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Aimed Monthly, Volume 2, Issue 5

Welcome to Volume 2, Issue 5 of Aimed Monthly. This month’s issue includes updates on our recent policy and advocacy activities, including our new report on Hawaii’s leading health insurance program, a sign-on opportunity to expand access to care for patients amidst the COVID-19 pandemic, and our new scholarly article on early detection and diagnosis of cancer.


Aimed Alliance Hawai'i Report Shows Primary Care Providers Struggle Under Insurer's Payment Model

On May 28, Aimed Alliance released a new report titled “Trouble in Paradise: Assessing the Outcomes of Payment Transformation in Hawai’i.” The report reveals that many primary care providers (PCPs) are struggling to stay in business because of changes made to the way they are compensated by the state’s largest insurer, Hawaii Medical Services Association (HMSA). Key findings include:
  • A majority of PCPs (55 percent) somewhat or strongly disagree that the payment system has enabled them to deliver higher quality of care.
  • Nearly 80 percent of surveyed PCPs felt that the payment system has caused an increase in administrative tasks.
  • More than 80 percent of Hawai’i providers feel that the payment system has worsened the primary care physician shortage in Hawai’i.
  • Nearly 65 percent of surveyed PCPs report knowing a primary care practice that has closed because of the payment system, particularly small and solo practitioners.
  • Nearly all (93 percent) surveyed PCPs believe that the payment system needs to be improved.
Read more about the study’s findings and our recommended fixes here.
Sign-On Opportunity to Limit Prior Authorization & Step Therapy During COVID-19 Pandemic

Aimed Alliance has joined a coalition of patient advocacy groups calling on Congress to temporarily prohibit prior authorization and step therapy requirements during the COVID-19 public health emergency. This new effort is in addition to past activities in which we called on the Centers for Medicare and Medicaid Services (CMS), state governors, and state Medicaid directors to take similar actions.
In light of the pandemic, many health care providers have closed their offices or furloughed staff who are essential to meet the administrative requirements of prior authorization. Therefore, many patients and practitioners are forced to call health plans personally to request authorization for their treatment. Yet, many providers and most patients do not currently have access to outmoded forms of communication, such as fax machines, to submit and receive the requisite documentation for prior authorization approval, leaving them without timely access to the medications they need. As such, we are asking Congress to prohibit prior authorization and step therapy for the duration of the public health emergency.
If you are interested in signing on to the letter, please contact us.
Early Detection and Diagnosis of Cancer

On April 27, the Washington College of Law published a scholarly article co-authored by Stacey Worthy and Shruti Kulkarni, both counsel to Aimed Alliance, titled “The Clinical and Economic Impact of Early Detection and Diagnosis of Cancer” in the Health Law & Policy Brief. The article notes that many detectable cancers are often undiagnosed, misdiagnosed, or diagnosed too late. The article advocates for “Early Detection and Diagnosis (EDD),” a method where practitioners 1) teach patients to self-assess abnormal symptoms, see their practitioner promptly, and accurately describe symptoms; and 2) make diagnoses in response.

Despite EDD’s effectiveness, barriers including low health literacy, symptom misinterpretation and minimization, and inadequate patient-provider communication have impeded wide adoption in the United States. The authors suggested that widespread education and awareness efforts, including state legislative and regulatory activity, can overcome these barriers. Read the article in full here.
HealthyWomen Publishes Final Report on Women-Focused Chronic Pain Summit

Healthy Women has published a final report on the organization’s July 2019 event, the Science, Innovation, and Technology Summit: Chronic Pain in Women— Focus on Treatment, Management and Barriers. Clinical professionals, researchers and policymakers, and representatives from federal agencies, industry, nonprofit organizations, and advocacy groups came together at the event to advance the dialogue on effective treatment and management of chronic pain in women. Aimed Alliance counsel, Shruti Kulkarni, presented at the summit and discussed how gender differences play a role in disease progression, effects of medications, and barriers to treatment. Specifically, she discussed the unique legal and societal barriers women face in obtaining medically necessary treatment, including lack of childcare and punitive attitudes towards pregnant and parenting women.

Legislative Update

While many state policymakers have understandably tabled the majority of non-COVID-19-related legislation over the past few months, some bills are beginning to move again.
  • New Jersey introduced A4179, which would require all state health benefit plans, Medicaid and NJ FamilyCare, State Health Benefits Programs, and School Employees’ Health Benefits Programs to provide expanded coverage for services provided using telehealth.
  • Ohio’s House of Representatives has scheduled a House Health Committee hearing for June 2, 2020, in which HB 469 is tentatively on the agenda. HB 469 contains protections that limit health insurers’ use of copay accumulator programs for brand medications if no generic equivalents are available.  
  • Ohio also passed HB 388, which addresses surprise medical bills. The bill prohibits health care providers from charging out-of-network costs at in-network facilities for unanticipated or emergency care or when patients are transported to a facility by an out-of-network ambulance.

Media Coverage

  • On May 28, 2020, Hawai’i Public Radio published an exclusive story covering Aimed Alliance’s new report “Trouble in Paradise: Assessing the Outcomes of Payment Transformation in Hawai’i.” You can read the exclusive and hear clips from the radio interview here.

Where We've Been

  • On May 28, 2020, Aimed Alliance offered a free webinar titled “CBD in the Workplace: What Employers Need to Know.” An archived version of the webinar will be available on our website early next week.
  • On May 21, 2020, Aimed Alliance and the Derma Care Access Network (DCAN) co-hosted a webinar titled “Dermatological Care in the Time of COVID-19: Medical, Legal, Policy and Access Considerations for Patients.” An archived version of the webinar is available here.
  • On May 6, 2020, Aimed Alliance hosted a webinar titled “Providing Quality Benefits for Employees with Inflammatory Bowel Disease and Other Chronic Conditions.” View an archived version that webinar here.

In Case You Missed It

  • HHS Allows Plans to Implement Copay Accumulators Without Any Patient Protections
    • On May 7, 2020, the Departments of Health and Human Services (HHS) released its Notice of Benefit and Payment Parameters (NBPP) for 2021 final rule, which allows health plans to implement copay accumulator programs regardless of whether or not a generic alternative is available. Copay accumulator policies prevent the value of the coupon from counting toward a patient’s deductible. Copay accumulators make medications unaffordable for many patients. When patients cannot access their medications, they are at risk for adverse events and disease progression.
      Last year, HHS finalized the NBPP 2020, which would have only allowed health plans to implement copay accumulators when both a brand and generic medication were available. NBPP 2020 was a major win for patients with chronic, rare, and debilitating diseases who do not have access to alternative, less costly medications.
      This year’s rule revokes those protections. Instead, NBPP 2021 explicitly allows health plans to implement copay accumulators in all instances. It limits patients’ access to medications, putting their health at risk and potentially increasing costs to the health system. This is particularly concerning during the COVID-19 pandemic in which many Americans have lost jobs and may increasingly find themselves unable to afford their medications. Read the rule here.
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