Payers, Plan Sponsors Hope for 2022 Telehealth, Drug Price Laws

by Peter Johnson

Carriers and plan sponsors are taking stock of what federal policies deserve a fresh look as they work though tumultuous events like the pandemic and the telehealth boom. In the next year, major industry trade groups plan to push for policies including drug price reform and comprehensive telehealth regulation. 

Groups Outline Their Goals 

• For the Alliance of Community Health Plans (ACHP), a trade group of nonprofit carriers, top priorities include changing Medicare Advantage risk adjustment rules to account for audio telehealth encounters, making some pandemic-era rules for telehealth permanent and passing drug price reforms.  
• Meanwhile, the Purchaser Business Group on Health (PBGH), a health benefits management and policy group for large employers, also plans to lobby for drug price reform and comprehensive telehealth regulation. 

Telehealth Evangelists Aim to Combat Skeptics 

• Both groups agree telehealth should be an area of focus for lawmakers next year. But there is a vast range of policy ideas; as of November, forty-four bills had been introduced by members of Congress from both parties and in both chambers to address telehealth issues, according to JD Supra. 
• “All of us who believe in [telehealth] and are seeing the benefits of it — we have an important job to do over the coming months to really demonstrate why it is effective, why consumers love it so much, the ways in which it can reduce costs, and really answer some of the skepticism,” Ceci Connolly, president and CEO of ACHP, tells AIS Health.  
• Shawn Gremminger, PBGH’s policy director, says PBGH hopes that Congress and the Biden administration will take actions to prevent providers from charging a facility fee for telehealth. Pay parity is another hot topic: Early in the pandemic, the Trump administration mandated that Medicare must reimburse most telehealth visits at parity with traditional visits; some states also have laws that create similar mandates. 

PBGH Sets Sights on Provider Consolidation 

• Gremminger says that plan sponsors also hope the Biden administration will take an aggressive stance against provider consolidation — which has reached unprecedented levels, according to a recent PwC analysis. He adds that slowing down mergers could help arrest the growth of health care premiums. 
• “We have a bill that was introduced in the fall that we are really pleased about. We’re looking to work with the administration, who I think is very focused on this — issues around both market competition and consolidation among health systems,” he says. 

From Health Plan Weekly