Payers want to end surprise medical bills for members, population health solutions focus on patients as consumers, and more.

1. The Centers for Disease Control and Prevention (CDC) reported the following flu activity for the week ending December 8:

  • Outpatient visits for flu-like symptoms remained at the nation’s baseline of 2.2 percent.
  • 613 people tested positive for influenza A and 52 for influenza B across the country.
  • 544 people tested positive for flu in flu-associated hospitalizations between October 1 and December 8.
  • Six children have died of the flu during the 2018-19 season.
  • Three states, California, Georgia and Massachusetts, suffered widespread flu activity.

2. Payers say patients should not get surprise bills

No more surprise bills — that’s the message America’s Health Insurance Plans (AHIP) and Blue Cross Blue Shield Association (BCBSA) have set forth in their new set of guiding principles. “Surprise medical bills undermine the health and financial stability of the patients and consumers we serve,” said Matt Eyles, President and CEO of AHIP. “By agreeing to these guiding principles, we are showing our commitment to protect hardworking American families from these unexpected costs. Together, we can make a real difference in improving health care affordability and access for everyone.”

Additional payer organizations that have also consented to the new guidelines include the American Benefits Council, Consumers Union, ERISA Industry Committee, Families USA, National Association of Health Underwriters, National Business Group on Health and National Retail Federations.

“Everyone in America deserves affordable, high-quality coverage and care, and control over their health care choices,” said the groups in a statement. “Surprise medical bills undermine these values, putting the health and financial stability of millions of patients at risk every year.”

3. Payers must up their digital game

Healthcare payers, listen up: Consumers want digital experiences that help them control their spending while improving their health, according to a PricewaterhouseCoopers (PwC) report. More than half of consumers would like to use online tools to treat or manage a health condition. These tools would allow payers and providers to run analytics and use data to help predict and prevent a chronic disease from worsening.

“Seamless health data collection and sharing can help patients make positive lifestyle changes and can help physicians intervene to prevent poor outcomes,” the report stated. The report also said payers should partner with digital therapeutics companies to gather user data and offer insights to risk and spending.“Digital therapeutics and connected devices may make it easier to construct value-based contracts and other outcomes-based financial models with payers and providers to drive adoption,” PwC noted.

4. Is the ACA headed to the Supreme Court?

The Affordable Care Act (ACA) is likely headed to the U.S. Supreme Court, thanks to a ruling by Judge Reed O’Connor of the Federal District Court of Fort Worth. O’Connor ruled that the act is unconstitutional because it requires Americans to buy health insurance, according to a New York Times article.

Republican governors and state attorneys general backed the ruling. But a coalition led by Democrats defended the healthcare law and have vowed to appeal.

“If this Texas decision on the ACA is upheld, it would throw the individual insurance market and the whole health care system into complete chaos,” Larry Levitt, a senior vice president of the Kaiser Family Foundation, wrote on Twitter, the Times reported.

5. Pop health solutions target patients as consumers

Population health management (PHM) platforms are shifting gears, found a Frost & Sullivan study. No longer will they focus on traditional PHM solutions that focus on high-cost patient populations. Instead, they’re looking at a more holistic and evidence-based approach with a focus on preventive care and patients as consumers.

“The ability to benchmark patient risk profiles in real-time and develop customized health plans is a significant competitive advantage for vendors,” said Koustav Chatterjee, transformation health analyst at Frost & Sullivan. “Interoperability among disparate data sources is another critical differentiating factor.”

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