MDLIVE specializes in providing 24/7, on-demand, online telehealth services for patients, hospitals, physician groups, employers and payers.
Cigna health services subsidiary Evernorth has completed its previously announced acquisition of privately held MDLIVE Inc., a 24/7 telehealth delivery platform, the Bloomfield, Connecticut-based company announced this week.
Financial terms of the deal were not disclosed.
The transaction, first announced on February 26, "expands Evernorth's capabilities to lower the cost of care – while increasing access to healthcare providers – through virtual visits that can be accessed from the home or anywhere," the Bloomfield, Connecticut-based company said in a media release.
Miramar, Florida-based MDLIVE specializes in providing 24/7, on-demand, online telehealth services for patients, hospitals, physician groups, employers and payers. Evernorth executives say the acquisition comes as more Americans grow comfortable with virtual care.
"By bringing MDLIVE into Evernorth, we have a highly complementary platform that will rapidly expand our capabilities to deliver greater affordability, predictability and simplicity for our customers and clients," said Evernorth President and COO Eric Palmer. "Evernorth is uniquely positioned to bring new, differentiated and future-state care solutions that substantially lower medical costs and improve the overall healthcare experience."
MDLIVE will continue to serve its existing clients and customers and expand access to virtual care as a Evernorth health services subsidiary, which already includes Express Scripts, Accredo and eviCore.
"MDLIVE and Evernorth share a common vision and passion for changing healthcare for the better," said Charles Jones, chairman and CEO of MDLIVE. "Together, we can accelerate the delivery of new virtual care capabilities in a way that will optimize the care journey for our clients and customers."
ACA marketplace enrollment would increase 60% in 2022 by extending ARPA's temporary subsidies.
The numbers of uninsured people in the United States would fall by 4.2 million if the temporary health insurance subsidies in the American Rescue Plan Act were made permanent, according to a new study by the Urban Institute.
The study, commissioned by the Robert Wood Johnson Foundation, estimates that subsidized enrollment would increase by 5.1 million, and that 317,000 people with non-Affordable Care Act-compliant coverage would switch to a more comprehensive ACA-compliant plan if they were to become newly eligible.
When those estimates are combined, the report said, it could lead to a 60% increase in marketplace enrollment in 2022 if the ARPA were to become permanent.
"Making the enhanced ACA subsidies in the American Rescue Plan Act permanent would have a dramatic effect on both coverage and affordability," said Katherine Hempstead, a senior policy adviser at RWJF.
"Enhancing premium tax credits could positively impact the marketplace, leading to greater insurer participation and resulting in lower premiums. That’s good news for consumers and insurers," she said.
Under the ARPA, people with incomes over 400% of poverty are eligible for subsidies to buy health insurance on the ACA marketplace. The law also increases financial assistance for lower-income people who were eligible for ACA coverage. Both provisions took effect retroactively on Jan. 1, 2021 and will expire in two years.
President Biden is expected to sign the bill, which has already cleared the Senate.
A bipartisan U.S. House on Tuesday night voted 384-38 to delay until the end of 2021 Medicare's reviled 2% across-the-board sequestration cuts that were supposed to take effect on April 1.
The Senate passed the bill 90-2 last month and President Joseph R. Biden is expected to sign it in the coming days. To pay for the estimated $18 billion in delayed cuts, the bill increases the fiscal year 2030 sequester cuts.
American Medical Association President Susan R. Bailey, MD, said the overwhelming support in Congress for delaying the cuts "acknowledges that cutting Medicare payments during a pandemic is ill-conceived policy."
"Physician practices are already distressed, and arbitrary 2% across-the-board Medicare cuts would have been devastating," she said.
Rick Pollack, president and CEO of the American Hospital Association, said the delay was needed while hospitals and clinicians contend with the coronavirus pandemic and ongoing vaccination efforts.
"Even though our country is making great progress by vaccinating millions of people a day, it is clear that this pandemic is far from over and that there is an urgent need to keep hospitals, health systems and our heroic caregivers strong," Pollack said.
