Anthem, Kroger Partner for Medicare Advantage; CMS Overspends on Generic Drugs

July 20, 2021 - In the modern-day take on A Tale of Two Cities, the threat of COVID-19 has become a matter of where you live, putting clearly in harm's way those without the power to be vaccinated or avoid the highly contagious Delta variant.

Anthem, Kroger Strike Medicare Advantage Deal

Anthem Blue Cross and Blue Shield and Kroger Health have announced that they will be partnering to offer a Medicare Advantage plan in 2022. The Medicare Advantage plan will be offered in four regions, primarily in the midwest and on the east coast: Atlanta, GA; Louisville, KY; Cincinnati, OH; and southern Virginia.

From the payer’s end, the partnership will leverage Anthem’s experience with provider networks and membership. Meanwhile, the healthcare branch of a major retail company—The Kroger Co.—will offer its expertise in the member’s shopping and healthcare journey.

Kroger Health ranked third among retail companies in 2018 based on revenue, trailing behind Amazon.com with over $119 billion in revenue, according to the National Retail Federation. However, another strength it may add to this partnership is that it is strategically positioned to offer healthcare services to many communities, given the company’s reach. READ MORE

Medical Debt Proves a Major Problem for Black, Latinx Adults

Black and Latinx adults were more likely to incur medical debt and income loss during the pandemic, according to a new survey from the Commonwealth Fund. More than half of surveyed Black adults and almost half of Latinx adults reported having medical bill problems and debt, compared to 32 percent of White adults.

The Commonwealth Fund surveyed over 5,400 adults between the ages of 19 and 64 across the nation between March and June of 2021.

Almost half of Black adults and Latinx adults reported experiencing income loss during the pandemic, compared to a third of all US adults. Of all survey respondents who had employer insurance coverage, one-third said they had a medical bill problem. Almost half of adults with individual and marketplace coverage also said they are struggling to pay off medical debt. READ MORE

Medicare Significantly Overpays for Generic Drugs

Medicare overspent by 13.2 percent in 2017 and 20.6 percent in 2018 compared with Costco pharmacy member prices for the most commonly prescribed generic prescription drugs, according to a JAMA Network Open cross-sectional study.

The study identified the 184 most common generic products prescribed in 2017 Medicare Part D claims and matched them to their member prices at Costco pharmacies nationwide.

Across over 1.4 billion Medicare Part D claims for the 184 products, the mean total prices were $12.02 and $24.32 for 30-day and 90-day prescription fills, respectively. Medicare overspent relative to the Costco member price on 43.2 percent of all prescription fills for these products.

In comparison, Costco’s streamlined distribution system could have saved $2.6 billion on the drugs, with generic medications accounting for 22 percent of Part D spending. READ MORE

Applying Analytics to Social Determinants of Health

By implementing predictive analytics, UnitedHealthcare is addressing the social determinants of health to enhance care for those they serve. To address the issues regarding health disparities brought to light from the pandemic, UnitedHealthcare has created an advocacy system using predictive analytics to support members who might be struggling due to their social environment.

UnitedHealthcare’s advocacy system identifies those who need support in three different ways. The first is through a predive analytics model and the use of machine learning. By evaluating de-identified claims from members, the system can determine the need for social services.

“We know that so much of an individual’s health is determined by what happens outside of the doctor’s office. And we look at that as an organization, a chance to redefine a traditional insurance model, especially for the most vulnerable,” says Rebecca Madsen, chief consumer officer at UnitedHealthcare. READ MORE

Waystar Looks to Increase RCM Footprint Through Acquisition

Revenue cycle management (RCM) vendor Waystar recently announced that it plans to acquire Patientco, in the latest deal between an RCM vendor and a patient payment company.

Waystar, which offers healthcare payment and RCM solutions, shared publicly late last week that it has a definitive agreement to acquire the provider of omnichannel patient payments, communications and engagement software. The RCM vendor intends for the combination to boost the patient financial experience by offering users consumer-friendly options for paying medical bills. The options are also simplified for healthcare providers collecting the payments, according to the announcement.

Waystar also said the acquisition of Patientco would provide transparency into the patient payments process, resulting in greater patient satisfaction and provider reimbursement. Together, the companies would process nearly $1 trillion in healthcare claims annually. READ MORE

Telehealth Adoption Linked to Demographic Differences

An Anthem analysis of telehealth use for mental health services during the pandemic finds that Hispanic and Latino members were the highest users, while black members were far less likely to seek virtual care.

Among specific populations, Hispanic and Latino communities embraced telehealth for mental health services during COVID-19 at the highest rate, at 40 percent, while 34 percent of white members, 33 percent of Asian members and 28 percent of black members were accessing online care.

For example, among blacks, whom researchers say have experienced much higher levels of behavioral health challenges during the pandemic, overall visits dropped from 56 percent pre-pandemic to 49 percent during the pandemic. And when compared to white members with similar socioeconomic, demographic and clinical backgrounds, black members reported 7.4 percent fewer visits. Meanwhile, Hispanic and Latino members embraced telehealth faster than white members, by an 8.1 percent margin. READ MORE