The new deal extends the contract through the end of 2024.
Anthem Blue Cross and Sutter Health have agreed on a multi-year extension to their existing contract that was set to expire in 18 months, the two sides announced.
The new deal extends the contract through the end of 2024.
"We are pleased to continue working with Sutter to make healthcare simpler and more accessible," John Pickett, Anthem's regional vice president of provider solutions, said in a media release.
"We value the relationships we have with the providers in our network, which are important to creating choices for our consumers and fulfilling our mission of improving the lives of the people in the communities we serve," Pickett said.
The contract applies to Anthem customers enrolled in Medi-Cal, HMO and PPO plans and provides continued in-network access to providers and affiliates of Sutter Health, the largest health system in Northern California.
Sutter spokeswoman Grace Davis said the extension "will give our Sutter patients stability and access to our integrated network for years to come."
The health system is urging its customers to "take action" and "call Anthem at the number on the back of your insurance card and urge them to work with Dignity Health doctors and hospitals on a new agreement."
San Francisco-based Dignity Health has brought its ongoing contract dispute with Anthem Blue Cross before the court of public opinion.
In several posts on its website, Dignity – the largest not-for-profit health system in California – announced that its contract with for-profit Anthem expired in mid-July, and that patient access would be adversely affected as negotiations sputter.
"Anthem has claimed that Dignity Health's rates are exceptionally high in California, but this is simply not true," the health system said in its plea to consumers. "Dignity Health's rates are competitive with other hospitals in our markets. According to the most recent RAND Corporation study reviewing hospital prices nationally, at least eight other health systems in California have health plan rates that are higher than Dignity Health."
"Because of Anthem's unwillingness to negotiate a new, responsible contract, more than 1 million patients lost in-network access to care at most of Dignity Health's California facilities on July 16, 2021."
Describing its fight as a battle with the "nation's largest for-profit insurance company," Dignity noted that Anthem recorded $1.7 billion in profits in Q1, "exceeding even Wall Street analysts' projections. Profits are distributed to shareholders, not reinvested in patient care or expanded access."
"We are doing everything we can to restore our in-network status, including offering Anthem a proposal with rates that do not even cover hospital inflation costs and are below increases included in our prior agreements."
Dignity said the expired contract means that more than 1 million consumers will have limited – if any – access to its venues in more than 30 communities and will be "forced to travel great distances to receive the care – especially specialized care like oncology services, neonatal ICUs, pediatric care, burn centers, accredited stroke centers and more."
The health system is urging its customers to "take action" and "call Anthem at the number on the back of your insurance card and urge them to work with Dignity Health doctors and hospitals on a new agreement."
"If you receive insurance through your employer, for more information, talk to your human resources or benefits department and urge them to contact Anthem," Dignity said.
The average rate change for the past three years is only 1.1%, which also marked the third year since the launch of California's state subsidy program.
Covered California projects that preliminary health insurance rates for 2022 will increase by an average of 1.8% statewide.
The state's health insurance marketplace credited the relatively low rate hike to expanded subsidies sent to the state under the American Rescue Plan, which lowered premiums by an average of 50% for hundreds of thousands of Californians--with some paying as low as one dollar in premiums per month.
Gov. Gavin Newsom said "California is continuing to make significant progress towards covering everyone in our state, and a key part of that is to make sure folks can take advantage of the federal support through the American Rescue Plan."
"The pandemic highlighted how important it can be to have access to quality, affordable healthcare coverage, and Covered California is making that happen for more people than ever before," Newsom said.
The preliminary average rate change of 1.8% will apply to California's individual market, which covers 2.3 million people – the highest enrollment in the marketplace's history -- including the 1.6 million enrolled through Covered California and "off-exchange" enrollees who sign up directly through a health insurance carrier.
From 2020 to 2022, Covered California payers said that the improved risk mix from new enrollment has contributed to lowering premiums by 3% to 5%. Other factors have caused premium trends to be below the usual medical cost trend of 5% to 7%, such as the impact of the COVID-19 pandemic and deferred care.
The average rate change for the past three years is only 1.1%, which also marked the third year since the launch of California's state subsidy program.