Anders Gilberg, senior vice president, government affairs, at the Medical Group Management Association, said his association was "relieved that Congress heeded our call to protect medical groups from the arbitrary 2% Medicare sequester cuts through the end of 2021."
"MGMA has long opposed the sequester cuts, a tax that penalizes medical practices for Congress’ inability to meaningfully address the country’s budgetary affairs," Gilberg said. "To reinstate the Medicare sequester in the middle of a global pandemic would threaten the viability of physician practices and adversely impact the patients they treat."
With the extension in place, Gilberg urged Congress "to work in a bipartisan manner to expeditiously pass legislation that would prevent an additional 4% Medicare spending cut next year due to the budgetary effects of the American Rescue Plan."
The bill also tweaks the rural health clinic provisions in the Consolidated Appropriations Act, 2021. Specifically, requirement that the payment rate for RHCs be capped at $100 per visit beginning April 1, 2021.
The rate will increase gradually based on the Medicare Economic Index, but the AHA said it will remain well below typical provider-based RHC rates.
The bill also includes both Medicare-enrolled RHCs located in a hospital with less than 50 beds and RHCs that have applied for Medicare enrollment as of this date.
Medicare also faces a separate 4% cut -- about $36 billion -- owing to the Pay-as-You-Go mandates that offset the cost of the American Rescue Plan Act. The House had already passed a bill eliminating PAYGO for the stimulus bill, but the Senate did not act on it.
Pollack said the AHA will continue to press Congress and the Biden administration for more "support, resources and tools" for the nation's hospitals.
"This includes continuing to advocate for more overall funding for the Provider Relief Fund, relief for hospitals and health systems with Medicare accelerated payments, hospital and health system priorities to be included in the upcoming infrastructure legislative package and Congressional action by the end of the year on Medicare cuts due to the effects of PAYGO," he said.
AMA president applauds the initiatives announced this week but calls them 'just a first step.'
President Joseph R. Biden's proposals to require serial numbers and background checks for "ghost guns" and model legislation for "red flag" laws that identify potentially dangerous gun owners are getting healthy reviews from physicians.
Susan R. Bailey, MD, president of the American Medical Association, applauded the administration for its "bold action" on a "public health crisis" that claims more than 40,000 lives each year, but stressed that the proposals "are just a first step."
"People die every day—and almost every place—in our country from firearm-related injuries. Movie theaters, grocery stores, places of worship, and elementary school classrooms have all been scenes of violence," Bailey said in prepared remarks. "Most of these deaths are preventable, and now is the time for lawmakers, policy leaders and advocates on all sides to seek common ground and save lives."
The AMA in 2016 declared firearm-related violence a public health crisis and one of the leading causes of intentional and unintentional injuries and deaths in the United States.
Biden on Thursday rolled out the initiative, which comes in the wake or shootings in Georgia and Colorado that have claimed 18 lives. The president called the nation's gun violence epidemic "a national embarrassment,"
He also conceded that his options to address the problem through executive authority are limited and that more aggressive action to curb gun violence would require action from Congress.
"We’ve got a long way to go — it seems like we always have a long way to go,” Mr. Biden said during an appearance in the Rose Garden, The New York Times reported.
Jacqueline W. Fincher, MD, president of the American College of Physicians, said the initiatives put forward this week by Biden "are consistent with the types of recommendations that ACP put forward in our 2018 policy paper Reducing Firearm-Related Injuries and Deaths in the U.S."
"In the past year, even as the US has been fighting a global pandemic, injuries and deaths from firearms increased more than any other year in the past two decades," Fincher said. "Advocating for policies, like those announced today, to reduce the toll of these injuries and deaths is in the medical profession’s lane—this is our lane —as is any issue the causes harm to our patients and could be prevented by sound public policy."
Fincher called on Congress to step up and advance other gun control measures, including universal background checks on firearms sales and a ban on assault weapons.
