AHA participates in Capitol Forum panel about vertical integration by commercial insurers

Participating Oct. 26 in a panel discussion hosted by The Capitol Forum, AHA highlighted some of the negative downstream effects of vertical integration and consolidation by commercial health insurers.
 
“We routinely hear about delays and denials, trouble getting paid for services that are provided, patients who just can’t get access to the things that they need, especially in a timely way,” said Michelle Millerick, AHA’s senior associate director for health insurance coverage and policy. “Sometimes it looks like steering patients to (other) sites of care or different parts of the health care system that might not clinically or financially be in their best interest, but might actually benefit the plan financially, so patient steering for us is top of mind in this space.”
 
The panel also discussed issues with prior authorization and payment denials from Medicare Advantage plans, as well as pharmacy benefit managers and possible ways to hold them accountable through regulation. Millerick said there currently aren’t streamlined ways to raise violations with federal regulators. 
 
“This is sort of an unprecedented phenomenon for insurers to be so big and have so much power across the spectrum of health care delivery,” she said. “We might need new or different tools that we didn’t need 20 years ago.”