The Anthem Public Policy Institute was established to share data and insights to inform public policy and shape the health care programs of the future. The Public Policy Institute strives to be an objective and credible contributor to health care innovation and transformation through publication of policy-relevant data analysis, timely research, and insights from Anthem’s innovative programs.
Recent insolvencies in the long-term care insurance industry have exposed inadequacies in the structure of state guaranty funds, which are used to pay claims when an insurance company is deemed insolvent by the courts. The current guaranty fund system can be improved by expanding the base of insurers who contribute to the funds and equalizing the burden shared between life and health insurance companies. A new issue brief from the Anthem Public Policy Institute discusses why changes to the guaranty fund framework—adopted by the National Association of Insurance Commissioners—provide states with a blueprint for better addressing insolvencies and protecting policyholders.
Many states are establishing All-Payer Claims Databases (APCDs) to collect data from private and public payers and make it available to third parties for a variety of research and data-transparency activities. APCDs have value but they also pose challenges with data collection and use, such as privacy concerns, potential disclosure of proprietary data, and unknown validity of the data collected. This new paper from the Anthem Public Policy Institute discusses the key policy and technical issues facing APCDs and presents high-level recommendations that should guide the operation of APCDs to ensure the intended goals and objectives are achieved.
Anthem conducted focus groups and one-on-one phone interviews with a total of 25 participants who are enrolled in Anthem-affiliated Medicare Advantage (MA) chronic condition special needs plans (C-SNPs) to better understand how enrollees perceive the benefits and overall value of their plans, as well as how they shop for and select their plans. The takeaways from these discussions, which are highlighted in this infographic, indicate that individuals enrolled in Anthem-affiliated C-SNPs highly value the tailored benefits, interconnected care, robust communication, and out-of-pocket savings—among other benefits—provided by their C-SNPs.
More than 11 million newly eligible individuals have enrolled in Medicaid, since states began expanding the program in 2014 to working age adults (age 19-64) with incomes below 138% of the federal poverty level. However, research looking into the utilization and spending associated with these new enrollees has been limited. A new study conducted by Avalere Health and funded by the Anthem Public Policy Institute analyzes data from several managed care organizations (MCOs) across multiple states, in order to observe enrollment and cost trends of the expansion population over time. The findings released by Avalere indicate that, despite some early signs of pent-up demand, costs increase substantially over time and the health needs of enrollees appear to shift towards chronic care. Avalere’s analysis provides valuable insights regarding the Medicaid expansion population that can inform policy discussions at the state and federal level.
The Medicare Advantage (MA) Star Ratings program is one of a number of quality incentive programs that link Medicare payments to quality performance. The Star Ratings are a key factor in determining MA plans’ payments, and they may also influence enrollees’ plan choice. Likewise, quality incentive programs are used in traditional, fee-for-service (FFS) Medicare to reward provider performance and aid beneficiaries’ decisions about where to receive care. A new paper from the Anthem Public Policy Institute compares the MA Star Ratings program to quality incentive programs used in FFS Medicare along four dimensions: program processes, measure sets, scoring methodology, and transparency of quality information for consumers. The paper identifies areas of improvement for both the MA Star Ratings program and quality incentive programs in Medicare more broadly.
Nearly one-third of Medicare beneficiaries are enrolled in Medicare Advantage (MA)—private plans that offer an alternative to traditional Medicare fee-for-service (FFS). A new paper from the Anthem Public Policy Institute offers an overview of MA, including how MA plans differ from the FFS model; how plan payments and risk adjustment work; and how MA plans work with providers to deliver value and quality to their members. For instance, unlike FFS, MA plans have robust care management and care coordination programs, out-of-pocket cost protections, and supplemental benefits. MA plans also support the long term viability of the Medicare program overall; MA has “spillover” effects onto traditional Medicare that lead to improvements in service utilization and lower costs for the program. In addition to the full paper, below is a link to a shorter issue brief that focuses on MA plan payments.
Medicaid managed care is turning towards new and innovative practices and approaches to meet the health and supportive service needs of children on the autism spectrum and their families. These efforts seek to seamlessly connect children to an array of services and supports that are tailored to the children’s and families’ preferences, needs, and goals. One of the emerging approaches is a health home designed specifically to support children on the autism spectrum. A new paper from the Anthem Public Policy Institute (PPI) demonstrates the important role health homes can play in serving children and youth on the autism spectrum. In partnership with MCOs, health homes can enhance the experience of children and their families by improving coordination, implementing a child- and family-centered approach, and offering critical assistance to children and their families as they navigate multiple agencies and delivery systems.
As policymakers debate reauthorization of Medicare Advantage (MA) special needs plans (SNPs), a new analysis from Avalere Health, sponsored by Anthem’s Public Policy Institute, highlights how these specialized plans can improve outcomes and care utilization for their enrollees relative to other Medicare plans. The analysis, which focuses on chronic condition SNPs (C-SNPs), found that MA beneficiaries with diabetes enrolled in a diabetes-focused C-SNP are more likely to receive primary care services, less likely to use inpatient care, and more likely to be adherent to their antidiabetic medications and receive diabetes specific testing than beneficiaries enrolled in non-SNP plans. This new analysis offers insight into the value that C-SNPs, with models of care and programs tailored to focus on specific chronic conditions, can provide for Medicare beneficiaries with those chronic conditions.
State and federal policymakers are considering a variety of approaches to reform and modernize the Medicaid program. As these discussions take place, it is important to understand how state Medicaid programs have already achieved value-driven and cost-effective programs, including through the adoption of managed care. This paper from the Anthem Public Policy Institute presents findings from the literature demonstrating the impact of risk-based managed care on improving quality, managing costs, and enhancing the overall member experience. The data show that Medicaid managed care offers a successful foundation on which to build Medicaid reform efforts.