President’s letter: Advocating for health insurance coverage that works

Tuesday, January 24, 2017 05:22 AM

by Katie Lozano, MD, FACR, CMS President

A range of salient health insurance policy debates will likely occur in the 2017 Colorado General Assembly and 115th U.S. Congress due to macro-economic and political influences including the presidential election outcome, the prospective political backlash from anticipated double-digit increases in health insurance premiums in the individual market, the political engagement of the health plans being litigated by the U.S. Department of Justice, the budget pressures generated by a growing Medicaid-eligible population and backlash from a perceived “crowd-out” of other infrastructure funding needs, and unresolved network adequacy and access issues from 2016 Division of Insurance (DOI) rulemaking.

The legislative and executive branches of state government are two years into a debate over policy solutions to address the consequences of narrow networks. Narrow networks in highly concentrated insurance markets create a powerful and unfair advantage over providers. A good-faith mediation last summer between the Colorado Association of Health Plans (CAHP) and CMS failed when a few insurance companies insisted that CAHP discontinue discussions. The DOI recently finalized a series of rulemakings on some but not all network adequacy issues, such as finding a consensus on surprise medical bills and excess charges. Resolution of inequities in the current multi-payer system is critical so interactions between providers and insurance companies can turn to a focus on value rather than market share and volume.

As approved in the 2017 CMS work plan, your medical society will take full advantage of the post-election public policy environment to aggressively advocate for incremental changes in the multi-payer system, both public and commercial and at the state and national level. We aim to reduce barriers to cost-effective, quality care and increase your professional satisfaction. To achieve this, CMS will:

• Continue efforts to block the mega-mergers of Anthem-Cigna and Aetna-Humana.
• Ensure a successful transition to the Medicare Quality Payment Program (QPP) by Colorado physicians.
• Advocate for enhanced patient and provider protections for network adequacy of health insurance plans through the DOI’s Physician Advisory Group, including a pilot project that allows DOI to act on a pattern of provider complaints against insurance companies for unfair practices.
• Authorize the Council on Legislation to cause legislation to be filed to protect consumers from surprise out-of-network (OON) charges not covered when care is provided in an in-network facility, create appeal rights for providers when they are being de-selected without cause from insurance products, and address other network adequacy and access reforms consistent with CMS policies.
• Influence how health care systems reduce cost and improve quality by proactively engaging with the state’s Commission on Affordable Health Care.
• Optimize the Accountable Care Collaborative (ACC) program as a quality, Colorado community-focused alternative to national Medicaid managed care plans.
• Improve care quality and access for injured workers in Colorado.
• Participate in United’s acquisition of Rocky Mountain Health Plans to ensure a fair and transparent transition and to preserve and expand RMHP’s culture of collaboration with physicians, and
• Shape the federal conversation about the future of health care in America by participating in a Colorado-based federal coalition, working in concert with the American Medical Association and leveraging our own relationships with federal legislators.

The Colorado Medical Society has a long history of supporting health insurance coverage for all Coloradans. This is not a new debate and we are experienced in approaching the issue with a focus on physicians and our patients. We also understand that we are only one advocacy organization in a complicated network of interests and no reform proposal will satisfy all of our goals for fair coverage. Navigating this realm requires agility and flexibility by the Colorado Medical Society, which is fortunately supported by the new CMS governance model and Central Line virtual engagement platform. I look forward to working with all of you this year and gaining your insight and perspective.