The Check Up: Matt Eyles of AHIP

After a period where they withdrew from Affordable Care Act exchanges, insurers are showing renewed interest in those markets. And one of the industry’s main lobbying groups is also pushing for states that have yet to expand Medicaid to do so. Join Modern Healthcare Managing Editor Matthew Weinstock and Matt Eyles, president and CEO of America’s Health Insurance Plans, as they discuss key issues on the insurance industry’s lobbying front, as well as efforts insurers are taking to aid in COVID-19 vaccination efforts.

MH: Hello, I'm Matthew Weinstock, managing editor of Modern Healthcare. Thanks for tuning into the latest edition of The Check Up.

So, as we all know, the coronavirus pandemic has caused a lot of upheaval in the industry and not just in the way care is delivered, but also the way it's paid for, the way organizations are interacting within themselves and with others across the industry. And it's also forced industry leaders to revamp some of their strategic and operational plans going forward.

So we wanted to take a look at what the impact of these changes may have on companies in the long term, and particularly, this episode, the insurance industry.

I'm pleased today to be joined by Matt Eyles. He's the president and CEO of America's Health Insurance Plans. That's one of the large trade associations for the insurance industry. Matt, thanks for being with us today. We appreciate your time.

Eyles: Good to be with another Matthew today.

MH: It is, isn't it? It'll make the name exchange pretty easy.

So, Matt, I kind of want to start first with sort of a policy question where the Biden administration has been in for a little bit. It's obviously had some upheaval over its time since being inaugurated in January, sworn in in January. The insurance industry got some wins in the latest COVID relief bill. As you think about the next few months, where are you focusing some of your lobbying activities with the Biden administration and with Congress?

Eyles: Yeah, it's a great question because we know that there is going to be a lot of activity. I mean, in the short term, we know that there were a couple of things that were not included in the latest relief package that were important. We know sequestration is one that's sort of on the horizon that looks like that's going to be imminent. That's an important fix.

In addition, we've been focused on Medicare Advantage and some issues with respect to how certain types of telehealth are treated, especially those encounters that are only over the telephone that right now aren't counting for Medicare Advantage. And we think that's going to have an impact on potentially benefits and premiums for next year. So that's one short-term area.

And then we also know prescription drug prices, Medicare Part D reform. There's a whole host of issues where we're going to have to be focused while we do everything that we can to make sure people get their vaccines as quickly and as equitably as possible. And that's a huge focus area, although not as much on the lobbying side.

MH: Yeah. And I certainly want to touch on telehealth, but let's stay on the COVID and vaccine front for a second and we'll jump back into a couple of other things. But on that front, how are your members working with providers to make sure that folks are getting shots in arms? Because it is all over the board, it's Walgreens or CVS or a health system or your public health agency, and maybe your members don't know when a patient's going in to get a shot in the arm.

Eyles: It is a huge focus area for us right now. And your listeners might have seen reports about us announcing with the Blue Cross Blue Shield association a major initiative called the Vaccine Community Connectors to really make sure that individuals, starting with those aged 65 and older who live in the most socially vulnerable communities, are getting connected. We know how challenging it is to get an appointment and get access and we really want to make sure that we're doing everything we can to help facilitate appointments, to help overcome any barriers to get to appointments.

So for example, if someone might need access to transportation or a ride to get there, doing a lot of proactive outreach and making sure that people know that it's their turn and that it's available to them.

We do know that supply is definitely still an issue and the scheduling is still a little challenging, but things are getting better, but we really need to keep focused on making sure that everyone gets vaccinated as quickly and as equitably as possible.

You note the data access, and that is a challenge. And that's an area where we are strongly trying to work with states, to work with the federal government and other partners to make sure that we can get access to the state immunization information systems so that we know when people are getting vaccinated and that we can make sure that they're getting their second dose, and as we think about longer term, if there have to be boosters.

So it's really important that health insurance providers do have access to that data. There are significant gaps, but we hope that those will be closed over time.

MH: Got it. I want to pivot a little bit to what I said at the intro of sort of rethinking plans going forward, but piggybacking on what you were talking about with, for instance, what you're doing with Blue Cross Blue Shield in helping patients get the vaccines, especially in areas where they may have problems getting to a vaccine. How did some of those things translate to longer term changes and operations for the insurance industry? Are there things you're learning now that will hold two, three, five years down the road?

