AHIP 2023 Medicare, Medicaid, Duals & Commercial Markets Forum Recap and Learnings
Stephanie Czuhajewski, MPH, CAE, Executive Director
On March 14-16, I had the opportunity to attend the Medicare, Medicaid Duals & Commercial Markets Forum (Forum), sponsored by America’s Health Insurance Plans (AHIP), which represents more than 1,200 companies that offer health insurance policies to more than 200 million Americans.
The Forum, hosted in Washington D.C. featured sessions led by high-ranking federal and state government officials, leading health insurance actuaries and analysts, and advocates (like me) seeking improved access to care for beneficiaries and improved reimbursement processes and policies for providers. AHIP sessions focused on CMS policy priorities and health plan implications, Medicare Advantage regulatory updates, and emerging issues in the employer, individual and small group commercial insurance markets.
Key takeaways from the AHIP Forum:
- Decisions about health benefit design are fragmented and often made at the plan level (if you have seen one health insurance plan, you have seen one health insurance plan).
- When it comes to supplemental benefit plans for hearing, vision, and dental, a turnkey thirdparty administrator (TPA) approach is very attractive to health plan sponsors.
- One of the biggest challenges in the structuring of the plan and benefit design (for plan sponsors) is recruiting and maintaining providers and provider networks (audiologists, optometrists, dentists) for the specialty services.
- When TPAs can bring a ready-made, established provider network it is a key selling point (it is more important, according to those I spoke with, than any other administrative functions undertaken by the TPA).
- Therefore, the TPA is only as valuable as the network of providers that it attracts and maintains (if providers refuse to participate with a TPA, the TPA is no longer a valuable partner for the plan sponsor).
- Salespeople, actuaries, sponsors, and other stakeholders at the plan level do not have a good working knowledge of the structure of their plan partners (for example, a health plan contracting with a TPA would not know, wonder, or consider asking whether the TPA is owned by a hearing aid manufacturer, and/or whether it owns audiology/hearing aid clinics.
- There are tremendous opportunities for ADA and ADA members to inform and educate health insurance plan sponsors about the important role that audiologists play in health care delivery, the deficiencies with many current plan benefit structures, and the opportunities to reconstruct and design plan benefits to reward high-value services and improved patient outcomes.
- AHIP and its members have tremendous leverage to influence Congress and administrative agencies such as the Centers for Medicare and Medicaid Services (CMS). They are, therefore, an important stakeholder for audiologists and other health care providers.
Attending AHIP gave me a new perspective on health plan benefit design and the challenges faced by benefit sponsors and government regulators. It was refreshing to hear the perspectives of plan sponsors and actuaries about why they structure plan benefits, such as hearing benefits, the way that they do. Attending and networking also positioned ADA as a go-to resource for these decision-makers. Building relationships with health plan decision makers will provide ADA and its members with more opportunities to influence and inform them—and will allow us to be better informed about emerging policy trends, and their implications for audiologists and their practices.
I look forward to working with all of you to advance advocacy initiatives that advance evidence-based patient care and the profession of audiology! ■