As the impact of George Floyd’s tragic death continues to reverberate around our state, nation and world, millions of people have banded together to call for greater awareness of racial injustice and push for substantial change. Minnesota’s nonprofit health plans are committed to being part of that effort, and I want to share the actions they’re taking to promote racial equity, diversity, inclusion and awareness.

Our member health plans have long valued the diverse backgrounds of the communities they serve, and over the years they’ve launched various initiatives to address health equity issues and close gaps in care. They’ve worked to not only create diverse workforces within their organizations, they have also worked to address the cultural needs of their members and improve their access to care.

Already through our collaboration as a Council, health plans are collectively working on an ambitious goal of reducing health disparities by 50% by 2025. To get there, we know we need to do more. We have an obligation to ensure that we are meeting the needs of everyone we serve — and that all who engage with us feel valued and supported.

That’s why our mission is now shifting into high gear as health plans have made robust pledges to further advance racial justice within their organizations and in our communities. This includes commitments to conduct listening sessions in their workforces, forge new and stronger community partnerships, provide training on unconscious bias, and expand the work of their equity and inclusion teams.

For example:

• Blue Cross and Blue Shield Minnesota recently affirmed that racism is a public health crisis and dedicated a number of resources to promote social justice inside and outside its organization. The entire executive leadership will take various steps to accomplish this, including: fighting for the equitable health, well-being and safety of all Minnesotans; denouncing racism inside the organization and throughout the community, attending community events and discussions to better understand why systemic racism exists; continuing those conversations through its Associate Resource Groups, Health Equity Summit and upcoming “Safe Space Conversations” series; and continuing to rebuild damaged cities.
• HealthPartners committed to a series of actions to address racism and injustice, including organization-wide listening sessions in which leaders share their own experiences and take questions; committing resources to community organizations that are helping Twin Cities neighborhoods rebuild; and making the efforts of its Diversity and Inclusion team more visible and impactful by created a central location on the company’s intranet to share resources. Employees also took part in a moment of silence and solidarity on June 4 at 3:15 p.m., the same day as George Floyd’s Minneapolis memorial service.
• Medica recently announced that it is now hiring a Director of HR, Diversity and Inclusion to better engage the community and recruit talent. Additionally, the health plan is reaching out to organizations of color and those focused on issues of societal equity, and is enhancing the Medica Foundation’s focus on nonprofit organizations that address health issues disproportionately affecting diverse communities. Internally, the company is also hosting listening sessions to gauge employees’ thoughts and concerns; expanding efforts to diversify its staff and board; engaging its executive leadership team and board members in unconscious bias and cultural competency training; and rolling out a new unconscious bias class in August for all employees.
• UCare has held a series of Listen and Share sessions with a professional facilitator versed in race relations; compiled and shared a resource list of educational books, websites, films, videos and podcasts with employees; committed to strategies focusing on health equity and inclusive employer practices; created a new position to lead its health equity work; and assisted displaced providers who serve diverse members. In the wake of the unrest, UCare also helped its employees and members in affected neighborhoods get access medications, urgent care and food.
• Additionally, several of our Council member CEOs signed their names to a joint statement from more than 50 executive leaders across Minnesota condemning the repeated occurrence of racially charged events like George Floyd’s murder, and vowing to address racial inequities and social injustice in their organizations and communities.

We’re so proud of these efforts, but they’re also only the beginning. Our member health plans recognize that true success in addressing systemic racial inequity goes far beyond an initial push in the wake of a high-profile tragedy. The hard work involves listening and then doing. Blue Cross president and CEO Craig Samitt said it best in his recent blog post: “While collectively raising voices to condemn racism, discrimination and social injustice is important and essential, it’s not enough because actions speak louder than words.”

Those actions will ultimately lead to greater patient satisfaction, lower health disparities and a healthier Minnesota. In that spirit, we must keep the momentum going. We must never forget. And I’m looking forward to sharing more with you as our health plans fully commit to real and meaningful change.

As we head into summer after a lengthy stay-at-home order in Minnesota, we all feel a powerful urge to “return to normal.” Who wouldn’t? As individuals, families, a state and a nation, we’ve never gone through anything like this before.

The good news is that we can do many activities today that we couldn’t in the spring – both because of the weather and the easing of restrictions. But as we enjoy more flexibility, we also must remember that we’re living in a new era when it comes to work and personal safety. As we return to the office, attend small family gatherings and maybe visit some lakes, pools, restaurants and malls, we need to be even more sensitive to the risks involved. Most importantly, we need to acknowledge that the decisions we make don’t just affect us; they affect everyone.

