Payer Roundup—Walmart taps former Humana executive for health unit; Azar appoints value-based care lead

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Walmart's pick for health and wellness VP reinvigorated rumors of a merger with Humana. The two companies currently offer a drug plan together. (Walmart)

Walmart recruits former Humana executive for healthcare business 

Former Humana executive Sean Slovenski will join Walmart as vice president of health and wellness starting Aug. 1, Bloomberg reported on Monday. He will report directly to Walmart U.S. CEO Greg Foran.

Slovenski was Humana’s vice president of innovation in 2013. After leaving Humana, he was CEO at Intel and GE’s Care Innovations. In his most recent role, he was president of the population health business at Healthways, a wellness company owned by Sharecare.

Rumors that Walmart and Humana will merge, or that Walmart will acquire Humana, have floated around since March. At present, the two companies jointly offer a prescription drug plan meant to bring consumers to Walmart’s 4,700 pharmacies. (Bloomberg article)

Azar appoints CMMI director as value-based care adviser

Adam Boehler, Director of the Center for Medicare & Medicaid Innovation (CMMI), will lead the Department of Health and Human Services' (HHS) efforts to advance value-based care as senior adviser for value-based transformation and innovation, HHS Secretary Alex Azar announced on Wednesday.

Azar appointed Boehler to be CMMI director in April. Before leading CMMI, Boehler served as CEO at home health provider Landmark Health, which he founded; he also founded lab benefit management company Avalon Health Solutions, the announcement notes.

Azar has now filled the advisory posts for each of his four priorities. Prior to this announcement, he named Dan Best as senior adviser for drug pricing reform, Brett Giroir as senior adviser for mental health and opioid policy, and Jim Parker as senior adviser for drug pricing reform (as well as director of the office of health reform). (Release)

Insurers using 'lifestyle' data to raise rates, avoid covering high-need consumers

Health insurers are collaborating with data brokers to collect countless bits of personal information to determine how much they charge consumers, according to an investigation by NPR and ProPublica.

Companies use computer-based algorithms to analyze “lifestyle” data, from race and net worth to online purchases and TV habits, to determine an individual’s likely health needs. For instance, a woman who recently changed her last name may have gotten married recently and become pregnant in the near future. Patient advocates say that these tactics—which do not always reveal correct information—are discriminatory. Insurance companies claim they are using this data to channel patients toward the services they need.

Isn’t this illegal, one might ask? The Health Insurance Portability and Accountability Act (HIPAA) only protects medical information, and the Affordable Care Act (ACA) prohibits denying coverage for pre-existing conditions and underwriting in the individual and small-group markets. Experts say insurers may discriminate more subtly—for instance, by modifying benefits after a patient enrolls or excluding certain types of providers from their networks. (ProPublica article)

Big bucks from drug industry influencing Medicaid coverage decisions

Through a calculated web of schmoozing, lobbying, and incentivizing, drug companies duck state regulations to get Medicaid to pay for their products.

An investigation by the Center for Public Integrity and NPR found that drug manufacturers pay Medicaid drug committee members to include their more expensive products on states’ preferred drug lists—often directly, but also in the form of meals, travel, consulting fees and speaking opportunities. To skirt preferred drug lists, the article says, they fill out prior authorization forms for physicians. 

These and other efforts contribute to the ever-expanding cost of Medicaid. According to the National Association of State Budget Officers, whose report (PDF) is referenced in the article, 28.7% of state expenditures went toward Medicaid in fiscal year 2016—compared to 20.5% in fiscal year 2008—nearly $2 trillion dollars.

Pharmaceutical companies argue they are ensuring patients can access important medically necessary drugs. (NPR article)