"Deaths and injuries from firearms are avoidable and preventable," Fincher said. "Changing the laws that surround the purchase and use of guns, in ways that are fully consistent with the second amendment, is something that must be done in order to end this crisis that America is facing."
More than half (54%) of government hospitals, 36% of nonprofits, and 43% of for-profits provided less than $1 of charity care for every $100 of expenses.
Tax-exempt nonprofit and government hospitals aren't meeting their obligations for charity care, according to a new study in Health Affairs.
Using 2018 Medicare data that compared charity care at 1,024 government, 2,709 nonprofit, and 930 for-profit hospitals, researchers from Johns Hopkins University’s Carey Business School and Bloomberg School of Public Health found that nonprofit hospitals spent $2.3 on charity care out of every $100 in total expenses, which was lower than government ($4.1) or for-profit ($3.8) hospitals.
The report also found that 54% of government hospitals, 36% of nonprofits, and 43% of for-profits provided less than $1 of charity care for every $100 of expenses.
"A large number of government and nonprofit hospitals provided little charity care," said study lead author Ge Bai, an associate professor at Carey Business School. "That seemed badly out of sync with the favorable tax treatments that these hospitals enjoy. Government and nonprofit hospitals should not have their cake and eat it, too."
"The reality is that just as other critical infrastructure, including our nation’s roads, bridges and transit systems, have aged, so too have many of our nation’s hospitals," American Hospital Association President and CEO Rick Pollack said in a March 31 letter to the president. "Many hospitals faced financial challenges prior to the pandemic, but COVID-19 has brought unprecedented financial losses."
AHA General Counsel Melinda Hatton on Wednesday challenged the Johns Hopkins findings. She cited a 2017 Ernst and Young reportshowed that for every dollar invested in non-profit hospitals and health systems through the federal tax exemption, $11 in benefits is delivered back to communities.
"The authors of this report fail to recognize that charity care is only one part of a hospital’s total community benefit," Hatton said in an email to HealthLeaders.
"Looking only at charity care does not account for the numerous programs and services that hospitals provide to meet the varied needs of their community, such as help accessing healthy food, educational programs and health screenings, transportation to ensure patients arrive at needed medical appointments, and assistance with housing and other efforts to address the social determinants of health, among many others," Hatton said.
Bai said hospital charity care obligations aren't a high priority for the Internal Revenue Service, which he said "doesn't specify any requirements for charity care or community benefits offered by a nonprofit hospital."
"On top of that, the IRS faces significant challenges in overseeing these activities or using them to determine tax-exempt eligibility. When charity care is a matter of little consequence, hospitals are not motivated to provide more," Bai said.
To move the needle, the study authors recommended a publicly disclosed ranking system for hospital charity care for all three ownership types.
"As a special form of the transparency approach, [ranking] has the potential to overcome the shortcomings of bright-line rules and promote competition among hospitals to provide more charity care," the researchers said.
“As a special form of the transparency approach, [ranking] has the potential to overcome the shortcomings of bright-line rules and promote competition among hospitals to provide more charity care,” the researchers write.
They also recommend revising the tax code to bring hospitals' provision of charity care more into line with their tax status.
AMA survey finds 94% of physicians said the prior authorization demands caused care delays, and 79% said patients gave up on treatment because of authorization fights with insurers.
Even as COVID-19 cases were spiking in late 2020, physicians complained that health insurance companies were continuing to demand prior authorization for patient care, a new survey shows.
According to the findings, commissioned by the American Medical Association, almost 70% of 1,000 practicing physicians surveyed in Dec. 2020 said payers had either gone back to past prior authorizations policies or never relaxed these policies in the first place.
Ninety-four percent of physicians said the prior authorization demands caused care delays, and 79% said patients gave up on treatment because of authorization fights with insurers, the survey found.