June is the perfect time to renew our focus on health and safety because with it comes the official start of summer – June 20 – and it’s also National Safety Month. Started by the National Safety Council in 1996 to build awareness and reduce illness, injuries and death, this tradition has taken on more significance this year than ever before. In addition to shining a spotlight on vital issues like mental health, ergonomics, driving and building an overall culture of safety, it also gives us an opportunity to review the safety challenges brought on by COVID-19.

In a recent blog post, the chief medical officers of Blue Cross Blue Shield Minnesota, Medica, PreferredOne, UCare and HealthPartners remind us that COVID-19 is most frequently spread between family members and at large gatherings. So as our neighborhoods and economies continue to open up during the summer, it can be easy to grow complacent about safety protocols at the exact time when following them is most critical.

For employers, the National Safety Council offers a great resource page with comprehensive COVID-19 safety guidance. For the general public, the Council’s medical directors remind all Minnesotans to:

• Keep washing your hands frequently, preferably using soap and water, lathering the backs, between your fingers and under your nails, and scrubbing for at least 20 seconds. This isn’t a winter activity; it’s a year-round requirement.
• Wear a mask when you leave home, making sure that it fully covers your mouth and nose and fits snugly against the sides of your face. Wash it after each use in the washing machine or by hand using a bleach solution, and allow it to dry completely.
• When in public, talking to your neighbors or being with anyone outside your household, always remain at least six feet away.
• If you or someone in your household has COVID-19 symptoms like cough, fever, shortness of breath, body aches, sore throat or the sudden loss of the sense of taste or smell, everyone in your household should isolate from others, and you should call a health care provider for advice on COVID-19 testing and treatment.

Additionally, there are plenty of articles and resources available online to help you assess the level of risk with various activities, be it going to the mall, the gym or a hair salon. A good place to start is the CDC website, which has an “Errands and Going Out” page that offers some recommendations on how consumers can protect themselves in certain environments.

As summer heats up, don’t let your guard down. Take care of yourself and your family, as well as friends, coworkers, and the elderly and vulnerable by following social distancing guidelines and other measures to prevent infection, illness and death.

Our new safety normal is going to be with us for the foreseeable future. As you head outside or in public to enjoy everything Minnesota summers have to offer, remember that what you do now directly impacts what life will look like in the fall and winter. Let’s use this time to make our future months as healthy as possible.

Recently, the state legislature passed the ground-breaking Prescription Drug Pricing Transparency Act, mandating that drug companies must now notify Minnesota consumers when they institute significant price hikes for certain prescription medications. This bipartisan legislation didn’t happen overnight. It was the culmination of more than a year of negotiations between legislators and various advocacy groups, and I’m proud so say that Minnesota’s nonprofit health plans played a significant role in making it happen.

How does the new legislation benefit me as a consumer?

The new law creates “news you can use” when it comes to your medications. You’ll have a window into when and why your prescription meds are going up in price, and you’ll be armed with better information to potentially help you save money by finding more affordable alternatives. As the saying goes, “sunlight is the best disinfectant,” so the longer-term hope is that greater transparency in pricing will lead to lower drug prices overall.

Specifically, if you’re taking a medication that already costs $100 or more for a 30-day supply, the new law requires the makers of that drug to publicly disclose any sharp increases in price. For brand-name drugs, the requirement kicks in when the price jumps at least 10% over 12 months, or 16% over 24 months. Changes for generic drugs must be reported when prices go up by 50% or more.

When the requirements kick in next year, drug manufacturers must disclose the following information to regulators, which you will then be able to see online via the Minnesota Department of Public Health’s website:

• the name of the drug and the net price increase
• the list of factors leading to the price increase
• the names of any generic versions of the drug that are available
• the introductory price approved by the F.D.A. and year-over-year increases
• costs incurred by the manufacturer associated with the prescription drug, including manufacturing, marketing and distribution
• net profit and sales revenue on the drug for the previous 12 months
• the total amount of financial assistance the manufacturer has offered through patient assistance programs
• any agreements between the manufacturer and another entity about delaying the production of generic alternative

When will I be able to take advantage of this new system, and what are the consequences if the drug companies don’t comply?

