On the first day of its National Health Policy Conference Online, a virtual conference, the leaders of the Washington, D.C.-based America’s Health Insurance Plans (AHIP), offered attendees virtual sessions focused on various policy and industry issues.
The opening general session was led and moderated by AHIP president and CEO Matt Eyles, who held discussions with Chris Jennings, founder and president of Jennings Policy Strategies, Inc., a Washington, D.C.-based healthcare policy consulting firm, and Bruce Broussard, president and CEO of the Louisville-based Humana Inc.
Speaking of the past year and the COVID-19 pandemic, Eyles told attendees that “We have learned important lessons and will make essential improvements for better public health and better individual health for all Americans long-term,” Eyles told his audience. “We have forged even stronger public-private partnerships and relationships in our communities fortified by the same goal: better health. We are more focused and united in our shared commitment to health equity. Together – this type of caring will change everything for the better.”
He also strongly highlighted AHIP’s creation, announced on March 3, of its “Vaccine Community Connectors” program. As the press release posted on March 3 to the AHIP website noted, “Health insurance providers today committed to supporting a new effort that will promote health equity by removing barriers to vaccinations for 2 million Americans most at risk of COVID-19. Every American deserves access to safe, effective COVID-19 vaccines. Health insurance providers have been working with federal, state, and local leaders to ensure Americans can get vaccinated as quickly and equitably as possible. Today, members of America’s Health Insurance Plans (AHIP) and Blue Cross Blue Shield Association (BCBSA) extended that commitment with the announcement of the Vaccine Community Connectors pilot initiative.”
That press release went on to note that “The Vaccine Community Connectors pilot initiative aims to enable the vaccination of 2 million seniors age 65+ in America’s most at-risk, vulnerable and underserved communities – such as African American and Hispanic communities. Insurance providers will focus on their members and the communities they serve. They are working to reach this important goal quickly, depending upon the increasing availability of vaccine supply. Members of AHIP and BCBSA invite all health insurance providers to join them in this commitment.”
Speaking of that new program, Eyles emphasized that, “As appointments become more available, health insurers will use our data and information to make sure that vulnerable seniors get vaccinated. We’ll contact seniors to help them understand how to get a vaccine and get an appointment and overcome barriers, such as transportation. And we’ll track our progress to make sure that those who need vaccines most will get them. We nurture strong relationships in communities and among community leaders. Our commitment will not stop until together, we achieve community immunity for everyone,” he added.
Five key areas cited
Eyles cited five areas of focus that AHIP has concentrated on in the past year. “The first area,” he said, “has been working together to improve health equity. COVID has shone a spotlight on the significant discrimination and systemic racism in the healthcare system. Change requires action. We’re just getting started. AHIP and its members will continue to act until every American has good access to health.”
The second area: telehealth. “The pandemic has accelerated patients’ and providers’ use and acceptance of digital technologies. It’s convenient, effective, high-quality, and saves time and reduces cost. The insurer community has encouraged the use of telehealth,” Eyles stated. “Telehealth includes digital monitoring equipment, so that patients can receive continued monitoring, and includes audio care via telephone. To ensure telehealth remains a valuable part of the healthcare experience, AHIP will continue to work with policymakers.”
The third area: mental and behavioral health. “COVID-19 and the stress, fear, uncertainty, and isolation, have contributed to soaring demand” for mental health services, Eyles said. “In a CDC [Centers for Disease Control and Prevention] survey, 40 percent of respondents reported struggling during the pandemic. AHIP moved quickly to reduce or eliminate cost-sharing for behavioral care; new apps were launched, telehealth was expanded. We are committed to integrating behavioral health into physical health,” he said. The fourth and fifth areas of focus: supporting the expansion of value-based care delivery and payments; and strengthening the existing system of health insurance coverage. With regard to value-based healthcare, Eyles said that, “Throughout COIVD, we’ve consistently seen that value-based care arrangements can provide continuity for hospitals and doctors. Providers have been insulated from the swings in demand, who were in value-based contracts. We’re seeing new and exciting types of value-based care contracts” emerging all the time now, he emphasized. As for health insurance coverage, he emphasized that “We support more personalized cost and price transparency for consumers while protecting their data. We also believe that we can achieve universal coverage by building on existing system. Through the Affordable Coverage Coalition, we’ve joined, to work together to deliver the access to care that Americans want and deserve. The Coalition supports expanding the premium…. Look that up. America’s existing healthcare system helps millions of Americans, and we’re committed to expanding access.”
