The CDC estimates that over three-quarters of American adults have at least one chronic condition, forcing healthcare leaders to strategize around system strain, quality of life and costs.
In a March report, AHIP — formerly America’s Health Insurance Plans — outlined approaches payers can take to address this challenge. The trade association suggested several areas of focus for insurers, including upstream prevention, benefits design, social determinants, medication adherence and more.
Even though health plans can voluntarily take steps toward improving outcomes for those with chronic diseases, AHIP also laid out nine policy and regulatory recommendations:
- AHIP advocated for updated regulations with employee wellness programs and more flexibility for states to incorporate wellness programs into the individual market.
- Currently, some administrative costs can serve as a benefit expense in the medical loss ratio, if they directly boost quality. AHIP is pushing for HHS to broaden the definition of allowable costs in the numerator to incentivize chronic disease prevention strategies.
- CMS should continue rolling out and amplifying chronic disease-focused models to support value-based arrangements.
- Greater flexibilities for health savings accounts and high-deductible plans could allow members greater access to chronic disease treatments.
- CMS could broaden Medicare and Medicaid policies to allow members to embrace supplemental benefits and “in-lieu-of-services” for proven chronic condition resources and services.
- Prioritizing food — by establishing nutrition program safe harbors and releasing best practices for Medicaid food interventions — is another of AHIP’s calls to action.
- Wider data interoperability and permanent telehealth flexibilities can help with prevention coordination and care access.
- In terms of the workforce, AHIP calls for multi-state licensing to eliminate care gaps and more robust resources for community health workers.
- Behavioral health integration is a proven strategy for boosting outcomes, AHIP said. An emphasis on behavioral health can also help alleviate comorbidities.
At the Becker's 5th Annual Fall Payer Issues Roundtable, taking place November 2–3 in Chicago, payer executives and healthcare leaders will come together to discuss value-based care, regulatory changes, cost management strategies and innovations shaping the future of payer-provider collaboration. Apply for complimentary registration now.
