Colorado’s “public option” primed to move forward

What a Difference a Year Makes in Colorado's Case for a Public Option Plan  | Kaiser Health News

We’ve closely tracked Colorado’s pursuit of its own public option insurance plan, which seems now to have reached a compromise that will allow a bill to move forward, according to reporting from Colorado Public Radio. The saga began two years ago when state legislators passed a law requiring Democratic Governor Jared Polis’ administration to develop a public option proposal. Amid the pandemic and broad industry opposition, progress stalled last year on the proposal. Lawmakers picked up the proposal this session, and have made progress on a compromise bill now poised to pass the state’s Democratic legislature.

Unlike the earlier versionthe new legislation would not lay the groundwork for a government-run insurance option, but rather would force insurers to offer a plan in which the benefits and premiums are defined and regulated by the state. The bill would also allow the state to regulate how much hospitals and doctors are paid.

In the current version, hospital reimbursement is set at a minimum of 155 percent of Medicare rates, and premiums are expected to be 18 percent lower than the current average. While state Republicans and some progressive Democrats are still opposed, the Colorado Hospital Association and State Association of Health Plans are neutral on the bill, largely eliminating industry opposition

The role hospitals played in fighting the pandemic surely paved the way toward the compromise bill, which is viewed as much more friendly to providers than the previous proposal. With the Biden administration unlikely to pursue Medicare expansion or a national public option, we expect more Democratic-run states to pursue these sorts of state-level efforts to expand coverage.

In the wake of the pandemic, providers are well-positioned to negotiate—and should use the goodwill they’ve generated to explore more favorable terms, rather than resorting to their usual knee-jerk opposition to these kinds of proposals.

Amwell CEOs on the telehealth boom and why it will ‘democratize’ healthcare

Amwell CEOs on the telehealth boom and why it will 'democratize ...

The COVID-19 pandemic has catapulted the telehealth industry forward by decades in a matter of months, according to Amwell’s Roy Schoenberg.

That not only benefits the Amwell’s business, but it’s a win for patients, said Schoenberg, who serves as the company’s president and co-CEO.

“We are going to see an enormous amount of change, nothing short of a revolution, going forward,” he told Fierce Healthcare.

Roy and his brother Ido Schoenberg have been telehealth advocates for more than a decade since launching Amwell, formerly American Well, in 2006. The Boston-based telehealth company works with more than 240 health systems comprised of 2,000 hospitals and 55 health plan partners with over 36,000 employers, reaching over 150 million lives.

Like other virtual care companies, Amwell has seen skyrocketing demand for its services during the COVID-19 pandemic as stay-at-home orders and social distancing guidelines prevented many patients from visiting doctors in person. Shares in public digital health companies like Teladoc and Livongo have grown by double digits during the health crisis.

The momentum around telehealth also has attracted investors. The company recently raised $194 million in a series C funding round.

Amwell also is gearing up to go public later this year, according to CNBC’s Christina Farr and Ari Levy. The company confidentially filed for an IPO earlier this week and has hired Goldman Sachs and Morgan Stanley to lead the deal, Farr and Levy reported last week, citing people who asked not to be named because the plans have not been announced.

The company declined to comment on the CNBC report.

Before the COVID-19 pandemic began, Amwell was providing an average of 5,000 telehealth visits a day. That has jumped to 45,000 to 50,000 virtual visits a day due to the coronavirus, said Ido Schoenberg, who serves as chairman and co-CEO. 

“We saw 30 times, 40 times higher volumes and we have clients that had 2% to 3% of their patient volume online that now have 75% of visits online,” he said. “It’s truly incredible. The number of active providers on our platform grew seven times over in two months.”

As visits surged, technology companies struggled to keep up with demand, and patients reported long wait times for virtual visits on some platforms.

Roy Schoenberg acknowledged Amwell also faced challenges rapidly scaling its technology and services almost overnight as it was “thrown into the center stage of trying to save the world.”

The company leverages automation for processes such as onboarding physicians, credentialing, licensing, and working with health plans and that capability proved critical to scaling its services, the executives said.

“We needed to allow 40,000 to 50,000 physicians to come on to our system and begin to use it. If this was a manual process, it would have been broken,” Roy Schoenberg said.

Regulatory barriers to telehealth also quickly fell away, at least temporarily. The Centers for Medicare and Medicaid Services and commercial health plans have expanded access to telehealth by offering payment parity for many telehealth services for the first time.

While questions remain about what regulatory flexibilities will remain in place to support the ongoing demand for telehealth, Amwell executives believe virtual care has proven its value to providers, payers and patients.

CMS will likely tighten up some of the relaxed requirements around telehealth which is a “fiscally responsible approach,” Roy Schoenberg said.

“At the end of the day, even though the government tends to be a little bit slow, it gravitates to where the value is. How long will it take for the payment structure to retract and then expand, that’s anyone’s guess. We have an election year coming in. Who knows what that is going to do? There may be some changes, but I think overall, the genie is out of the bottle, the toothpaste is out of the tube, or whatever phrase you want to use,” he said.

The executives never doubted that telehealth would, at some point, reach the mainstream. Now that it’s happened, health systems and patients have become advocates for the technology and that will also put pressure on CMS and commercial payers to continue to support it, they said.