The new requirements take effect on Oct. 1, 2021. At that point, manufacturers will have 60 days after they increase prices or introduce new drugs to submit the information above to the state health commissioner. If they fail to do this, or if they provide inaccurate or incomplete information, they’ll face fines of up to $10,000 a day. Those funds would go into the state’s Health Care Access Fund, which helps pay for MinnesotaCare and other programs that increase access to health care for lower-income Minnesotans.

Why is this issue so important to Minnesota’s nonprofit health plans?

It’s all about affordability and accountability. Health insurance premiums reflect the overall cost of care, and prescription drugs are a major driver of health care costs. In fact, most people don’t realize that prescription meds account for nearly 25% of all health care expenses — which is more than in-patient hospitalization costs. Under our current system, drug companies can raise prices with little exposure or justification. The latest round of price increases happened in January of this year – prices increased on more than 200 prescription drugs. The steep increases in drug prices not only harm patients but taxpayers as well who help to pay for public programs, such as Medicare and Medicaid. The new law empowers consumers by making drug companies more accountable to them, and it empowers policymakers by providing better data to help drive better policy.

Bottom line: Creating more transparency of drug prices is an important first step toward raising awareness of the role of drug prices in health care. Minnesota’s nonprofit health plans believe that greater transparency in drug pricing will help drive down the cost of prescription drugs and make health care more affordable for everyone.

By Mark Steffen, M.D., Chief Medical Officer at Blue Cross and Blue Shield of Minnesota; John Mach, M.D., Chief Medical Officer at Medica; Abigail Miller, M.D., Chief Medical Officer at PreferredOne; Julia Joseph-Di Caprio, M.D., Chief Medical Officer at UCare; and Patrick Courneya, M.D., Chief Medical Officer at HealthPartners

Don’t drink and drive, wear your seatbelt and put on your sunscreen are being joined by wash your hands, wear your mask and stay 6 feet away from others as universal messages this summer from healthcare professionals.

As the Chief Medical Officers of Minnesota’s nonprofit health plans, we are adding our voices to this very important advice. 

As the weather gets warmer, don’t let your guard down. Join us in taking care of our family, friends, coworkers, and especially our elders, by following social distancing guidelines and other measures to prevent infection.

As we learn more about COVID-19, we know this virus is most frequently spread between family members and at large gatherings. And the summer months are prime times for get-togethers. 

That’s why if you or someone in your household is having COVID-19 symptoms, like cough, fever, shortness of breath, body aches, sore throat, or the sudden loss of the sense of taste or smell, it is important that everyone in your household isolate away from others. This means staying home and calling a health care provider for advice on testing and treatment.

Wash your hands, wear your mask and remain 6 feet from others. Remember these messages and please join us in doing your part to stop the spread of COVID-19.  The health of all Minnesotans depends on it. 

For more information and resources on COVID-19, please visit the Centers for Disease Control and Prevention and Minnesota Department of Health websites.

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Lucas Nesse, president and CEO of the Minnesota Council of Health Plans, issues statement on House passing Prior Authorization Legislation

Statement:

“Prior authorization is a critical tool for ensuring safe, effective and efficient treatment for patients. Individuals and employers greatly benefit from the associated cost savings and lower premiums. Minnesota’s nonprofit health plans are proud to have played a key role in refining this legislation to ensure that important elements supporting patient safety and lower costs were maintained.”

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Pandemics impact us all, but certainly not equally. Among the many tragedies of COVID-19 is that it is hurting people who were already in need — including Minnesotans who were struggling with their health, financial stability and other basic necessities long before any of this started.

One silver lining of this unprecedented crisis is that it is also bringing people together in ways big and small. If we needed any more evidence that our Council members support the overall well-being of their enrollees, then this situation is proving it. The social determinants of health (SDOH) — like food, housing or another need — are becoming increasingly important for our enrollees during this pandemic, and I’m so proud of the ongoing work that Minnesota’s nonprofit health plans are doing to support people and communities during this tough time.

Our members — including Blue Cross Blue Shield of Minnesota, HealthPartners, Hennepin Health, Medica, PreferredOne, Sanford Health Plan and UCare — are directly aiding those who are most vulnerable. This includes health care workers, seniors, people with chronic medical conditions, people with emotional and behavioral problems, those facing abuse and those who lack income to meet their basic needs.

