Feb 28, 2019
The recent Employee Benefit Planning Association (EBPA) Summit in Los Angeles highlighted industry trends to watch in 2019. Attorney Marilyn Monahan of the Monahan Law Office in Marina Del Ray discussed important new laws in California: Maternal Mental Health Under A.B. 2193, practitioners must screen mothers for maternal mental health conditions, and insurers must develop maternal mental health programs. The law goes into effect July 1, 2019. Prescription Drugs
- AB 315 bans PBM gag clauses, in which pharmacies are prohibited from telling consumers when the retail price of a prescription drug is lower than their cost-sharing amount. The law goes into effect on January 1, 2020. A.B. 2863 requires pharmacies to tell customers when the retail price is lower (except when the pharmacy charges the lower price automatically).Also, under AB 315, AB 2863, and SB 1021, an enrollee can’t be required to pay more than the retail price for a prescription drug at the pharmacy.
- A.B. 2789 requires providers to issue prescriptions electronically, effective January 1, 2022.
- Legislation that was signed into law in 2018 allows pharmacists to dispense a Schedule II controlled substance as a partial fill. A.B. 2048 requires insurers to divide the cost sharing by the number of days or number of pills.
- Under A.B. 1860, the coinsurance or copay for any prescribed, orally administered anti-cancer medication cannot exceed $250 a month. The law sunsets in 2024.
Medical Loss Ratios A.B. 2499 codifies existing medical loss ratio (MLR) standards of 80% for the small group market and 85% for the large group market. So California’s Medical Ratio requirement will stay in place regardless of what happens to the MLR at the federal level. Patient Records Under AB 2088, both minors and adults can provide a statement to include in their medical records. Dental Plans Under SB 1008, dental plans must disclose their loss ratio to state regulators and the public annually. The law is effective January 1, 2021.
Health Tech Trends to Watch in 2019
The conference also featured technology that could make important progress to address persistent health care challenges. Michael Lujan, Market Director at Oscar Health said, “Billions of dollars are being invested in the future of how health care can be. If we can fix our own house, we can deliver a better consumer experience and rein in costs, fraud, waste, and abuse.” Lujan highlighted the following trends:
- Telehealth will expand to annual wellness exams, chronic conditions, behavioral health, and Medicare. There is also a massive shift toward the virtual primary care provider. Centers of excellence will give patients virtual access to the best physicians. In her presentation on Telehealth, Rachel Sunday of Playa Vista Insurance Services noted a recent study in JAMA, revealing a 261% jump in annual telehealth visits among commercially insured consumers from 2015 to 2017. “Many of those encounters would otherwise likely have occurred in a physician's office, urgent care, or emergency room,” she said.
- Artificial intelligence is projected to save $150 billion a year in healthcare costs. Alphabet, Google’s parent, is working with three universities to develop an AI system that predicts hospital mortality and reduce readmissions and prolonged hospitals stays.
- Blockchain will enable patients to access their complete health records and help in efforts to aggregate clinical data for researchers and practitioners.
- The lack of health care literacy leads to huge costs throughout the entire health care system. More insurance companies are engaging with consumers throughout their health care journey by offering, multiple check-ins, in person and online enrollment, and help finding quality providers and booking appointments.
- With a platform focus, more carriers are taking a holistic approach to the product, the facility, the providers, and the enrollment platform. They’re developing cross-provider networks to transmit data across different health care models.
LISI is committed to staying on top of these trends. Contact your LISI Regional Sales Manager for more information.