The executives now see an opportunity for Amwell to use its platform to expand the reach of healthcare to more patients. There is a growing industry of telehealth providers, device makers, and technology-enabled disease management companies that will enable digital home healthcare services, they said.

“What we built is something way bigger than a video conference between doctor and patient, which you can easily do using Zoom or FaceTime,” Ido Schoenberg said.

Digital connectivity will enable providers to gather health data on patients from wearables and devices to better understand gaps in care, get an overall picture of patients’ health and then provide more effective interventions, all without patients leaving their living rooms. The combination of telehealth and remote devices will enable elderly, frail patients to receive care at home, where they want to be, rather than being moved to a skilled nursing facility, they said.

“It’s about the ability to democratize healthcare and make great care available to many more people that today don’t always have access to it,” Ido Schoenberg said.

Roy Schoenberg added, “These are the opportunities opening fast and furious in front of us and the promise is to make healthcare less painful as an individual experience. That’s the value proposition.”





“All policy is health policy”

PPT - Health in All Policies PowerPoint Presentation, free ...

The effects of racism are often inseparable from black Americans’ health and well-being, as “black communities bear the physical burdens of centuries of injustice, toxic exposures, racism, and white supremacist violence,” Rachel Hardeman, Eduardo Medina and Rhea Boyd write in the New England Journal of Medicine:

Any solution to racial health inequities must be rooted in the material conditions in which those inequities thrive. Therefore, we must insist that for the health of the black community and, in turn, the health of the nation, we address the social, economic, political, legal, educational, and health care systems that maintain structural racism. Because as the Covid-19 pandemic so expeditiously illustrated, all policy is health policy…

The response to the pandemic has made at least one thing clear: systemic change can in fact happen overnight.


Cartoon – U.S Health System Readying for Coronavirus

Corona response | Cartoons |

GOP Needs a Health Care Plan, Not an Immigration Plan

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On Thursday, President Trump unveiled his proposal for shifting the United States to a merit-based program for admitting future immigrants. The plan, which offers meaningful change and deserves serious consideration, is a non-starter politically, given that it does nothing to address the question of the Dreamers, or the millions of other immigrants already in the country illegally. Democrats, as expected, quickly condemned the president’s plan.

Trump isn’t wrong to highlight immigration. A broad-based restructuring of our immigration system is a laudable goal, and we do have a crisis on our southern border – as some Democrats now begrudgingly admit.

So immigration, legal and illegal, is an important issue, particularly to the president’s political base. The problem is that it’s not the most important issue for a most Americans, including many Republicans. It’s not even close. On the issue that is considered the most important – health care –Trump and the Republican Party have no plan at all.

Last week our polling firm, RealClear Opinion Research, released a new survey showing that health care is far and away the most important issue to Americans. At 36%, it was 10 percentage points above the number two issue – the economy – and more than 21 points ahead immigration, which ranked as the number three issue at 15%. (Education and the environment were tied at 11%, and foreign policy ranked last at just 3%.)

Attitudes about our current health care system were even more striking. Although 72% of registered voters rated their own health care as “excellent” or “good,” just 4% said the system was working for all Americans well enough that it needs no significant changes, while 28% think the current system is broken and needs to be replaced.  The vast majority (68%) is somewhere in the middle, viewing the current system either positively or negatively but agreeing that it is in need of improvements.

RealClear Opinion Research pollster John Della Volpe described the findings this way: “Significant proportions of Democrats, Republicans, and Independents agree that the current system needs substantial reform. The debate will be where to start, and how dramatic the correction.”

Democrats are already having that debate. Every single one of the 23 candidates running for the party’s nomination has embraced some form of reform, from expanding Obamacare or advocating “Medicare for All” to calling for a government-run single-payer system.

Meanwhile Trump and the GOP are standing on the sidelines. Nearly two months ago, Trump’s Justice Department came out in support of a Texas district court ruling striking down all of Obamacare. At the same time, the president took to Twitter (where else?) to declare that “the Republican Party will become ‘The Party of Healthcare!'”

Trump claimed that “the Republicans are developing a really great healthcare plan with far lower premiums (cost) & deductibles than Obamacare,” further promising that a “vote will be taken right after the Election when Republicans hold the Senate & win…”

After Republicans complained Trump had caught them off guard, on April 3 the president tweeted, “I was never planning a vote prior to the 2020 Election on the wonderful HealthCare package that some very talented people are now developing for me & the Republican Party. It will be on full display during the Election as a much better & less expensive alternative to ObamaCare…”

Since then, crickets. The thumping the GOP took in the House in 2018 should have been a wake-up call given the prominent role health care played in sending Republicans down to defeat. According to exit polls, 41% of voters in 2018 said health care was the most important issue facing the country, with immigration and the economy running a distant second and third place at 23% and 22%, respectively. More than two-thirds of voters said the health care system needed “major changes.”

Notice how closely those numbers mirror our new findings from RealClear Opinion Research. Six months after Republicans lost the House, voters’ opinions about the importance of health care and the need for reform haven’t budged. If  the president and his party don’t come up with a viable plan to address voters’ concerns, they may find it’s “déjà vu all over again” in 2020.