AMA President Susan R. Bailey, MD, said some payers had relaxed prior authorization requirements at the onset of the pandemic in early 2020, but that that changed as the public health emergency wore on.
"By the end of 2020, as the U.S. health system was strained with record numbers of new COVID-19 cases per week, the AMA found that most physicians were facing strict authorization hurdles that delayed patients’ access to needed care," Bailey said.
The survey also found that 30% of physicians reported that prior authorization requirements led to serious adverse events for patients in their care, including:
Patient hospitalization – reported by 21% of physicians;
Life-threatening event or intervention to prevent permanent impairment or damage – reported by 18% of physicians;
Disability or permanent bodily damage, congenital anomaly, birth defect, or death – reported by 9% of physicians.
The survey also found that:
Only 15% of physicians reported that prior authorization criteria were often or always based on evidence-based medicine.
90% reported that prior authorizations programs have a negative impact on patient clinical outcomes.
85% said the burdens associated with prior authorization were high or extremely high.
Medical practices complete an average of 40 prior authorizations per physician, per week, which consume the equivalent of two business days (16 hours) of physician and staff time.
40% of physicians employ staff who work only on prior authorizations.
Bailey said the findings illustrate the need to streamline or eliminate low-value prior-authorization requirements to minimize delays or disruptions in care delivery.
"Delayed and disrupted treatment due to an archaic prior authorization process can have life-or-death consequences for patients, especially during a public health emergency," she said. "This hard- learned lesson from the current crisis must guide a reexamination of administrative burdens imposed by health insurers, often without any justification."
The same surveys found that public trust in the U.S. Postal Service and the FEMA bumped up significantly over the same period.
The public's trust in the Centers for Disease Control and Prevention dropped during the coronavirus pandemic, according to a new RAND study.
Surveys of more than 2,000 people in May and October 2020 show about a 10% drop in trust of the CDC over that period, with the overall population-level trust in the agency falling to the same lower level of trust long held by Black Americans about the agency.
In contrast, the same surveys found that public trust in the U.S. Postal Service and the Federal Emergency Management Agency bumped up significantly over the same period, despite those agencies facing their own challenges.
"The Biden administration will have an uphill battle in rehabilitating trust in the CDC at this critical junction in the coronavirus pandemic," said Michael Pollard, lead author of the study and a senior social scientist at nonprofit RAND.
"A key challenge in the months ahead will be to identify who will be viewed as trusted messengers regarding vaccines and public health policies," Pollard said.
The study found that non-Hispanic whites and Hispanics reported significant declines in trust in the CDC, while the changes were not statistically significant for non-Hispanic Black or "other race" respondents.
"There is remarkable consistency and convergence in reported levels of trust in the CDC across these subgroups after the declines," Pollard said. "Lack of trust among Black Americans has been a well-publicized concern regarding the COVID-19 vaccine rollout, and the convergence in lower levels of trust across race/ethnicity highlights a key challenge that the CDC now faces."
Black Americans have long held a low level of trust in healthcare institutions, widely seen as a legacy of past racism in the nation's health system, Pollard said.
The survey respondents, all members of RAND's American Life Panel, were asked in May to rate their trust in the CDC, USPS and FEMA on a scale of 0 to 10, and again in October.
Trust in the CDC fell from 7.6 in May to 7 in October. Conversely, trust in the Postal Service rose from 6.9 in May to 7.7 in October; trust in FEMA rose from 6.4 in May to 6.7 in October.
Drop in trust of the CDC was notable among people who intended to vote for Donald Trump or another candidate other than Joe Biden in the 2020 presidential election or did not intend to vote at all. Pollard said that finding suggests that views of the CDC are now strongly politicized, although similar politicization was not observed for FEMA or the USPS.
"The public trust in federal government agencies has never been as important as during the current COVID-19 pandemic, yet public suspicions of scientific experts and distrust of government institutions are increasing for a variety of reasons," said Lois Davis, co-author of the report and a senior policy researcher at RAND.
