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Client Congress 2021: A Year to Review

Client Congress 2021: A Year to Review

As Client Congress 2021 comes to a close, we’re reminded how fortunate we are to continue to provide the valuable content the conference has always delivered while staying committed to the safety, health, and well-being of our attendees, speakers, and staff, by holding our second successful virtual event. Nearly 1,000 registrants tuned in to hear from some of the nation’s most influential voices addressing the programs, perspectives and policies shaping U.S. healthcare and to hear insights into strategies designed to help you thrive in today’s dynamic marketplace.

One of our favorite sessions, which we’ll highlight today, is The Three Futures session. This annually recurring session shares how health plans, providers and operators can effectively navigate changes by preparing their organizations for short- and long-term industry shifts in 2021 and beyond.

Contributing voices to this discussion are:

    • Sarah Butler, Head of Client Solutions, Marketing & Operations, Life Sciences & Advisory, Inovalon
    • Elizabeth Carpenter, Head of Advisory Services, Life Sciences & Advisory, Inovalon
    • Matt Kazan, Principal, Policy, Life Sciences & Advisory, Inovalon

The focus for this year’s discussion was the three futures that we believe will impact our healthcare landscape in the year to come.

1. The Evolving Impact of COVID-19

COVID-19 has interrupted day-to-day, traditional care. Statistics reflect the U.S. is still low regarding standard preventive care measures (for instance, colonoscopies are down 55%) even though most providers have taken steps to ensure the safety of their patients. Between January and November of 2020, there were an estimated 26 million routine vaccine doses missed relative to prior years.

With the COVID-19 pandemic resulting in lower than expected utilization of care, Congress may act to modify the Medical Loss Ratio (MLR) requirements in response to the public health emergency. Due largely to the impact to risk scores – specifically patients appear to be healthy when in fact they are just not getting the testing or treatment needed.

The Centers for Medicare and Medicaid Services (CMS) continues to offer nationwide waivers and flexibilities regarding reporting, enrollment, and enforcement. CMS has extended these in 2022 – giving providers an opportunity to reengage their patients and ensure the safety of their practices.

2. The Changing Policy and Regulatory Landscape

There are big ambitions for the legislative debates to come and large goals related to coverage: 1) Extending ACA subsidies that were passed as pandemic relief and have moved the needle on exchange enrollment, 2) Medicaid coverage gap (in states that have not expanded Medicaid) just short of 3 million people fall in this gap, because the state chose not to expand Medicaid. 3) Expanding the Medicare benefit to add dental, vision, and hearing. This will be interesting because most MA differentiators are dental, vision, and hearing. MA plans could look to offer a “more robust” benefit from the base or shift those dollars to different supplemental benefits.

The drug pricing debate is on the table as a way to pass and fully fund these three coverage goals. Reforming the Part D benefit structure includes adding a cap and shifting liability from the government to manufacturers and health plans.

If you’re affected by these anticipated policy changes, you need to be planning for best-case and worst-case scenario outcomes for these policies. For those companies launching new products – you should be thinking about when policies are going to be implemented and if they’re going to be phased in.

3. Engaging the Consumer to Reduce Cost and Drive Health Equity

Health equity is the guiding light for the current administration’s approach to policies. For those thinking about going to this administration with a proactive policy solution, understating how that policy will be viewed under the lens of health equity will be critical.

We’re looking at new ways to address health equity in the care provided:

    • Medicare payment rules are explicitly soliciting a request for ways in which policy could be changed to affect health equity.
    • Determining if the Medicare Star and quality rating system address social risk factors as written today and how they could be improved.
    • Benefit flexibility on supplemental benefits. Many of these flexibilities are being used to address social determinants of health.

Where can you start in addressing health equity? First, you can examine if you have the data necessary to develop a program to reduce healthcare disparities and drive a more equitable system for the patients that you care for. How specific is the data that you have? We know COVID-19 has created gaps in care – is your data reflecting those gaps? If you cannot see the gaps in care present in your data, you cannot address them.

To close, The Three Futures panelists were asked to forecast the one ‘hot topic’ for 2022:

    • Matt Kazan: “CMMI – we’ll have a decent understanding of where Congress is going to land on MA reforms, and that’s where the CMS Innovation Center is going to engage.”
    • Elizabeth Carpenter: “It’s the start of the year of reckoning – COVID testing, vaccines, and how public health fits into how we think about our healthcare.”

In Summary

To hear the full discussion, log in to the Client Congress 2021 site for on-demand access. All content will remain accessible for registrants until November 19, 2021.

Each year during Client Congress we look to provide our customers with an experience that aligns with their needs, addresses their challenges, and provides actionable insights for every organization, member and patient across the healthcare landscape.

Thank you to our customers and partners for joining us virtually and for sharing their insight and time with us.

By Inovalon, on October 28, 2021