LAS VEGAS--While they must contend with an increasingly complex “maze” of government regulations, health plans also have key opportunities to work with regulators to improve the delivery system, executives said during a panel at the 2016 AHIP Institute.
The recent Medicaid managed care rule, for example, is going to affect every aspect of some plans’ business, said Centene Corporation Senior Adviser John Kaelin. And in addition to the initiatives included in the proposed Medicare Access and CHIP Reauthorization Act rule, there’s a “tremendous” amount of activity going on at the state level to drive Medicaid plans toward payment reform.
“What we need to be careful of is, we don’t want to see all these payment reforms become siloed,” Kaelin said. Health plans can help in that effort, he added, by stitching together disparate data in order to not just move providers toward taking on more risk, but help them manage that risk.
New network adequacy regulations also offer health plans an opportunity to “engage and educate” state regulators on the implications of time and distance standards, he said.
Indeed, “too often our regulatory partners are stuck wanting outcomes and regulating processes,” said Michael P. Radu, senior vice president of clinical operations and business development for WellCare Health Plan.
For instance, when it comes to network adequacy, health plans’ attempts to funnel members to high-value providers may actually limit choice, but ultimately benefit the system, he said. Similarly, according to Radu, restrictions on the use of telehealth that are meant to protect consumers may in fact limit innovation.
But amid all the challenges, perhaps the most important factor is for plans to get involved in the policy development process, said Susan Montgomery, MVP Health Care’s vice president of Medicaid and regulatory affairs. That helps health plans understand what regulators are trying to accomplish as well as ensure those goals are operational.
Health plan leaders on dealing with "maze" of gov't regs: key is to be involved in policy development #AHIPInstitute
— Leslie Small (@lesliecsmall) June 16, 2016
Montgomery, for instance, has found value in joining a Twitter chat that allowed plan leaders to engage regulators directly. In addition, being involved in government workgroups “is a really powerful place to be,” she said.
She further suggests health plan leaders get past the paradigm in which hospitals and insurers’ lobbying efforts are at odds with one another by framing the discussion instead about what’s best for members.
Radu also touted the benefits of collaboration, noting that for too long insurers have considered so many aspects of their business as proprietary. But organizations have to get past that and have a unified voice, he said. "I think group therapy is important."