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Benefest 2023: Talking Costs and Laws with Carriers

By: Jessie Boyle and David Ostrowsky

By March, amidst the snowbanks contracting and days growing incrementally longer, conference season – at least for the healthcare industry -- is in full bloom. One of the marquee Massachusetts-based healthcare conferences, Benefest 2023, focused on “shaping the future of healthcare” in the commonwealth, was held earlier this summer at Worcester’s Polar Park -- during the peak of conference season.

On June 15, the Massachusetts Chapter of the National Association of Benefits and Insurance Professionals (NABIP), which represents over 100,000 licensed health insurance agents, brokers, general agents, consultants, and benefit professionals and has over 200 chapters across the United States, convened to discuss the most pressing health insurance issues facing Massachusetts residents and employers. In particular, there was an acute focus on espousing affordable health insurance market solutions.

Benefest 2023 featured two panels, the Executive Leader Panel and the Legislative Panel, each of which showcased speakers from prominent organizations including UnitedHealthcare, Blue Cross Blue Shield of Massachusetts, and Aetna. There were quite a few developments to discuss, perhaps the most impactful being that of site neutral payments, which would discontinue the practice of giving different reimbursement amounts for the same service based on where the service was delivered. In effect, site neutral payments would make healthcare services more affordable to patients by incentivizing providers to work at cost-effective clinics. While site neutral payments could be perceived as a short-term solution, other longer-term reimbursement strategies, particularly those concerning commercial contracts and new cost models, remain viable options over the next three to five years. Naturally, price transparency – and how the processes for understanding, following, and applying the new regulations -- was another hot topic. Interestingly, there was strong consensus among all panelists that complying with the regulations has been relatively easy.

From a legislative perspective, the state of business and healthcare in Massachusetts is at a critical juncture as Governor Maura Healey recently appointed Kate Walsh, formerly CEO of Boston Medical Center, as the new Health and Human Services Secretary who will be chiefly responsible for managing soaring healthcare costs and the ongoing devastating behavioral health crisis. Meanwhile, both the Massachusetts House of Representatives and State Senate recently finished preparing the budget for Fiscal Year 2024; subsequent discussion about how budget constraints align with healthcare initiatives remains a high priority for the administration.

The Legislative Panel focused the majority of their attention on two topics: the ongoing popularity of Telehealth and expansion of connector care sub-eligibility. As is well known, Telehealth use spiked during the pandemic as the phenomenon was a true win-win: medial practices had a new revenue stream while non-emergent patients could still safely receive care while paying the same for virtual services as they would for an in-person visit. Now, with the pandemic having largely receded, should there still be such monetary parity between the two services? With healthcare providers now able to conduct in-person visits with patients (and provide arguably higher quality services than those rendered on a virtual basis), the movement to lower Telehealth charges is gaining traction. In terms of expansion of connector care sub-eligibility, it was noted how, historically, patients could get subsidized health insurance through Mass Health Connector if they had an income totaling 300% of the federal poverty level. Now, there is potential for that threshold to be increased to 500%, which would equate to approximately $150,000 per family. Naturally, however, there are significant concerns as to whether the Massachusetts State House has the wherewithal to appropriate requisite funding for this to come to fruition.

Surely, how such developments play out will be a focal point of Benefest 2024 next summer.