health insurance
UnitedHealthcare backs down on RPM (for now)
UnitedHealthcare will delay implementing a new coverage policy that would significantly reduce the remote physiologic monitoring services it pays for. The new policy, set to go into effect from Jan. 1, has been delayed until later in the year, the insurer confirmed to me.
Technology vendors that help health care providers offer blood pressure monitoring and other services began celebrating when screenshots of an email to providers about the update began circulating, but it's probably too early to start doing victory laps. "We still intend to implement this policy in 2026 and will share an updated timeline once it is finalized," a spokesperson said.
UnitedHealthcare faced criticism after releasing the policy for its Medicare Advantage and commercial plans this fall. At the time, the insurer argued that RPM for most conditions "is not reasonable and necessary due to insufficient evidence of efficacy." Yesterday, in fact, researchers published a critique of UnitedHealthcare's read of the evidence in Health Affairs. While technology vendors may be angry about the proposed policy change, UnitedHealthcare appears to be on stable legal footing: Though traditional Medicare pays for RPM, private insurers that run Medicare Advantage plans have leeway to determine medical necessity when the government has not issued rules determining exactly how a service must be covered.
The subtext is that UnitedHealthcare's parent company, UnitedHealth Group, is trying to improve its financial performance by curbing the use RPM, a fast-growing service that's already facing scrutiny from federal health authorities. An August report from a health department watchdog found that in 2024, Medicare payments for RPM exceeded $500 million and said that it's tracking the services for signs of abuse.
Both RPM advocates and critics have argued that Medicare regulators and other policy makers ought to put rules around coverage in place to allow RPM supported by evidence and curb unnecessary use. In particular, advocates point out that a short course of RPM for hypertension when paired with medication management can lead to improved outcomes.
Medicare declined to do anything during its payment rule-setting process last year, and in fact, it followed an American Medical Association coding panel's recommendations to expand what RPM services it pays for. If I had to guess, UnitedHealthcare has its eyes on next year's Medicare fee schedule to see what changes might be coming. Policymakers are paying attention now. In their comments around the new experimental ACCESS model, Medicare leaders have made clear they want to move away from paying for individual technology services toward paying for outcomes. The RPM industry is already working behind the scenes to shape whatever guardrails might be in the works.
If anyone has intel on UnitedHealthcare's decision here, do get in touch: mariojoze.13 on Signal or by email.
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Misleading pharma, wellness ads
More than three dozen state attorneys general, from both sides of the political divide, are urging Meta to curb a "surge of misleading" pharmaceutical and wellness ads for weight loss drugs on Instagram and Facebook. In a letter to Meta, they cite company policies indicating pharmaceutical advertisers are supposed to share information about the medical effectiveness and affordability of their medicines and target only adults. And, Ed Silverman writes that the state officials also want the company to take action to prevent artificial intelligence-generated content in the ads.
Read more here.
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