"Healthcare costs are never a one-year story," said Peter V. Lee, executive director of Covered California. "The past three years show how California has led the way not only by providing stability and lower costs to our consumers, but also through the state's modeling of expanded financial help, which is now reflected in the American Rescue Plan."
"By getting more people insured and lowering the costs of coverage, we are creating a virtuous cycle of more people being insured, healthier consumers and lower rates for everyone," Lee said.
The rate hike reflects changes in premiums before federal subsidies, which cover about 89% of the premium for those getting financial help. In addition, premiums will vary by region and by an individual’s personal situation.
The rate change for unsubsidized enrollees who switch to the lowest-cost plan in the same metal tier is -7.9%, which will allow many enrollees to shop for a lower gross premium.
California Association of Health Plans President/CEO Charles Bacchi said the low rate hike "makes it abundantly clear that the Affordable Care Act is thriving in California."
"With the expanded coverage options providing most enrollees with four to five health plan choices, there is ample opportunity for consumers to shop around for even lower premiums, he said. "With record enrollment in California's individual marketplace along with new state polices extending Medi-Cal to more undocumented Californians, we are well on our way to closing the uninsured gap in California."
The special enrollment period runs from November through the end of 2021.
Virtual care advocates note that telehealth demonstrated its value as a care option for seniors during the pandemic, when in-person care venues were shuttered.
More than 430 telehealth stakeholders are asking Congress to make permanent the reforms put forward during the public health emergency that facilitate remote healthcare.
In a letter sent this week to lawmakers, the stakeholders urged Congress to act before the PHE expires – tentatively this autumn -- and threatens to create a "telehealth cliff" for Medicare beneficiaries who've come to rely on virtual care options.
Specifically, the stakeholders are asking Congress to:
Remove "arbitrary restrictions" on where a patient must be located to be eligible for telehealth services;
Ensure that federally qualified health centers, critical access hospitals, and rural health centers can furnish telehealth services;
Authorize the Department of Health and Human Services to allow additional telehealth practitioners, services, and modalities;
Remove restrictions on telemental health services.
The stakeholders note that telehealth has demonstrated its value as a care option for seniors during the pandemic, when other care venues were shuttered.
"Because of this, many providers and health systems have made substantial investments in telehealth. Congress must act now to pass legislation to ensure patients and providers are not left in the lurch with fewer options to address critical health needs," the letter said.
The letter was co-led by the Alliance for Connected Care, American Telemedicine Association, Consumer Technology Association, eHealth Initiative, HIMSS, Health Innovation Alliance, Partnership to Advance Virtual Care, and PCHAlliance.
"One acknowledged bright spot resulting from COVID-19 has been the extraordinary use of telehealth that has allowed patients to access quality care from the convenience of their homes," Kyle Zebley, ATA vice president of public policy said in a media release.
"However, there is now much uncertainty around the future of telehealth, creating chaos and concern for patients and healthcare providers alike, as the 'telehealth cliff' threatens to abruptly cut off access to care, especially for our underserved and rural populations," Zebley said.
The 32nd annual version of widely read rankings featured mostly the same top 20 hospitals that make the list in year's past.
For the sixth straight year, Mayo Clinic sits atop the 20 Best Hospitals rankings published Tuesday by U.S. News & World Report.
The 32nd annual version of widely read rankings, which emphasizes outcomes, patient experience and risk adjustment, featured mostly the same top 20 hospitals that make the list in year's past.
Vanderbilt University Medical Center is the only new hospital to crack the Honor Roll, while Keck Medical Center of USC, Los Angeles, ranked 18th last year, was dropped from the Top 20.
Using data primarily from Medicare's Standard Analytical File, much of which predates the pandemic, hospitals across the nation in were ranked on 26 adult specialties, including: cancer, cardiology and heart surgery, diabetes and endocrinology, ear, nose and throat, gastroenterology and GI surgery, geriatrics, gynecology, nephrology, neurology and neurosurgery, ophthalmology, orthopedics, psychiatry, pulmonology and lung surgery, rehabilitation, rheumatology, and urology, U.S. News said.
This year's methodology includes seven new "bellwether" ratings that include back surgery (spinal fusion), diabetes, heart attack, hip fracture, kidney failure, pneumonia and stroke.
