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This Week in Managed Care: January 22, 2021


This week, the top managed care news included President Joe Biden's executive orders to reform public health; CDC director to prioritize communication, coronavirus disease 2019 vaccine rollout; CMS finalizes rule on electronic prior authorization.

Biden focuses on public health reform with numerous executive orders; CDC director to prioritize communication, coronavirus disease 2019 (COVID-19) vaccine rollout; and CMS finalizes rule on electronic prior authorization.

Welcome to This Week in Managed Care, I’m Matthew Gavidia.

Focusing on Public Health, Biden to Seek Change With Numerous Executive Orders

After Joe Biden was sworn in this week as president amid unprecedented security, he signed 17 executive orders aimed at undoing the Trump administration’s policies related to COVID-19, public health, climate change, and other issues. And in some cases, instituting new ones, such as a “100 Days Masking Challenge” across the federal government.

The Biden transition team said that one of his first actions would be an executive order calling on Americans to do “their patriotic duty” and wear a mask. As the nation crossed the threshold this week of 400,000 deaths from the pandemic, Biden will also require masks and physical distancing in all federal buildings, on all federal lands, and by federal employees and contractors.

The Biden administration also took steps to:

  • rejoin the World Health Organization
  • rejoin the Paris Climate Accord, and revoke the approval of the Keystone XL oil pipeline
  • restore the National Security Council Directorate for Global Health Security and Biodefense, which was created by the Obama administration and dissolved by President Trump in 2018
  • and create the position of COVID-19 Response Coordinator, who will report directly to the president

Jeff Zients, who previously served in the Obama administration as director of the National Economic Council, and acting director and deputy director of the Office of Management and Budget, will be responsible for coordinating the federal COVID-19 response.

In addition to the executive orders, the Biden transition team said there will be a review of all regulations and executive actions from the previous administration “that are deemed damaging to the environment or public health,” as well as a directive to federal agencies to “prioritize racial equity and review policies that reenforce systemic racism.”

When Donald Trump took office 4 years ago, he signed just 1 executive order, which pledged to seek the repeal of the Affordable Care Act. Although repeal efforts failed, the Supreme Court is expected to issue a ruling in a case brought by Texas seeking to overturn the health law before its term ends in June.

For more, visit AJMC.com.

New CDC Guidance to Base State COVID-19 Vaccine Supply on Administration Rates

As Rochelle Walensky, MD, MPH, assumed the role of CDC director on January 20, the infectious disease specialist faces a myriad of challenges wrought by the ongoing COVID-19 pandemic.

Despite the unprecedented speed with which pharmaceutical companies have developed vaccines for COVID-19, rollout has been fragmented at the state level and racial disparities in administration rates are beginning to become apparent.

Although some states have been widely successful in administering the allotment of COVID-19 vaccines they were given, many have reported roadblocks. Part of the Biden administration’s plan to enhance rollout is to expand vaccine allocation to 4 key locations: federally qualified health centers, community vaccination centers, mobile units, and pharmacies.

“Part of the challenge with COVID-19 was that we had a frail public health infrastructure to start. It wasn't ready to tackle what it was given,” Walensky said during a livestreamed interview with JAMA's Howard Bauchner, MD, the journal's editor-in-chief. As director, she hopes to bring this reality to Congress’ attention. “We're in this because we had warnings for many, many other public health scares in the last 20 years and we didn't fix our public health infrastructure and our data infrastructure,” in response to those tests.

In an additional effort to improve the national rollout of COVID-19 vaccines, Walensky plans to increase the CDC’s communication to combat any hesitancy in receiving the vaccine, and indicated she wanted to increase media appearances above those made by former director Robert Redfield, MD who departed with any remaining Trump administration officials this past Wednesday.

“Science is now conveyed through Twitter. Science is conveyed on social media, on podcasts, and in many different ways. And I think that's critical,” said Walensky.

January 21st marks the 1-year mark since the first case of COVID-19 was reported in the United States, while current data indicate the country has surpassed 400,000 deaths. In comparison, the 1918 flu pandemic took 675,000 American lives, and the US reported a total of 405,000 fatalities during World War II.

For more, visit AJMC.com.

CMS Finalizes Rule on Electronic Prior Authorization

Last week, CMS finalized a new rule that will allow certain payers, providers, and patients to have electronic access to pending and active prior authorization decisions.

The agency said the rule will streamline the prior authorization process and allow providers to devote more time and focus to providing better quality care to patients, as well as promote secure electronic access to data in new ways that will drive interoperability, empower patients, and reduce costs and the burden on the health care system.

“Thanks to this rule, millions of patients will no longer have to wrangle with prior providers or locate ancient fax machines to take possession of their own data. Many providers, too, will be freed from the burden of piecing together patients’ health histories based on incomplete, half-forgotten snippets of information supplied by the patients themselves, as well as the most onerous elements of prior authorization,” said then-CMS Administrator Seema Verma in a statement.

The CMS Interoperability and Prior Authorization rule will require Medicaid, Children’s Health Insurance Program managed care plans, fee-for-service programs, and issuers of individual market Qualified Health Plans on the federally facilitated exchanges to implement application programming interfaces, or APIs. Doing so will enable providers to access data through integration with their electronic health records.

Payers regulated under the rule will be required to include claims and encounter data, including laboratory results and information regarding any pending and active prior authorization decisions, into an API. They will also be required to reduce their decision timelines for prior authorizations to a maximum of 72 hours for urgent requests and 7 calendar days for nonurgent requests.

CMS said that enabling patients to review the status of a prior authorization application will provide them with a better experience, because they can better understand the timeline for the process and in turn be more able to plan next steps with their provider.

For more, visit AJMC.com.

Promoting Equitable Access to Telemedicine During the COVID-19 Crisis

Even before the COVID-19 pandemic prompted a sweeping shift toward telemedicine instead of in-person care, technological innovations were not reaching all patient populations evenly, creating a “digital divide” between those with access and those without.

In this week’s Managed Care Cast, we speak with with 2 coauthors of an Original Research article published in the January 2021 Health IT issue of The American Journal of Managed Care®, titled “Differences in the Use of Telephone and Video Telemedicine Visits During the COVID-19 Pandemic.” The study describes patterns of telemedicine visits by patients’ race, ethnicity, age, and language amid the pandemic in Spring 2020.

The authors, Jorge A. Rodriguez, MD, and Ishani Ganguli MD, MPH, of Harvard Medical School and Brigham and Women’s Hospital in Boston, discuss their findings and suggestions for making telehealth access more equitable for all.

For the podcast, visit AJMC.com.

For all of us at AJMC®, I’m Matthew Gavidia. Thanks for joining us!

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