Since this pandemic began, Council members have stepped up in numerous ways to help enrollees. For instance, The Medica Foundation announced in late March that it was donating $1 million across 18 Minnesota nonprofits to meet emergency needs brought on by COVID-19, including $50,000 to Anna Marie’s Alliance to help provide safe shelter and support for battered women and their children. Meanwhile, The Blue Cross and Blue Shield of Minnesota Foundation announced in late April that it was contributing over $1 million to support communities during the pandemic, including $100,000 to the Coalition of Asian-American Leaders as part of its anti-racism campaign.

Also, the UCare Foundation announced in late April that it was providing $500,000 in assistance for Minnesotans impacted by the pandemic, including infrastructure grants up to $25,000 to small provider groups and community clinics for enhancements to provide care in a COVID-19 environment.

And these are just a few initiatives that have kicked off since the pandemic started. Collectively, health plans and their foundations have:

• Provided millions of dollars for assistance related to social isolation, mental health, telehealth, food insecurity, domestic abuse and personal protective equipment. Organizations receiving support include the Greater Twin Cities United Way, People Serving People, YMCA of the Greater Twin Cities, the University of Minnesota Department of Family Medicine, NorthPoint Health & Wellness, Wellness in the Woods, Twin Cities Mobile Market, Higher Ground Shelter, Mary’s Place, Carris Health, Minnesota Recovery, Minneapolis Public Housing Authority, Open Arms, Washburn Center for Children, Anna Marie’s Alliance, Big Lake Community Food Shelf, Christian Social Services in Monticello and many more.
• Distributed some 15,000 individual hand sanitizers to our members, group homes, small businesses, senior and other organizations across Minnesota.
• Supplied bags to local food banks and food shelves to help in the packing of food.
• Purchased and distributed iPads for telehealth video interactions.
• Supplied remote home monitoring equipment to help people manage their chronic medical conditions.
• Distributed snack packs, toothbrushes and toothpaste to those in need.
• Provided disposable medical masks to group homes, transportation providers and non-physician small allied providers.

The COVID-19 crisis may be with us longer than we’d like, but it will end at some point. When that happens, we can be grateful that Minnesota’s nonprofit health plans stepped up in a big way to ease the pain of those affected by the pandemic’s health and economic impacts. And as a world-renowned health care community, we can also be proud that the various players in our system came together to keep Minnesotans as healthy and safe as possible when they needed it most.

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Ghita Worcester, SVP of Public Affairs & CMO, shared her take on the ACA turning 10 during a pandemic – and UCare’s experience as an ACA leader: www.linkedin.com/pulse/aca-turns-10-pandemic-ghita-worcester/

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Lucas Nesse, president and CEO of the Minnesota Council of Health Plans, issues statement on Minnesota House Passing Drug Price Transparency Legislation

 Statement:

 “Minnesota’s nonprofit health plans are proud to have played a key role in advancing this bipartisan legislation. Prescription drugs are a major driver of premiums and now account for nearly a quarter of health care expenses – even exceeding in-patient hospitalization costs. Greater transparency of these expenses will help advance affordable drug pricing for all Minnesotans and lead to useful data to better inform policymakers.”

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​With the COVID-19 pandemic unfolding worldwide, telehealth is quickly being revolutionized. Everyone – individuals, families and organizations alike – must adapt to this increasingly popular way clinicians are practicing medicine, and that’s especially true across every facet of Minnesota’s health care system.

For a sense of scale on the rapid rise of telehealth, consider this: A 2019 J.D. Power survey found that only 1 in 10 patients nationwide engaged in telehealth. By contrast, the Washington Post recently reported that one of America’s largest digital health care providers has seen a 900% increase in patients using telehealth services across its 800 partner hospitals. Closer to home, a recent Stratis Health study found that since the COVID-19 outbreak, telehealth use in Minnesota has increased more than 1,000 fold—from 1,149 visits per day to 15,480. The federal government, which has been reticent to pay for telemedicine except under very specific circumstances (like for those who live in rural areas), has also been quick to expand telehealth benefits and pay providers the same rates as in-person visits.

As with any massive shift, people are wondering just how this system is changing. Since I’ve had a (virtual) front row seat to witness the nimble pandemic response of Minnesota’s nonprofit health plans, I want to share some details on how our member health plans are helping to advance telemedicine. Given that telemedicine can be an incredibly convenient form of care delivery for both patients and health care professionals, we shouldn’t be surprised if its popularity outlives the pandemic. This presents an opportunity for health plans to innovate and create an even more robust telehealth experience

How are telehealth appointments being covered by insurance in Minnesota?