Eyles: Oh, for sure, right? I mean, I think everyone's learned so much right now through the pandemic in terms of being nimble and changing how you operate. And whether it's by helping make sure that people get access to care by expanded telehealth, by making sure that social barriers are overcome, whether it be transportation, food insecurity, other areas, and really sort of focusing on preventive care and making sure that patients and consumers aren't missing out on preventive treatment and services. We know the short-term decline that we saw in utilization, and it's come back to a large extent, especially as telehealth has expanded, but really trying to understand what those implications will be longer term and focusing on preventative and chronic care treatment management so that health conditions don't get exacerbated and worsened over the long run.

MH: Got it. And so, Matt, one of the things the Biden administration did almost out of the gate was extend the open enrollment period for the ACA exchanges. They just recently announced that'll go all the way until August. We've seen insurers really jump back into the exchanges after a period of time where they were withdrawing from those markets. What do you credit to that renewed interest in exchanges from the insurance industry?

Eyles: It's amazing how resilient the Affordable Care Act marketplaces have been over time given the challenges when you think back really to the launch a little more than half a decade ago. And I think the resilience has been really around the innovation with respect to how benefits are being offered, the ability to offer lower premium plans as we went from silver loading and now into new premium subsidies that are available. I think that we're going to see continued growth.

We were very supportive of the special enrollment period and making sure that people had access to coverage. And I think as the provisions with respect to the American Rescue Plan Act are implemented, we're going to see continued interest in growth in the exchanges. This is a time period where it will be important to get as many people covered as possible and hopefully we can build on that and make some of those changes permanently over the long run.

MH: Does it surprise you at all that that renewed interest is happening while we're still waiting for a Supreme Court ruling?

Eyles: Well, perhaps a little bit, but I know when I think back to the hearing last November, there is a sense of sort of cautious optimism around the decision and that the entire law will not be found to be unconstitutional. And if there is a constitutional issue that needs to be addressed, I think the policy makers and Congress and the administration will recognize that they need to make some decisions and take action to ensure that they stay in place.

If this was a back in the early days, it might be something different, but I think given where we are with respect to implementation of the exchanges and really being such an important source of coverage now for millions and millions of Americans, that people know that we're going to have to take action if something comes out from the court that forces that kind of action.

MH: Another piece of the American Recovery Plan that I wanted to talk about was the focus on Medicaid expansion and the monies that are going out to states that haven't yet expanded Medicaid to encourage them to do so. Obviously we're seeing some heavily red states still balk at expanding coverage, but I know you guys in some recent testimony really are pushing forward, trying to get states to really look at Medicaid expansion. Tell me a little bit about what you're seeing there and what your activities are on a lobbying front.

Eyles: Right. We would like to see the remaining states take advantage of the Medicaid expansion. We know how important it is for those individuals that don't qualify for exchanges, that sort of coverage gap that exists in so many of those states. And we do think that there is some interest out there. We've seen reports from Wyoming, Alabama. We've seen some of the ballot initiatives in states like Missouri that have passed recently, and others. And we would like to see those states take up the Medicaid expansion. It's good for consumers, patients. It generally has the support of the population in those states. And now the additional incentives that are available make it a very attractive option.

And people often forget how long it took for the original Medicaid program to be taken up across all the different states. Hopefully it won't take 17 years like it took for the original Medicaid, but we're going to continue to advocate for those types of expansion to make sure people have access to coverage.

On the policy side, in addition, what we would hope is that over the long term, that perhaps some of the issues that weren't addressed directly around Medicaid in the rescue package, for example, an additional bump in the matching rate, might be able to be put in place over the longer term so that there is this sort of counter cyclical protection for Medicaid as you see an economic downturn. And hopefully that's something that might be considered over the longer run.

MH: And it's interesting too. We had a story, I guess, about two or three weeks ago, her insurance reporter looked at, based on quarterly report investor calls, a lot of insurers, as you well know, are using Medicaid Managed Care and Medicare Advantage as a new line of business, not new, but a growing line of business to bulk up some of their operations. Can you just talk about that trend line that you're seeing among your members?