"Reasons for this include a blurring of the line between opinion and fact, and access to more sources of conflicting information," Davis said.
Davis said the CDC could rebuild trust and depoliticize public's views of the agency by ensuring that the public understands the scientific rationale for policy changes and guidance during the COVID-19 pandemic.
HHS said four out of five consumers now enrolled in a plan through HealthCare.gov will be able to find a plan for $10 or less per month with additional ARP assistance.
Many beneficiaries enrolled in Marketplace health plans will see their premiums decrease, on average, by $50 per person per month and $85 per policy per month thanks to expanded financial assistance under the American Rescue Plan, the Department of Health and Human Services announced Thursday.
HHS said four out of five consumers now enrolled in a plan through HealthCare.gov will be able to find a plan for $10 or less per month with additional ARP assistance.
Additionally, with advanced payments of premium tax credits, an average of three out of five uninsured adults eligible for coverage on HealthCare.gov may be able to access a zero-premium plan and nearly three out of four may find a plan for $50 or less per month on HealthCare.gov, HHS said.
"Today help is here and millions of Americans can start saving money on their health insurance premiums thanks to the American Rescue Plan," HHS Secretary Xavier Becerra said in a media release. "The Biden Administration is committed to bringing down healthcare costs for families."
To spread the word on the new plan options during the special enrollment period, Becerra said HHS has launched a $50 million public awareness campaign.
Consumers who want to enroll in coverage and see if they qualify for more affordable premiums can visit HealthCare.gov or CuidadoDeSalud.gov to view 2021 plans and prices and, if eligible, enroll in a plan that best meets their needs.
Additionally, consumers can call the Marketplace Call Center at 1-800-318-2596, which helps in more than 150 languages.
Consumers in states that operate their own Marketplace platforms should visit those state websites or call centers.
AHA President and CEO Rick J. Pollack tells President Biden that the COVID-19 pandemic has crippled the nation's hospitals.
The nation's hospitals want a share of the $2 trillion infrastructure plan put forward on Wednesday by President Joseph R. Biden.
In a letter Wednesday to the president, American Hospital Association President and CEO Rick J. Pollack noted that healthcare is one of the 16 critical infrastructure sectors designated by the Department of Homeland Security, and that the ongoing COVID-19 public health emergency has left hospitals badly strained.
"As your Administration works with Congress to develop policies aimed at rebuilding our nation's critical infrastructure, as reflected in today's announcement, we urge you to prioritize support for healthcare and its vital role in addressing critical challenges including health equity, emergency preparedness, access to care and more," Pollack said.
"The reality is that just as other critical infrastructure, including our nation’s roads, bridges and transit systems, have aged, so too have many of our nation’s hospitals," Pollack said. "Many hospitals faced financial challenges prior to the pandemic, but COVID-19 has brought unprecedented financial losses."
Pollack pointed to AHA estimates that the nation's hospitals lost more than $320 billion in 2020 and would lose as much as $120 billion in 2021 because of the pandemic and the ensuing shutdown of nonessential healthcare services.
"These compounding financial pressures have resulted in delays in necessary capital spending, including for needed maintenance and physical plant upgrades," he said. "In addition, some hospitals that are in the greatest need of repair have the greatest barriers to accessing capital."
Without providing a specific cost estimate, Pollack offered recommendations for healthcare infrastructure improvements that included:
Investing in hospital physical infrastructure, including physical plant upgrades, mechanical systems, IT, medical equipment, and supplies. "In addition, hospitals face the added challenge of needing to reconfigure care delivery and “right-size” so that they can continue to transform to meet the needs of the healthcare system for the future in an effort to make care more accessible and convenient for patients," Pollack said.
Building emergency preparedness and response capacity through continued funding and structural improvements for the Hospital Preparedness Program. "The COVID-19 experience reinforces the need for sustained federal investment to support increased capacity for emergency preparedness and response," Pollack said.
