Alliance of Community Health Plans (ACHP)

ACHP asks the Centers for Medicare & Medicaid Services to allow for a more effective sampling methodology in the Risk Adjustment Data Validation process in support of a more reliable marketplace. It’s time to enhance accuracy and transparency in the audit system to better serve patients and improve outcomes. https://achp.pub/3AZF6g8

Medicare Advantage star ratings should be a tool for better care, not just a metric. ACHP is pushing for changes that prioritize real, measurable improvements in senior care. Learn more about our MA for Tomorrow initiative: https://achp.pub/3ACUTBf #MedicareAdvantage #SeniorCare

The Biden Administration has proposed a new rule to include weight-loss drugs in Medicare coverage, as reported by Dan Diamond at The Washington Post. While ACHP has applauded the Administration’s work towards comprehensive coverage and care at an affordable cost for seniors, we are deeply concerned with this proposal. Drugmakers command excessive prices for these treatments and current evidence does little to show long-term success for patients with obesity. The proposed expansion is irresponsible without further analysis. Read more in ACHP President Ceci Connolly’s statement: https://achp.pub/4fIvXrb #Medicare #DrugPricing #GLP1 #Obesity

With pharmaceutical costs rising, ACHP members are encouraging affordable treatments through biosimilars. By switching to effective alternatives, we can lower the overwhelming costs of prescription drugs without impacting patient safety. Read more about ACHP's drug pricing policy priorities: https://lnkd.in/eXiDCwFx #Biosimilars #DrugPricing

“There is a balance in making sure that [prior authorization] is used appropriately while ensuring patients are able to get the care they need, when and where they need it,” says ACHP’s Dan Jones, vice president for federal affairs. Recent reforms by the Biden administration and Centers for Medicare & Medicaid Services are a step in the right direction, striving to improve patient access to timely care and encouraging appropriate use of resources, but it is just the beginning. As ACHP’s CEO Ceci Connolly explains in Modern Healthcare, “There are very clearly instances where prior authorization is about safety and appropriateness and can be about spotting fraud...we need to recognize that, especially if a patient is not in a good, integrated system.” We encourage collaboration between providers and insurers to continue improving prior authorization processes and access. Learn more about the recent changes and what ACHP leadership is encouraging for the future: https://achp.pub/4hU3EaN #PriorAuthorization #ValueBasedCare #HealthPolicy

75% of overdoses last year involved an opioid. CDPHP's ‘Courage to Care’ program expands access to opioid use disorder services by incentivizing primary care providers to treat these patients, giving up to $188 per visit on top of the standard reimbursement rate. This is a perfect example of how ACHP member plans leverage provider relationships to improve patient outcomes. View others in ACHP's 2024 Affordability Report: https://achp.pub/4fXNmMZ #OpioidUseDisorder #ValueBasedCare

ACHP wrote to the Centers for Medicare & Medicaid Services with recommendations to strengthen consumer protections and improve the individual market--because consumers deserve better. Learn more about the improvements we’re advocating for:

In collaboration with the Association for Behavioral Health and Wellness, we are requesting a one-year good faith compliance period for all Mental Health Parity and Addiction Equity Act provisions that will become effective on January 1, 2025.

Seniors deserve the best care possible. ACHP’s #MAforTomorrow?initiative modernizes Medicare Advantage ratings, ensuring seniors can make informed choices with a system that prioritizes quality care.

Looking to a new administration, we remain focused on reforms that make a difference: combating high drug costs, inadequate Medicaid rates and advancing our MA for Tomorrow priorities.