Eyles: Yeah, I mean, as we've seen Medicare Advantage become an even more popular program, we now have … 27 million out of the 60 million or so Medicare beneficiaries are enrolled in a Medicare Advantage plan. It really does offer great value, terrific benefits, affordable coverage options, and I think that's why we continue to see so many people, so many companies investing in Medicare Advantage.

Similarly, Medicaid Managed Care is a little bit different because there's the state component to it and the state relationship where companies are having to be a contractor with the state to get into that program, but Medicaid Managed Care is now the dominant delivery mechanism for coverage in state Medicaid programs. Over 55 million Americans are enrolled in Medicaid Managed Care plans, and we also expect that to continue, whether it's because we have additional states that expand Medicaid or just moving into additional populations that aren't covered under Managed Care right now. So we expect those trends to continue as well.

MH: Got it. I want to talk a little bit about telehealth. I know you referenced it in relation to Medicare Advantage, but I want to talk about it kind of in that global perspective. Obviously it boomed during the pandemic. So many visits across the board being done on telehealth. Insurers were pretty quick to waive copays for a lot of telehealth visits, although we are starting to see some of that dial back. Where do you think that equilibrium is for telehealth going forward in terms of a reimbursement structure that works for both insurers and for providers and ultimately patients?

Eyles: Yeah, that equilibrium question is a great one. It really is sort of the $64,000 question around telehealth about what is the long term state of equilibrium. And our members have been incredibly supportive of telehealth during the pandemic, but they were before the pandemic as well. And really, the way that we see telehealth becoming sustainable and probably reaching equilibrium over the term is by providing for flexible benefit design and not having overly prescriptive reimbursement requirements. We don't think that mandating parity is the right answer, but making sure that there's flexibility in there.

I think making sure that, with respect to telehealth, that those sort of are treated as on equal footing for other purposes, whether it be network adequacy, risk adjustment, other quality metrics as well. We know that telehealth I think is here to stay. It's just a question of is it going to be a third of visits going forward? Is it going to be 10%? I don't think we really know the final answer, but I think the indications are people are highly satisfied with telehealth. They like it. It's much more convenient, accessible. And especially if you think about services that have been so difficult for so many to access, such as behavioral health and finding providers, that it really has been a lifeline for so many individuals being able to get increased access to treatment and services, especially during the pandemic.

MH: So do you think it comes down to then individual contract negotiations as opposed to some sort of one size fits all from Washington?

Eyles: That's a good characterization of it. Yeah, I think not a one size fits all from Washington or from state capitals, because we do know the states still play such an important role when it comes to the regulation of health insurance markets and coverage, that it shouldn't be a one size fits all because it is very different depending upon the modality, how many patients they're able to see and whether it's primary care or specialist care.

MH: Great. And lastly, Matt, and for the last minute we've got left, you touched on it very briefly, the behavioral health crisis, which obviously we could probably do a whole other 10 segments on, a crisis in adolescents and kids, adults as well, isolation, behavioral health crisis across the board. What are you seeing from your members in their ability to respond to that and help patients and providers create some greater access?

Eyles: Yeah, it has been a top priority throughout the pandemic. And I think it's really important to note, and you've mentioned the adolescent pediatric populations, but it's extended across the entire spectrum of society, whether we're talking kids, working age parents who are facing new stress and anxiety and older Americans who are facing issues with respect to anxiety, loneliness, and others. And those investments I think in behavioral health will only expand over time. I don't think we're going to go back to the way things were prior to the pandemic.

And I've said in other places, if there is a silver lining to this, is that maybe once and for all, we will finally get rid of the stigma around mental health and treatment of mental health and making sure that people recognize that it's just as important as physical health.

MH: Yeah. I think you're right. In a lot of these conversations, we're starting to talk more about mental health and that the head is actually connected to the body and it's all part of the same thing.

Eyles: Right. No, it is. It is.

MH: Well, listen, Matt, we appreciate your time. We know it's a busy time for you in Washington, but we appreciate you taking a few minutes out to talk to us about trends that you're seeing across the insurance industry. And we'd love to check back in with you in a few months and see where we are with the Biden administration moving forward.

Eyles: Absolutely, Matthew. Thank you so much for having me here today.

MH:Thank you.

And I'm Matthew Weinstock with Modern Healthcare. Be sure to check back with us next week for another edition of The Check Up.