America's Health Insurance Plans (AHIP) Meetings

During a session presented at the America’s Health Insurance Plans (AHIP) National Health Policy Conference, Michael Chernew, PhD, the director of Healthcare Markets and Regulation Lab at Harvard Medical School, and Mark McClellan, MD, PhD, founding director at Duke Margolis Center for Health Policy, discussed the potential for Medicare innovation and reforms in 2021 and beyond.

The $1.9 trillion spending package aimed at providing COVID-19 relief for those with low and middle incomes also represents the biggest investment in the exchange marketplaces created by the Affordable Care Act (ACA) since the landmark law was passed 11 years ago.

During a session presented at the America’s Health Insurance Plans National Health Policy Conference, experts laid out potential policy priorities for states in the wake of the COVID-19 pandemic.

In a session presented at America’s Health Insurance Plans (AHIP’s) National Health Policy Conference, federal health officials and health plan representatives highlighted successes of the country’s ongoing COVID-19 vaccine rollout, placing particular emphasis on the role equity plays in distribution.

At the America's Health Insurance Plans Institute & Expo, a presentation focused on how artificial intelligence (AI) solutions can help payers deliver the seamless experience that consumers have come to expect.

A CMS investigation found that almost 46% of the doctor listings in Medicare Advantage (MA) directories contained incorrect information. Officials worry that these inaccuracies could make it more difficult for seniors to access the healthcare they need.

Working under the assumption that the outcome of the presidential race is pretty set, Avik S. A. Roy and John E. McDonough, DrPH, MPA, pondered the potential health policy changes during a Hillary Clinton presidency with a Republican-controlled Congress.

Healthfirst's Medicare Advantage members are largely low income, and actually poorer than its Medicaid members. In order to reach these members and foster trust, Healthfirst makes itself a part of the fabric of the community.

The Affordable Care Act’s changes in payment and reduction in benchmarks in Medicare Advantage raised questions about the future of the program that ended up being unfounded, said Sean Cavanaugh, deputy administrator and director of the Center for Medicare at CMS, during the opening keynote at America’s Health Insurance Plans’ National Conference on Medicare, held October 24-25 in Washington, DC.

Years after the country was sent into a tizzy over the fear of "death panels," there has been an enormous growth in palliative care in the United States, although it and hospice care are still very misunderstood by patients, said speakers at America's Health Insurance Plans' National Conference on Medicaid.

Senator Tim Kaine (D-VA) discussed Medicaid expansion, the Affordable Care Act, and politics at America's Health Insurance Plans' National Conference on Medicaid.

A decade after the introduction of the Medicare Part D program and the program has seen great success-but that may be coming to an end. Panelists debated just that and discussed rising drug costs during a session at America's Health Insurance Plans' National Conference on Medicare.

While there are reports of high patient satisfaction and well-managed costs in the Medicare program, the next 50 years will be full of new challenges, said Andrew Slavitt, acting CMS administrator, during the opening session at America's Health Insurance Plans' National Conference on Medicare.

Funding is an obvious issue facing Medicaid right now, but another is the changing demographic, J. Mario Molina, MD, president and chief executive officer of Molina Healthcare, said at the America's Health Insurance Plans' National Conferences on Medicare and Medicaid, and Dual Eligibles Summit.

There were a number of reasons why Michigan chose to expand its Medicaid coverage, and economics was just one part the decision, according to Stephen Fitton, Medicaid director at the Michigan Department of Community Health.

The quality bonus payments tied to CMS' star ratings makes it critical that health plans receive a 4 or better, Jonathan Harding, MD, chief medical officer of the Senior Products Division at Tufts Health Plan, said at the America's Health Insurance Plan's National Conferences on Medicare and Medicaid, and Dual Eligibles Summit in Washington, DC, from September 28 to October 2.

As the 2014 midterm elections near, healthcare could have an impact on voter decisions and campaign efforts, Avik Roy, senior fellow at the Manhattan Institute, said at the American Health Insurance Plans' National Conferences on Medicare and Medicaid, and Dual Eligibles Summit.

The rising cost of prescription drugs, CMS initiative updates, and successes in home and community-based services for dual Medicare and Medicaid beneficiaries were discussed at the America's Health Insurance Plans' National Conferences on Medicare and Medicaid, and Dual Eligibles Summit in Washington, DC.

Health plans, providers, and consumers have to collaborate in order to bring value, Craig Thiele, MD, chief medical officer at CareSource, said at the America's Health Insurance Plans' National Conferences on Medicare and Medicaid, and Dual Eligibles Summit.

At $531 billion, Medicaid is the second largest piece of healthcare spending and cannot be pushed off to be thought about another day, Cindy Mann, JD, CMS deputy administrator and director of the Center for Medicaid and CHIP Services, said at the America's Health Insurance Plans' National Conferences on Medicare and Medicaid and Dual Eligibles Summit.

The most recent Medicare Advantage and Part D program audits revealed that oversight of formulary administration is an area that health plans continue to struggle with, Sarah J. Lorance, vice president of Medicare Compliance at WellPoint, said at America's Health Insurance Plans' National Conference on Medicare and Medicaid and Dual Eligibles Summit in Washington, DC.

At the America's Health Insurance Plans' National Conference on Medicare and Medicaid and Dual Eligibles Summit in Washington, DC, Patrick Conway, deputy administrator for innovation and quality and chief medical officer for CMS, spoke on the future of delivery system reform.

"Health insurance exchanges are the first step in the consumerization of the healthcare marketplace," said David Brailer, MD, PhD, chairman, Health Evolution Partners.

An expanding retail marketplace means that there are more opportunities for health plans to develop innovative strategies to reach consumers that are entering the market space for the first time. It is essential for health plans to not only engage these consumers but also to assist them in making good healthcare decisions.

Ashish Jha, MD, MPH, associate professor of Health Policy and Management, Department of Health Policy and Management, Harvard School of Public Health, says that there are many challenges facing the quality of data used to transform healthcare delivery systems.

Gail Wilensky, PhD, senior fellow, Project Hope, says that larger payers are introducing plans that reward consumers for choosing high-quality healthcare clinicians with lower co-payments and premiums.

Incomprehensible amounts of data are collected by all sectors of the healthcare industry on a daily basis. It is important for organizations to not only understand how to handle and collect this data, but also to translate it into actionable information that can help transform healthcare delivery. Unfortunately, many pitfalls still exist, and there is a need for better processes to collect clinically relevant and more complete data.

Avik Roy, senior fellow, Manhattan Institute, says that health insurance exchanges will, over time, become the main method of delivering health insurance in the United States.

Tuesday morning at AHIP's Fall Forum 2012 included a session on the methods in which evolving technologies and disruptive innovations will undoubtedly lead to better and more cost-efficient patient care.

The America's Health Insurance Plans Fall Forum 2012 is taking place in Chicago's Renaissance Hotel from December 3-5. Here are some of the topics and trends that will be discussed.