Last Week in Healthcare Reform: September 27th, 2021

Hospital groups push back against stiffer price transparency penalties; patients continue to struggle with the high cost of prescription drugs; support grows for Medicaid; and, stakeholders innovate to expand the reach of virtual care.

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Week in Review

Transparency Penalties: Earlier this summer, the Centers for Medicare & Medicaid Services (CMS) proposed stiffer penalties for hospitals failing to comply with new price transparency rules. As a reminder, those rules went into effect at the beginning of this year and require hospitals to provide clear and accessible pricing information to consumers online about the items and services they provide. However, after six months, only 5.6 percent of hospitals were in compliance. In response to CMS’ latest proposal aimed at bringing more health systems into compliance, hospital groups have come together to push back against those heftier fines. Whether or not their protestations fall on sympathetic ears remains to be seen, but, for their part, lawmakers have already come out in support of the price transparency rule.

Rx Costs: According to the results from a new survey, more than 15 million US adults younger than 65 have struggled with the cost of their prescription drugs this year – to the point that they went without their medication. Drilling further into the data compiled by West Health and Gallup, twice as many young adults reported not filling prescriptions compared to seniors (8 percent versus 4 percent). A comparable difference was also observed in those having to skip doses in order to save costs (13 percent versus 6 percent). Further, patients with chronic conditions reported difficulty affording their prescriptions across a range of diagnoses, including diabetes (12 percent), chronic obstructive pulmonary disease (12 percent), and immuno-compromised (15 percent), at a rate nearly twice that of patients overall.

Medicaid Support: The vast majority of Americans now believe that Medicaid has become an essential part of our healthcare system, at least according to a new poll conducted by Morning Consult on behalf of the Modern Medicaid Alliance. Nearly nine-out-of-ten respondents (88 percent) to the nationwide survey agreed on the importance of maintaining a strong, sustainable Medicaid program. In fact, more than three-quarters of Americans (76 percent) have a favorable view of Medicaid, with issues of affordability and accessibility ranking as the top priorities concerning the future of the program.

Virtual Care: Stakeholders across the healthcare spectrum continue to focus on bringing new innovations to the market aimed at helping overcome barriers to care. That includes health insurers, who, with line-of-sight over the entirety of our healthcare delivery model, are able to capitalize on data-driven insights that many experts believe will be the foundational element of our evolving system of care. One example of how these innovations are being leveraged to patients’ benefit is the recently announced partnership between Anthem Blue Cross and Blue Shield and The Clinic by Cleveland Clinic to virtually expand members’ access to second opinions. According to The Clinic, nearly three-out-of-ten patients receive a changed diagnosis when they seek out a second opinion. As a result, approximately three-quarters of them then alter their courses of treatment. Through this new partnership with The Clinic’s virtual second opinion service, which offers patients support from 3,500 Cleveland Clinic physicians via online consultations, Anthem Blue Cross and Blue Shield will now offer large employers the opportunity for their employees to access this service, with plans to eventually expand the offering to more employers and more programs.

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