And, Eyles said at the conclusion of his opening remarks, “Let me wrap on a note of optimism: America will overcome the COVID-19 crisis. We’ve learned important lessons that will lead to improved health, including public health. We are more focused and united on our shared commitment to health equity.”
The policy moment, in March 2021
Eyles then welcomed Chris Jennings, to discuss the policy moment. Jennings served in the Clinton administration and in 2020, was appointed by Joe Biden to be an adviser to his transition team in the months between the November election and Biden’s inauguration on January 20.
Asked how he would summarize this policy moment, Jennings told Eyles that “I think it’s an exciting moment for the Biden administration. But the president would say, this is a victory for the American public. He knew from the beginning that job one was to address the pandemic’s effects, but health and economic, and to work with Congress to get this package done. With any president, you’ve gotta have that first big victory. And you have to go bold and go big and address the challenges, so that you can ultimately achieve ultimate success, because that success will beget other successes. So it’s a great, great first step.”
Further, Jennings said, “It also means the Administration’s going to have to implement it well. You know, there are so many elements of this policy that haven’t gotten a lot of attention yet, many of which are important to AHIP, including investments in affordability through additional tax credits, more subsidies through COBRA, a significant incentive for states that haven’t expanded Medicaid to do so, and investments in mental health, in home and community based service alternatives, maternal morality, etc. And there are other elements that have enormous HC implications, such as the investments in broadband, nutrition, housing, etc. So all of these things represent extraordinary opportunities for the country.”
“In our new initiative, the Vaccine Community Connectors Program, where we’re making a commitment to addressing equity,” Eyles said. “We’re really proud to be a part of this and also to be a part of the ad campaigns to address vaccine hesitancy. What do we need to do to educate Americans on hesitancy, and also to focus on vaccine equity?”
“I want to thank you and AHIP members for addressing those issues,” Jennings said. “We’re all going to have to work together effectively if we’re going to get to the herd immunity, to return to normal. And the equity and disparity challenge is an area that really needs to be job one, because we have to address not only hesitancy issues, but equity issues as well, at the same time. Your contributions are important and necessary but not sufficient; this investment through the rescue package and private efforts, will provide big dividends.”
“And this effort needs to be sustained,” Eyles noted. “We’ll need to continue to focus on vaccine equity. And how do we get to community immunity? We need to get to 70, 80 percent, and that’s going to take a concerted effort by everyone.”
“Yes, and that will require community-based, credible messengers,” Jennings said. “And targeted messages, as well as substantial investment in community infrastructure, will be really important. And your effort to notify members, esp. diverse members, will be so important. And I hope you’ll continue to financial support communities so all populations know about vaccination efforts.”
The social determinants of health and COVID
Later, Eyles brought up the social determinants of health, in the context of the pandemic. “When we get to a broader lens on health equity, clearly COVID-19 has made clear the longstanding disparities in healthcare that disproportionately impact communities of color—our members are dedicated to improving health equity. Addressing food insecurity, housing insecurity, other SDOH-related issues in our communities. What issues should our members be thinking about, in terms of addressing disparities? And is this an area where legislation is needed?” he asked Jennings.
