 10-year Plan for Nonprofit Health Plans

September 23, 2020
Peter Wehrwein

Telehealth gets a strong endorsement in a 10-year plan put out by a group representing many of the country’s blue-ribbon nonprofit health plans.

The Alliance of Community Health Plans’ “Health Care 2030: ACHP’s Roadmap to Reform” also calls for support of primary care with access to behavioral health services, heaps praise on Medicare Advantage, and advocates for reforming anti-kickback and Medicaid pricing requirements to encourage value-based contracting.

“This is not just an academic exercise for us,” said Ceci Connolly, president and CEO of the organization said during a media call yesterday about the plan. “We hope you will see it as very practical, on-the-ground, solution-oriented, nonpartisan.”

The report includes promises that member health plans will “track and improve population-based outcome measures for chronic disease” with a focus on diabetes and heart disease and that the organization will publish an annual “Report on Affordability” that will describe successful efforts by health plans to reduce healthcare costs.

The membership of ACHP includes Harvard Pilgrim Health Care, Geisinger Health Plan, HealthPartners (in Minneapolis), Health Alliance Plan (in Detroit), and Kaiser Permanente.

The ACHP roadmap says that the flexibilities provided by federal regulators “flipped the telehealth switch almost overnight” and that “given the consumer enthusiasm and the potential savings inherent in telehealth, policymakers have a rare opportunity to sustain the momentum created during the pandemic.” The document calls for expanded reimbursement and coverage that allows care to be delivered at home and other settings and for increasing the types of healthcare professional who can be paid for delivering telehealth services.

“I think telehealth and virtual care is one of the big social determinants solvers,” Michael Genord, M.D., MBA, president and CEO of the Health Alliance Plan, said during the media call, noting that it could remove the barriers of lack of transportation and child care that keep some people from getting timely care. He also mentioned virtual health’s potential for having a positive effect on the healthcare of people with chronic disease.

“When we can take people with serious chronicity of disease and take away the burden of actually traveling to see their doctor and have more frequent touch bases addressing things early in the disease process that is great opportunity to shift us to value-based care.”

Diane Holder, president and CEO of the UPMC Health Plan in Pittsburgh mentioned during the media call that telehealth may result in a “little less downstream testing” because the testing is less convenient.

Here are some of the points and calls for action made in the ACHP plan:

  • Strengthen primary care by, among other things, making home-based care options more available, including behavioral health and palliative care,
  • Empower medical professionals to work at the top of their licenses and get rid of “outdated network adequacy standards”
  • Reform intellectual property laws used to keep biosimilars off the market and empower the Federal Trade Commission to crack down on anti-competitive behavior.

The ACHP plan includes an endorsement of Medicare Advantage (many of the members sell Medicare Advantage coverage). “In contrast to the fragmented, fee-for-service Medicare program, MA emphasizes value, offering highly coordinated care and more benefits at a lower cost to both the employer and the beneficiary.” One of the goals mentioned in the “journey from volume to value” part of the report is to enroll seniors entering the Medicare program in top quality-rated Medicare Advantage plans.

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