September 27, 2017

This Just In…

Following the latest failed repeal effort, the Administration is considering executive actions aimed at propping up the individual market. The latest indication came this afternoon when President Trump said he plans to sign an executive order allowing the purchase of health care across state lines.

There’s some uncertainty around how the Administration threads this needle and whether it has the legal authority to do so. We’re following the issue closely.

Meanwhile, The Council will also intensify its plea to the Administration to either dramatically streamline or end enforcement of the employer reporting requirements. Additionally, we hope the Administration will take unilateral steps to improve the utilization of wellness plans, and to not move on the establishment of non-discrimination plans that would burden employers.

Something’s Gotta Give

Just another day here in Washington, filled with twists, turns and a little bit of drama. The consensus remains that the battle to repeal and replace the ACA is far from over, but is reaching a bipartisan healthcare compromise at all realistic in this environment?

And what does it all mean for brokers? Joel Wood and Joel Kopperud are in the thick of it.

From “Reference Pricing” to “Reference Benefit”

A new reference-based pricing model from Altarum purports to build on the concept of reference pricing to a “referenced benefit” through its Medical Episode Spending Allowance (MESA). “A MESA is a clinically nuanced pre-deductible allowance that is structured to encompass entire episodes of care, from start to finish, all component services included,” says Altarum, a nonprofit health systems research and consulting organization.

Like in other reference pricing models, members pay out-of-pocket when the cost of care extends above the specified allowance, and they have access to tools to research procedures, identify providers in their area, and view providers’ costs and quality ratings. Where MESA differs is it creates a reference price for an entire episode of care, not just for individual medications, lab tests or even hospital stays. In this way, it may help address the cost of care for people with chronic conditions, which typical reference-based pricing models have thus far not necessarily accomplished.

Joel Wood, SVP, Government Affairs
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Joel Kopperud, VP, Government Affairs
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