Honor Roll Hospitals received points if they were nationally ranked in 15 specialties – the more specialties and the higher their rank, the more points they got – and if they were rated high performing in any of 17 procedures and conditions. The top point-scorers made the Honor Roll.
The study evaluated nearly every community hospital in the nation. Only 134 hospitals out of more than 4,300 were nationally ranked in one specialty, while 563 were ranked among the Best Regional Hospitals in a state or metro area based on their performance in delivering complex and common care, U.S. News said.
Here’s the 2021-22 Best Hospitals Honor Roll. The numbers in parentheses are the 2020-21 rankings.
By greatly boosting the numbers of people using telehealth, COVID-19 may have jumpstarted broader adoption of telehealth for mental health conditions.
Latinos were the most engaged in using remote mental health services during the height of the pandemic in 2020, according to a new analysis commissioned by Anthem Inc.
The study -- Anthem, Inc. State of the Nation’s Mental Health – looked at Medicaid trends in 14 states in 2020 and found that, for people with existing mental health conditions, telehealth access to rose precipitously for all races and ethnic groups during the pandemic and accounted for 49% of all Medicaid mental health visits during a six-month period in 2020.
The study speculates that by greatly boosting the numbers of people using telehealth, COVID-19 may have jumpstarted broader adoption of telehealth for mental health conditions – especially with Hispanics/Latinos.
"In fact, during COVID-19, almost 40% of Hispanic/Latino members had a telehealth visit, while White members had 34%, Asian members had 33% and Black members had 28%, the study said.
"Overall gaps in getting mental health care between races and ethnic groups remained essentially the same before and during COVID," the study said. "A higher percentage of Hispanic-Latinos were already receiving in-person or telehealth mental health visits before COVID-19."
Despite the dramatic boost in telehealth visits during the pandemic, it didn't make up for the dramatic drop in in-person visits for all races and ethnic groups, and the study found there there were significant differences among them.
"In fact, Black people had the lowest percent of combined telehealth and in-person visits – 56% – before COVID-19 and remained the lowest with 49% after COVID-19," the study said.
"On average, Black people had 7% fewer mental health visits compared to White people with similar demographic, clinical and socio-economic backgrounds. The rates are particularly noteworthy as surveys have indicated that people of color were experiencing more stress and mental health conditions than other populations in 2020 and people of color were disproportionately impacted by COVID-19," the study said.
Historically, major depression and anxiety are underdiagnosed at rates of 32%-40% less in Black and Hispanic/Latino communities, according to the BCBS Health Index.
The American Psychological Association says that lower diagnosis rates are likely driven by lack of provider understanding of cultural differences, stigma around diagnosis or treatment and barriers getting care.
Anthem Chief Health Officer, Shantanu Agrawal, MD, said there could be a number of reasons why Black people are lagging in mental health care visits, both in-person, and remote, including a history of "culturally insensitive care."
"Health equity is a key driver for mental and physical well-being," Agrawal said. "To achieve equity in our healthcare, we need to understand where and why barriers to health exist, and then couple these insights with the scale and scope of Anthem to drive changes to a new system of health, that puts equity at the center."
The most common telehealth diagnoses for Medicaid members with existing mental health conditions were anxiety, depression and bipolar disorder, according to the special State of the Nation’s Mental Health report. High blood pressure was among the top five diagnoses for Black, Asian and Hispanic/Latino people, while high cholesterol was a top five medical diagnosis for Hispanic/Latino and Asian people. Opioid use disorder was one of the top five diagnoses for White people, while severe back pain was a top diagnosis for Black people. These data reinforce that mental health and physical health are connected and improving one can help the other.
"While telehealth wasn't a panacea in eliminating health equity gaps, it helped boost connectivity for all and made Internet visits possible when COVID temporarily closed physical doors, allowing health care to continue to be delivered with some semblance of normalcy," Agrawal said.
"This study is a key reminder that technology alone won't be sufficient to bridge this gap and the bridge may not be the same for all people. However, it may be the connector needed by certain communities or geographic areas. Clearly, outcomes during the pandemic would have been much worse without telehealth," he said.
The new platform provides patients with hundreds of videos and more than 8,000 leaflets in 20 languages and at a remedial reading level.
