April 23, 2021
AHIP Health IT SmartBrief
Reducing nursing home spend by 50%: Learn how today
Top Story
AHIP says a CMS rule requiring Medicare coverage of breakthrough medical devices does not sufficiently address patient safety concerns and could lead to fraud, waste and abuse. The Medicare Coverage of Innovative Technology rule, which has been delayed for CMS review, also poses operational challenges, and projections underestimate the number of devices that will qualify, AHIP says.
Full Story: Health Payer Intelligence (4/19) 
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Business management software company Intact studied data breaches from 2004 to 2020 and determined tech companies were hit the most, followed by health care providers. Facebook was on the list of the 10 most hacked companies.
Full Story: TechRound (UK) (4/22) 
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Technology Trends
Oscar Health is offering other insurers access to its full-stack technology platform through the company's new +Oscar business. Regional plans as well as plans sponsored by health care providers can gain patient insights and boost engagement through Oscar's EHR-integrated tools, workflows, and services, the company says.
Full Story: MobiHealthNews (4/21) 
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Advancing Care with IT
Harvard Pilgrim, Kaiser Permanente, and Priority Health are among the health insurers that built on last year's telehealth reimbursement models and offered plans this year focused on primary care delivered through telehealth in support of coordinated care, disease prevention, and chronic condition management. The plans appear to reduce costs without compromising care, and uptake has been positive, but barriers to market entry remain.
Full Story: NEJM Catalyst (4/15) 
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Blue Shield of California is adding two tools to its digital diabetes management platform: the Betr Health meal delivery service and the Care Compass shared decision-making tool, which facilitates sharing of blood glucose levels, medications, and other data.
Full Story: Becker's Hospital Review (4/16) 
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Highmark Health and ChristianaCare are collaborating on a data-driven, value-based care model in Delaware. The partners will set up a design center for data- and technology-driven digital health tools for improving outcomes, efficiency and the patient experience, and they will build on ChristianaCare's Center for Virtual Health, where virtual primary and specialty care tools are developed, tested and deployed.
Full Story: FierceHealthcare (4/21) 
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Government and Regulatory
Substantial changes to the Affordable Care Act are likely off the legislative table for the foreseeable future, but smaller changes with bipartisan support may be forthcoming, says Premier CEO Susan DeVore and former acting CMS Administrator Andy Slavitt. The Biden administration might reverse some Trump administration health care policies, such as Medicaid block grants, but some may prove politically sensitive, such as rules for association-offered and short-term coverage.
Full Story: MedCity News (4/22) 
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Health Insurance Exchanges
Enrollment in health plans for 2021 through HealthCare.gov and state-run exchanges was about 5% higher than signups during open enrollment for the 2020 plan year, but enrollment remains below the 2016 peak level, according to a CMS report. The proportion of enrollees who are new to the marketplace has declined to 21%, compared with 25% in the 2020 plan year and 39% for 2016.
Full Story: Health Affairs Blog (4/22) 
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Health Insurance Provider Company News
Solution Provider News
Another can't-miss keynote session at AHIP Institute & Expo Online (June 22-24). Hear from Dr. Mandy Cohen (NC Dept. of HHS), Cain A. Hayes (Gateway Health), Dr. Cheryl Pegus (Walmart), and Dr. Cameron Webb (White House COVID-19 Response Team). See all the speakers and keynote sessions on the agenda. Limited time: $0/Discount registration. Ends May 14. Register today.
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White papers and case studies submitted by our Affiliate Organizations (AOs) bring you the latest thinking on current topics in health care. This month's features include Blue Health Intelligence on their Whyzen Analytics solution; Availty on streamlining authorizations; MOBE on personalized health technology; Amplifon on MA hearing benefits; Boulder Care on telehealth addiction treatment; and Zipari on consumer experience solutions.
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Christopher Walken,
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  Member Engagement Manager
  Assistant Vice President - Compliance and Privacy - Ochsner Health Plan
  Vice President, Network Management
  Senior Vice President, Managed Care Strategy
  Project Associate, Operations
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