What’s Next for Payors and Plans (and their Members)

Categories: HealthCare

While frontline healthcare providers risk their lives every day to care for COVID-19 patients, supporting them in the fight are health insurance plans.

Health insurers are quickly and quietly removing barriers to care, supporting rapid pharma testing, helping commercial customers reopen businesses — all while speeding up payments and offering different types of health plans to the unemployed. Health insurance payors engage with the entire healthcare ecosystem.

  • Plan members
  • Care providers on the front line or who have pauses in services and struggle to run their clinic or pay rent as a result. And the Centers for Medicare & Medicaid Services (CMS) issued new guidance on how providers are evaluated and reimbursed.
  • Customers furloughing their employees.

4 Forward Looking Trends

Dr. Steve Miller, Chief Clinical Officer at Cigna recently commented on a podcast, “Everyday has new challenges, extraordinary innovation and we will have a better healthcare system as a result of COVID 19.

1. With increasing unemployment rates, plan types are shifting from employee-sponsored insurance (ESI) to Individual and Medicaid. (And yes, the number of uninsured adults will rise.)

One national study projects the unemployment rate to reach 32% by the end of 2020.

  • 18 million adults will leave employer-sponsored insurance.

  • 8 million adults will enter Medicaid.

  • 1 million adults will enter the individual market.

  • 7 million adults will become uninsured.1

Insurers should strategically prepare and be ready to offer plan types and options that attract displaced prospects and help retain current members.

What Can You Do Now?

Focus on educational communications that calm member fears and place the importance of mental well-being.* Financial stress directly impacts health and the need for health care.

  • Community education and outreach is critical. 
    • Increase member communication on the use of remote monitoring and virtual health (telehealth). 
    • Increase member communication on how to access behavioral health.
  • Optimize your digital outreach though podcasts and social media.

 *Medicaid has clear guidance on marketing restrictions and the enrollment process. Education and community outreach are pillars for reaching that audience.

2. Remote monitoring tools and virtual care will likely reduce costs to health plans.

For consumers and providers, COVID-19 has increased the acceptance of telehealth and virtual care, including remote monitoring (blood sugar, blood pressure, medication dosing, etc.). This is being fueled by a need for non-touch care and the waiving of co-payments and deductibles for COVID-19 and in some cases, for non-COVID-19 related health issues.

Post-COVID-19, it is expected that CMS will roll-back on some of the payment waivers. But insurance companies predict that consumer acceptance of virtual care and remote monitoring will help reduce the cost of claims.

What Can You Do Now?

As part of a communication plan, health insurance plans (and medical device companies) should increase remote monitoring education to members. Riding on the virtual care wave, remote monitoring is a natural next step for many patients.

3. Focus on expanding access mental health care to improve members’ quality of life and reduce costs.

Mental health conditions cost the U.S. healthcare system more than $200 billion annually — more than all chronic conditions combined.2 Yet, only 42% of people who suffer with a mental health disorder receive proper health care services.2,3

According to a recent study, American’s State of Mind2, there has been a rapid increase in prescription drug use since March. The increase correlates to: COVID-19 being declared a pandemic, and the U.S. declaring a national emergency.

Prescription drug use:

  • Anti-anxiety medications-up 34.1%
  • Anti-depressants-up 18.6%
  • Anti-insomnia medications-up 14.8% Women (39.6%) Men (22.7%)

Many health issuance companies are tackling the growing impact of isolation and mental health problems their members are facing by improving access to healthcare in real time. Prior to COVID-19, UnitedHealth Group, Inc., began promoting virtual care visits to reach those in rural areas.3 The way people receive mental health services is evolving, and virtual care can provide faster access to care.

What Can You Do Now?
When onboarding new members (mostly as a result of COVID-19), offer an online mini-mental health programs that directly addresses the impact of COVID-19 to show immediate value to the member and evaluate on-going member needs.

4. The metrics used to measure a plan’s success has been suspended. Staying close to providers will be critical to maintaining quality outcomes.

Due to COVID-19, CMS has temporarily suspended several key quality metrics to remove reporting requirements that takes time way from patient care. The focus is on immediate delivery of care for 2020.4

CMS has said it will use last year’s HEDIS® and CAHPS measure scores for the 2020 Star Ratings. These quality indicators are key for plan ratings (impacting exchange rates and prospective members). Not collecting and reporting this information will make it challenging to accurately compare plans in 2021. But many agree, the shift to immediate care rather than preventive care will impact the quality indicators.5

  • CAHS (Paused)
  • HOS: (Pushed back – late summer)
  • Star Ratings will remain the same

Payors will need to work closely with providers to adapt to the ever-changing environment and provide quality care.

What Can You Do Now?

Email providers regularly based on the type of care they deliver and where they are in the pandemic surge. Email offers a convenient way for members to access information on their mobile devices.

The impact of rapid change has reached every part of the health insurance industry. Focus on what you can do now:

  • Create digital educational campaigns to attract prospective members by calming fears.
  • Adapt the onboarding process to add valuable mental health mini-programs.
  • Ride the wave of virtual health by introducing the value of ongoing remote monitoring.
  • Segment your provider base by the type of care being delivered – meet them where they are with relevant support.

As innovation continues to emerge, focus on strategic planning for the future. We can help. Contact a Bluespire Healthcare strategist today.

Sources: https://www.advisory.com/research/health-plan-advisory-council/members/expert-insights/2020/how-covid-19-will-impact-payer-enrollment-mix, https://www.express-scripts.com/corporate/americas-state-of-mind-report, https://www.unitedhealthgroup.com/newsroom/posts/2019-08-30-improving-access-behavioral-care.html, https://www.cms.gov/newsroom/press-releases/trump-administration-makes-sweeping-regulatory-changes-help-us-healthcare-system-address-covid-19, https://healthpayerintelligence.com/news/cms-suspends-quality-reporting-measures-amid-pandemic.

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