Along with getting the economy in order, healthcare is high on the new administration’s agenda. Short and long-term healthcare goals have been established, and some will likely be implemented through executive orders.
TransUnion Healthcare’s Jonathan Wiik, Principal of Healthcare Strategy, and Anna Rosenberg, Sr. Consultant of Government Relations, weigh in on expected healthcare policies in 2021 and their impact on the industry.
Fighting COVID-19: Response and implications
One of the most urgent tasks for the new administration is to get an upper hand in the fight against COVID-19. As part of this urgency, a $1.9 trillion COVID relief bill — modeled on President Biden’s ‘American Rescue Plan’ — has been signed into law.
Some of the key healthcare provisions within this bill include:1
- Accelerating COVID-19 vaccine distribution and administration to achieve herd immunity
- Expanding subsidies in ACA marketplaces
- Providing $8.5 billion in funding to rural providers suffering loss of revenue due to COVID-19
- Providing new incentives for Medicaid expansion, and extending the Federal Medical Assistance Percentage (FMAP) increase
- Allowing those who became unemployed in 2021 access to the Health Benefit Exchange Silver plans with $0 premiums
These provisions help providers offset uncompensated care by increasing coverage and funding options on the governmental plans, as well as applying direct funding to continue their fight against COVID-19. Additionally, throughout the pandemic, CMS has instilled nearly 200 COVID-19-related waivers and regulations centered primarily on access, reimbursement and quality reporting.
The overall plan to help beat the virus while also being able to ease regulatory burdens for providers is an ambitious one. However, with this plan in place, overall recovery from the pandemic should be more achievable.
Bolstering the Affordable Care Act and Medicaid
The ACA continues to be a partisan issue. The recent executive order asks for a comprehensive review of the Affordable Care Act (ACA) and Medicaid.2 The order directs states to reconsider rules and other policies limiting access to healthcare and determine actions to help protect and strengthen that access.
As of today, 39 US states (including Washington D.C) are enrolled in the Medicaid Program, and research has shown the Program has significant benefits to improving hospital bottom lines and the health of the general community. If the ACA remains, the current leadership will likely push for increased public options and continued Medicaid expansion to protect and strengthen the public’s access to healthcare.
Navigating price transparency mandates
Hospitals have long guarded topics around pricing and costs of care, but rising customer expectations and increased pressure by CMS is pulling back the curtains. A new payer transparency rule slated to go live Jan. 1, 2022 would require health plans to make available to the public three separate machine-readable files that include detailed pricing information. Litigation around these new rules is likely as some payers don’t necessarily want to share their highest negotiated rates. As noted by CMS, the path to compliance lies in using payment/price estimators. Some payers will embrace this rule and make it a part of their enrollment strategy, while others will take it up in court.
Rising telehealth: The new reality or a temporary necessity?
Telehealth services have increased — and are more widely adopted — as a result of the ongoing pandemic. Telehealth maxed out at 80% of all ambulatory visits during the peak of the pandemic in March of 2020, and as of today, 20% of visits are telehealth visits.3 While it’s not expected these visit types will ever fully replace in-person visits, they likely aren’t going away. In our recent survey with patients who have used telehealth services, over two-thirds (67%) said they’d be at least somewhat likely to continue using this option once the vaccine is distributed. The key to sustaining this visit type as a revenue stream will be to achieve payer parity while making concessions in payer discounting for a lower-intensity service.
Curbing surprise billing
The No Surprise Act, included in the Dec. 2020 COVID Relief Package, aims to protect patients with health insurance from surprise medical bills, and calls for the dispute process to be observed by independent arbitration provisions. This act also outlines facilities may not bill a patient more than the cost-sharing requirements within their health plan or balance bill the patient unless the notice and consent requirements are met fully.
COVID-19 led to a massive shift in our healthcare industry, and additional disruptions can be expected as a result of heightened attention to patient care and experience. It’s imperative for providers to keep patients on the forefront as they strive to achieve revenue excellence.
For additional market trends and insights, visit: https://www.transunion.com/insights/healthcare