Expanding healthcare digital and data infrastructure, including access to adequate, affordable broadband to enable telehealth and increase access to care, particularly for remote and underserved areas, hardening cyber defenses to protect patient privacy, and modernizing data systems that support identifying issues that affect health equity, racial and ethnic disparities, care quality, and public health responses.
Strengthening the healthcare workforce by increasing the number of residency slots eligible for Medicare funding; funding educational loan pay-downs and vouchers for clinicians and other front-line workers; providing visa relief during emergency response; funding research and demonstration programs related to clinician wellbeing; establishing grants for cultural competency training in medical residency programs and in-service training for healthcare professionals; providing grants to expand, modernize and support schools of medicine and schools of nursing in rural, underserved areas or minority-serving organizations; and rejecting reductions to Medicare funding for direct and indirect graduate medical education.
Securing the supply chain by increasing domestic production capacity and manufacturing redundancy; and reinforcing the strategic national stockpile through continuous investment so that the equipment is available in adequate amounts when it's needed for public health emergencies.
Supporting behavioral health access with funding for new behavioral care sites; renovations to improve safety at psychiatric facilities; end-user devices to upgrade audio-video technology to support behavioral telehealth; therapeutics for children and adolescents, including mobile applications, text messaging, and remote biometrics that can assist in screenings and treatment for behavioral health conditions; and interoperable electronic health records for behavioral health providers.
Blue Cross Board Trustee Kathleen Blatz will serve as interim CEO starting on April 1.
After nearly three years at the helm, Blue Cross and Blue Shield of Minnesota President and CEO Craig Samitt, MD, will retire on May 3, the company announced Wednesday.
Kathleen Blatz, a former Minnesota Supreme Court Chief Justice and a Blue Cross Board of Trustees member for more than a decade, will serve as interim CEO starting on April 1, while the board looks for Samitt's replacement.
Blatz also served as interim president and CEO for Blue Cross before Samitt's appointment in July 2018.
In an interview with HealthLeaders in January, Samitt said he had "mixed emotions about the future" as the healthcare sector emerges from the pandemic.
"My greatest worry is that we go back to the way things were," he said. "We've been calling it the 'Day After Tomorrow' strategy; that what happens in June can't be what it looked like a year ago. It just can't. We have to leapfrog over tomorrow and go to the day after tomorrow and be somewhat insistent and brave. It's not a 'new normal,' I hate that expression. A 'better future' is the way that I would describe it."
"I've long predicted that something would disrupt healthcare; COVID didn't break our system because so much was already broken in our industry," he said. "We either didn't recognize it or we weren't rewarded to fix it."
As one of the first healthcare executives to identify racism as a public health crisis, Samitt made racial and health equity the cornerstone of Blue Cross’ initiative to make healthcare more equitable.
"The impact of racism on health is expansive, and frankly, much greater than we have historically recognized or, frankly, been willing to admit," Samitt said in a March 25 interview with HealthLeaders.
"The mission of Blue Cross is to focus on high quality, sustainable, affordable, and equitable healthcare, [but] we are missing a huge driver of poor health and inequities if we ignore the impact that racism has on the health," he said.
Blue Cross Board Chairman Michael Robinson said the insurer would continue to push for racial and health equity, while working with providers to keep healthcare affordable, sustainable, and accessible.
"Our talented executive leadership team at Blue Cross will stay true to our nonprofit mission and will remain focused on the important work of accelerating the change that will make healthcare more accessible, more affordable, and more effective for everyone," Robinson said in a media release.
Before joining Blue Cross of Minnesota in mid-2018, Sammit worked at Anthem, Inc., where he was president of Anthem's Diversified Business Group, and chief clinical officer.
Blatz was Chief Justice of the Minnesota Supreme Court from 1998 to 2006. She joined the Blue Cross Board of Trustees in 2009.
In 2017, Blatz spent five months as interim chair of the Metropolitan Sports Facilities Authority, which oversees the operations of U.S. Bank Stadium in Minneapolis.