“Well, I think it’s everything; it’s ‘all ands,’” Jennings said. “And I think we should have a moment of reflection around success, accountability, and failure, to do better. All of us who have been involved in healthcare policy, have known for decades about equity and disparity issues. I remember President Clinton announcing an initiative in 2000 to eliminate HC disparities by 2020. And the words are great, but actions are essential now, and we can’t have another ten, twenty years go by, and not see significant improvement in addressing these issues. And those of us in the healthcare are culpable, because we’ve known about it, so we have a responsibility to remedy it. So we need to work with leaders at the federal and state levels, and also at the community level. We need to address the siloed worlds, and also address non-medical drivers of health that have contributed to the disparities. And we should not boil the ocean, but rather focus on targeted priorities that will really return an investment in these areas. And it’s not just about care and healthcare, but addressing things like nutrition, transportation, and housing, factors that are huge… I’m hoping we’ll make big steps in the next years.”
Speaking of the bigger picture around healthcare policy, Eyles told Jennings that “Medicaid is also a critical piece of the package, and you noted some of the new expansion incentives for non-expanded states like Florida or Texas. What do you think are the most important areas for policymakers to focus on, with respect to Medicaid, and will any of those non-expansion states be more likely to expand, now?”
“In the future, we need to prepare as a country that if we ever have another pandemic, we should put in place countercyclical policies. It should be automatically in place, and I hope that Congress will be looking at that, in the next round of infrastructure priorities. Also, there is a substantial FMAP increase [a Federal Medical Assistance Percentage for Medicaid] for the states if they expand not just for the covered population, but for the entire Medicaid population. CBO endorses the idea that there will be some expansions. Still, it’s unlikely that all states will expand in the same way. And the fact that we have large populations with no access to healthcare, is outrageous, and if we’re serious, we can no longer tolerate that. So I suspect that there will be new approaches to incent states to expand coverage. And I think that this will be a priority of the Biden administration going forward,” he said.
Later, Humana president and CEO Bruce Broussard appeared on-screen. “Bruce, can you speak to why the private sector is best positioned to lead on affordability and access?” Eyles asked.
“What creates innovation is competition,” Broussard responded. In programs like Part D and Medicare Advantage and the exchanges, is that this competition really pushes innovation around price, affordability, access, clinical models. Part D—we have plans that are at $5-6, plans at $15 per month. That’s an example of the private sector continuing to compete against each other. With the right regulation, competition creates innovation. I think that payment model is so important. We’ve seen that in areas like MA, where penetration has gone from 20 percent to 40 percent. Importantly, minority coverage is about 28 percent in MA versus 20 percent in main Medicare.”
Indeed, Broussard said, “We continue to see innovation around value-based payment models, and I see great private-sector embrace of public-sector payment models, as well as the ability to work with employers. We feel that telehealth and home-based telehealth access, will continue to innovate, along with home care and hospital at home, and the use of care coaches. And then the last thing we see is this ability from science and technology to personalize the experience through NLP [natural language processing]. We’re using NLP at Humana to identify who is best to help serve the individual. We see proactive care in machine learning, and the ability to use interoperability to reduce the silos in healthcare, to help us to integrate. And lastly, genetics. The ability for us to come out with vaccines in such a short period of time, using genetic makeup, is quite amazing. So I’m optimistic about the future of HC; I think there’s a lot of innovation happening, and I see public-private partnerships as having the ability to make a great impact on cost and quality.”
“As the leader of one of the most influential MA organizations, what lessons in MA an be applied to other markets?” Eyles asked.
“One is this ability to view care holistically,” Broussard responded. “That’s an important mindset. And the second thing is—I mentioned the competition side, but this ability to compete really forces you to think over how you win over the consumer, how you create a personal level of service for them, and the need to constantly improve your service and efficiency, is so important. And lastly, the ability to constantly improve outcomes. How do we reduce downstream, preventable events? That really helps to drive cost reduction. One of the reasons that healthcare is costly is because of the cost of the system; and the more we can impact the cost of the system, the more we can make it affordable for everyone.”
