7 Achievements and Recommendations from the Alliance of Community Health Plans

"We know nothing in healthcare will be successful if we do not have a way to pay for it—and if [it] does not serve everyone in a community." — Alliance of Community Health Plans

Community health plans are often the unsung heroes in their markets, demonstrating close relationships with local providers and a deep knowledge of community needs. Covid-19 has made these bonds even more important, and inspired innovations that meet immediate pandemic needs while driving longer-term solutions. Local payers are taking these same actions, summarized by the Alliance of Community Health Plans in its 2021 Report on Affordability and a recent blog on federal policy recommendations for 2022.

Here are the top seven achievements and recommendations from ACHP and its members, which represent approximately 25 community health plans offering diverse lines of business across the U.S.

1. Expanding telehealth.

Service areas have included mental health; physical, occupational, and speech therapy; and even medication management, including dialysis. Telehealth aligned naturally with these and other services, with the Centers for Medicare & Medicaid Services (CMS) aiding and extending reimbursement beyond the public health emergency (PHE). Along with many stakeholders, the ACHP is calling for CMS to continue broadening telehealth’s potential.  

2. Creating remote admission and monitoring infrastructures.

The pandemic and telehealth technology have advanced hospital-at-home and remote monitoring. In addition to large payers, 75% of community plans have created or expanded these programs with the ACHP reporting "significant savings for both consumers and the health system, plus improved consumer satisfaction."

3. Designing virtual-first health plans.

Three "provider-aligned" ACHP plans—Harvard Pilgrim Health Care, Kaiser Permanente, and Priority Health—introduced virtual-first offerings in 2021, mirroring national payers such as UnitedHealth Group, Cigna, and Aetna. ACHP plan premiums were up to 20% lower. Harvard Pilgrim and Priority partnered with Doctor on Demand while Kaiser was able to build on a strong, existing telehealth foundation.

4. Calling for a better Medicare Advantage.

Among the ACHP’s policy recommendations is a strengthening of Medicare Advantage (MA) for the growing mass of older Americans aging and whose expectations differ. Specific suggestions include better ways to measure quality—a concern shared by the MA oversight agency, MedPAC—and to document patient status, particularly for data gathered from remote encounters.

5. Maintaining access.

There is a reason why states like Nevada are creating public options: between Medicaid and the marketplace, gaps in affordable coverage remain. There are still 12 states that have not expanded their Medicaid programs and an additional five did so in 2020 or later. There is also no guarantee that the federal government will make COVID-19-era subsidies permanent. The ACHP also notes a Medicaid redetermination process that remains complex for people whose eligibility shifts due to personal income changes.

6. Making health equity commitments permanent.

Here, the AHCP’s recommendations range from sustained funding and initiatives to standardized health data collection, two approaches for understanding just how uneven the playing field is and how to level it.

7. Controlling prescription drug costs.

While Build Back Better as a comprehensive package has likely fizzled, components with increasingly-hard-to-come-by bipartisan support could find new life as individual measures. This includes drug cost control measures ranging from federal negotiating power to faster generic approvals.

These achievements and recommendations reflect the ACHP’s broader 10-year Roadmap to Reform, which emphasizes collaboration, value, and community health.