Wolters Kluwer on Tuesday launched an interoperable patient platform that the software vendor says will provide patients with remote access to easily understood healthcare educational content.
The new platform, EmmiEducate™ provides patients with hundreds of videos and more than 8,000 leaflets in 20 languages and at a remedial reading level, so they can better understand their health issues and act accordingly.
In an email exchange with HealthLeaders, Jason Burum, a general manager at Wolters Kluwer, says EmmiEducate is designed to "improve alignment between patients and their care teams."
Ultimately, Burum says, "EmmiEducate will meet health system requirements for patient education while helping to reduce unwanted clinical variability, improving workflow efficiency and empowering patients."
"Unwarranted variability in care is a huge challenge impacting quality and cost, and an important tool in addressing the issue is the harmonization of the education a patient receives with the tools clinicians use to guide their care decisions every day," he says.
"With educational content tailored to a variety of learning and reading styles, and interoperability across disparate systems and access points, EmmiEducate gives providers the ability to easily support their patients' information needs within their workflow, delivering easy-to-understand educational materials that mirror the guidance provided to patients during the clinical encounter."
Burum says the platform allows providers to give patients access to content in several ways, from electronic medical records, from remote access, and from the bedside. As needs expand, Burum says, the platform will expand to include "smart outreach programs," and engagement tracking.
"With the addition of EmmiEducate to our solution set, we believe patients will become more empowered as partners in their healthcare," he says. "With better educated patients, hospitals could expect to see fewer readmissions, visits to the ED, patients better prepared for procedures and more likely to adhere to care plans."
The platform is billed on a "per bed" basis, with a range of pricing if the customer is new or adding EmmiEducate to existing WKL platforms.
Burum says the platform has several integration options to fit organizational capabilities.
"EmmiEducate integrates directly into the EMR, allowing providers to deliver this content more efficiently and making it easier to recommend, preview, and assign content," he says, adding that the platform has a website that allows patients to get health answers 24/7.
Favorable patient responses and new investments in the technology will propel the growth of telehealth in 2021
After a spike at the onset of the coronavirus pandemic, telehealth use has stabilized at levels 38 times higher than before the pandemic.
This strong continued uptake, along with favorable patient responses, and new investments in the technology will propel the growth of telehealth in 2021, according to a report from McKinsey & Co.
Overall telehealth use for office visits and outpatient care was 78 times higher in April 2020 than in February 2020, representing nearly one-third (32%) of office and outpatient visits for the month.
The surge in telehealth use was prompted by the pandemic, the shutdown in in-person visits, an increased willingness by patients and providers to use telehealth, and the availability of federal reimbursements for telehealth.
Since that high-water mark, "utilization levels have largely stabilized, ranging from 13% to 17% across all specialties," McKinsey wrote. "This utilization reflects more than two-thirds of what we anticipated as visits that could be virtualized."
"It would likely require sustained consumer and clinician adoption and accelerated redesign of care pathways to incorporate virtual modalities," the analysis said.
McKinsey identified other causes for the growth in telehealth, including:
Improving provider and consumer attitudes about telehealth since the pre-pandemic era.
Regulatory changes to expand telehealth, such as the expansion of reimbursements for virtual services by the Centers for Medicare & Medicaid Services. However, McKinsey warned that there is growing uncertainty about the status of those reimbursements when the public health emergency expires.
The skyrocketing growth of venture capital investment in digital health, which in 2020 was three times the level seen in 2017.
The ongoing evolution of telehealth care and business models, expanding from virtual urgent care or primary care to a wider range of services that would include hybrid virtual/in-person visits and longitudinal virtual care.
Researchers estimate that transportation-related carbon emissions for outpatient healthcare were cut nearly in half in 2020 as patients stayed home and flocked to telehealth.
The surge in the use of telehealth in 2020 saw a corresponding and dramatic drop in greenhouse gasses created by patients otherwise traveling to ambulatory care venues, a new study shows.
"The rapid and widespread adoption of telehealth during the COVID-19 pandemic has had significant environmental health benefits, primarily through reduction in transportation-associated emissions," the study authors wrote.