A survey of insurance coverage plans offered by our Council members shows that all of them cover telehealth services for members, and that they will reimburse these virtual visits as if they were done face to face. Hospitals and clinics are being asked to use specific reimbursement codes for remote services, and Council members have set up provider portals to deliver the most up-to-date information on reimbursement codes and procedures. The Council is also working with clinicians to further streamline this process to make it easier for providers, so that enrollees need not worry about whether their appointments will be covered.

 Who decides if telehealth is covered?

 For people who use Medicare or have their insurance coverage through one of Minnesota’s Health Care Programs, the federal and state governments dictate what services and treatments are covered. Telehealth is no exception. Prior to the COVID-19 health emergency, both the federal Centers for Medicare & Medicaid Services (CMS) and Minnesota’s Department of Human Services had strict rules about how Council members could cover and pay for various telehealth services. Council members have been working closely with people in government to figure out what rules need to be relaxed so people can continue to meet with their doctors, therapists, and other health care providers and get the care they need. Some of the changes made include allowing people to use a variety of audio and visual systems; allowing different types of health care providers – like psychologists, social workers, dieticians, and midwives – to provide care to their patients; and making sure that these providers are paid for this work just like they would be if they saw a patient in their office.

 What about self-insured plans?

Self-insured plans – those in which employers use their own funds to cover employees’ claims – can vary, but they generally have the option to cover services the same way as fully insured plans. The Federal CARES Act requires that all testing for COVID-19 and the related provider visit be covered by private insurance plans without cost-sharing (this includes a related provider visit done via telehealth). However, it does not mandate coverage of all telehealth services that are or are not related to COVID-19.

How are health plans letting hospitals, clinics and patients know that telehealth services for mental and behavioral health, as well as other services, are covered?

Council members are providing FAQ documents for health care providers and their members through their respective websites. If hospitals and clinics have additional questions, they are being encouraged to use a plan’s provider portal, or to reach out to the plan’s member services team to answer specific questions, as guidelines for telehealth are quickly changing.

Is there any concern that as telemedicine becomes more readily available and heavily utilized during the pandemic, the cost of mental and behavioral health services will go up?

Minnesota’s nonprofit health insurers care first and foremost about the health and safety of their members and provider partners. Therefore, they should not be concerned that costs for these vital services will rise. A recent MPR article reported that mental health providers are worried that rapid changes governing the way telehealth is delivered (for instance, phone calls versus video visits) could result in providers not being paid for their services. However, this is not the case.

Minnesota’s nonprofit health plans want people to get the care they need no matter which form of delivery is used. As they do with all forms of care, health plans will always monitor the cost of care to limit fraud, waste and abuse. But they fully support the appropriate use of telehealth, especially during emergencies and times of health crisis. So far, we don’t foresee any significant issues on this front.

We recognize that the current situation has people concerned and fearful on many fronts. But those who worry that a telehealth appointment may not be covered by insurance (e.g., a virtual visit with a psychotherapist) can rest easy knowing that Minnesota’s nonprofit health plans are working to address any issues that might arise. We’ll continue to do everything we can to ease the stress and help Minnesotans stay as healthy as possible during this crisis, while also keeping all parties up to date on the latest changes and information.

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The Minnesota Council of Health Plans today announced that Lucas Nesse has been named its president and chief executive officer. Nesse was most recently with the Minnesota Business Partnership and brings deep experience in public policy and team leadership.

In his five years at the Business Partnership, Nesse served as director of health policy and grassroots advocacy and was instrumental in the development and implementation of strategic policy initiatives and advocacy plans. Prior to that role, Nesse served in the Minnesota Legislature for 10 years, serving as the legislative director and chief advisor to the Senate leadership during his last four years.

“We are excited for Lucas to step into this new role,” said John Naylor, Minnesota Council of Health Plans board chair and president, and president and CEO of Medica. “I’ve personally worked with Lucas and have seen first-hand his passion, expertise and ability to build relationships across the aisle to further important health initiatives for our state. I look forward to the many contributions Lucas will bring to Minnesota Council of Health Plans, its members and the greater community.”

Nesse earned a Bachelor of Arts in Political Science from Gustavus Adolphus College and his Juris Doctor from William Mitchell College of Law. He currently resides in Lake Elmo with his wife and two children.

Nesse will begin his new role on Oct. 21. He replaces Patsy Riley, who has served as interim President and CEO since last March.