"If the US healthcare system were to maintain or expand upon current levels of telehealth utilization, additional reductions in GHG emissions would potentially be achieved through impacts on practice design. Ambulatory visit carbon intensity would be an effective way to measure these changes," the researchers wrote.
The study –- published in the August issue of The Journal of Climate Change and Health -- estimates that greenhouse gas emissions had been steadily rising from an estimated 18,473 tons of carbon emissions in 2015 to 19,569 tons in 2019, before falling off a cliff in 2020, dropping to 10,537 tons during the pandemic.
Another metric, the carbon-intensity of outpatient visits, was cut in half over the five years examined, a decreased from 8 kg CO2-eq per visit in 2015 to 4 kg CO2-eq in 2020. While the carbon-intensity was falling from 2015 to 2019, it saw its biggest decline in 2020.
"At the same time, telehealth visits had been growing quickly, at 39.3% per year through 2019, and then jumped in 2020 by 108.5%, for an overall increase of 669.6% or 53.2% per year during 2015–2020," the study noted.
The retrospective review relied on outpatient data from more than 600,000 patients at an unnamed health system in the Pacific Northwest. The researchers calculated average distance traveled to the care venue – 17.4 miles -- and calculated the transportation-related GHG emissions generated by an estimated 194 million automobile miles, 2.1 million bus miles, and 2.1 million bicycle miles traveled by patients for in-person visits in 2015–2020.
From 2015 to 2020, the health system saw 15.6 million total outpatient visits increased at 3.2% annually, to 2.7 million. Telehealth visits increased by an average of 53.2% annually while in-person visits saw modest gains of 1.5% annually until 2020, when they declined 46.2%.
"In-person outpatient visits had been increasing at 1.5% per year through 2019, only to decline by 46.2% in 2020 during the COVID-19 pandemic, yielding an overall decline during the study period of 43.0% (8.1% per year)," the study said.
The study authors said their results "likely underestimates emissions reductions."
"We did not account for decreased commuting by healthcare providers conducting telehealth visits from home," they wrote. "Furthermore, the environmental benefit of telehealth may not be limited to reductions in transportation-associated emissions if increased virtual care permits healthcare systems to care for more patients without increasing outpatient clinic space."
In the first six months of 2021, total revenue was the second highest in recent years at $17.2 billion with 27 transactions.
Health systems continue to see solid revenues even as they shift from acquiring smaller, independent hospitals and instead form regional partnerships, a new analysis from Kaufman Hall shows.
In the first six months of 2021, total revenue was the second highest in recent years at $17.2 billion with 27 transactions. In 2020, revenue for the same span was $17 billion with 43 transactions.
"For health systems, partnerships focused on resource sharing within a defined geography proved valuable during the heights of the COVID-19 pandemic," KH said. "Strong regional market presence allowed health systems to partner with health plans and local employers by offering the necessary scale for population-health-focused initiatives. By partnering with well-established organizations, health systems can preserve and leverage local knowledge within a newly combined organization."
Deal activity for Q2 2021 was below pre-pandemic averages with 14 announced transactions, though this was consistent with Q2, 2020 levels. KH said the fewer deals were offset by a high number of transactions with seller revenues above $500 million, including one "mega-merger" involving Spectrum Health and Beaumont Health, with combined annual revenues of more than $1 billion.
Many of the deals in Q2 2021 were concentrated in the Southeast, with Georgia reporting three deals involving eight hospitals and about $11.5 billion in transaction revenues.
In addition to the Spectrum / Beaumont proposed merger, other significant deals in Q2 included:
Tenet Healthcare's planned sale of five hospitals in south Florida's Miami-Dade and Broward Counties to Steward Healthcare System.
Piedmont Healthcare's planned acquisition of four Georgia hospitals from HCA Healthcare; in a separate announcement, University Healthcare System in Augusta, Ga. Said it would join Piedmont Health.
HCA's planned sale of a fifth north Georgia hospital—Redmond Regional Medical Center in Rome, Ga.—to Florida-based AdventHealth.
Rush Health Systems' plan to merge with Louisiana-based Ochsner Health.
The Medical University of South Carolina's plan to purchase three hospitals in Richland County and adjacent Kershaw County from LifePoint Health.
