By: Jasmine DeSilva and Stephanie Young
On March 17, we first reported on health plans’ Covid-19 responses. Since then plans have elevated their strategies to be more comprehensive and tactical in addressing the needs of members and providers.
Plans are revising operations and pioneering initiatives—some outside of their typical purview. Building on our research and discussions with health plan Chief Medical Officers, we’ve identified five key themes across plans’ evolving Covid-19 strategies.
1. Plans are alleviating financial and operational burdens, allowing members and providers to focus on Covid-19.
Many plans are waiving cost-sharing for testing and virtual visits, but a few plans are extending coverage to include all Covid-19 treatments.
Cigna, Humana, and UnitedHealthcare are temporarily waiving cost-sharing for all Covid-19 treatments.
Aetna is waiving cost sharing for Covid-19 hospital admissions. Humana is suspending prior auth (PA) and referral requirements and instead requesting notification within 24 hours of inpatient (acute and post-acute) and outpatient care—available for all providers for Covid-19 care and for in-network providers for non-Covid-19 care.
UnitedHealthcare is suspending PA requirements to post-acute care settings, effective March 24, 2020 – May 31, 2020. UHC is also removing PA requirements when a member transfers to a new provider through May 31, 2020 and suspending review for site of service through April 30, 2020 for many surgical procedures.
Additionally, many plans are allowing early refills for 30-day supplies of most maintenance medications. Arkansas Blue Cross is encouraging members to use their 90-day mail-order benefit and will ensure formulary flexibility if there are shortages. Other plans like Avmed are going one step further by offering home delivery of all prescription medications at no cost to members.
2. Plans are promoting telehealth through the creation of innovative online tools.
Beyond waiving cost-sharing, plans are encouraging telehealth use by enhancing its capabilities, such as personalized member education and virtual triage.
Capital District’s Physicians’ Health Plans and MVP Health Care partnered to standup a virtual ED triage system that offers diagnostic and prescription services over the phone. The provider can arrange for a test or refer the member to an in-person facility.
Oscar created the first tool to locate Covid-19 testing centers. The tool is linked to an online virtual assessment and Oscar’s virtual visit service, Doctor on Call.
Molina Healthcare launched a chatbot to educate members about Covid-19 risk factors and their own personal risk profile, offer live help, and recommend appropriate actions for members with symptoms.
3. Plans are redeploying plan staff to serve members’ immediate
needs and limit furloughs.
Plans are creatively redesigning employees’ roles, diverting attention to virtually and quickly communicate with members to educate them on Covid-19 and ensure their needs are met.
A predominantly Medicaid West coast plan is repurposing member-facing staff like administrative assistants, receptionists, and community health workers to call seniors and vulnerable members to ensure they have essential resources like food and medication refills.
A Midwest plan is redeploying care management staff that would typically visit members in-person to call the 20% highest-risk Medicare members. The staff identifies social, behavioral health, and clinical needs over the phone and refers them to resources as needed, such as community-based organizations.
Cigna is either transferring or redeploying hundreds of on-staff nurses and physicians to support telehealth as
the plan expands its offerings in this area.
4. Plans are addressing social and behavioral health needs surfacing
as byproducts of Covid-19.
Given many people are experiencing hardship, anxiety, and uncertainty amid the present crisis, plans are prioritizing investments to address the non-clinical needs of their members, employees, and communities.
UHG is providing 21,000 meals per week for the next eight weeks across the Minneapolis and St. Paul area in Minnesota. The food service workers that typically serve the UHG office cafeterias will be preparing the meals, allowing UHG to simultaneously feed the community and provide wages to the workers.
Florida Blue is donating $2 million to local community organizations to provide namely food for seniors, support for hourly workers, and behavioral health care.
Aetna is waiving cost-sharing for behavioral telehealth visits and setting up a crisis response line for all members experiencing Covid-19-related anxiety.
5. Plans are forming cross-industry collaborations to address unmet needs.
Recognizing the power in joining forces with disparate parties, plans are partnering with tech companies,
non-profits, and other organizations to address Covid-19 related issues like overburdened hospitals and blood shortages.
Blue Shield of California launched a digital triage tool in collaboration with GYANT, a company that uses artificial intelligence to connect people and providers. At no additional cost, the tool helps hospitals identify, triage, and treat Covid-19 patients through a series of basic questions, while directing lower-acuity patients to appropriate sites of care.
UnitedHealth Group collaborated with the Bill & Melinda Gates Foundation, the University of Washington, and Quest Diagnostics to study the effectiveness of a self-administered Covid-19 test, concluding that the self-administered test is as effective as the clinician-administered test. Moreover, it reduces exposure for health care workers, is less invasive, and limits the need for personal protective equipment.
L.A. Care helped the Red Cross address a severe blood shortage by hosting a blood drive at their office. As of 3/21 more than 7,000 blood drives had been cancelled across the country. The Red Cross organized the blood drive in a large conference room at L.A. Care and adhered to safety protocols, including appropriate social distancing.
Looking towards the future
The Covid-19 pandemic has placed immense pressure on our health care ecosystem to go beyond the status quo. Movements that have been years in the making—interoperability, cross-industry partnerships, and telehealth—are finally being prioritized.
Based on how health plans are responding, there’s hope that this crisis will revolutionize health care in the long-term – that the health care industry can emulate this kind of innovation, efficiency, and collaboration outside of crisis mode.
Questions for your next team meeting
- What existing plan staff and resources can we reallocate to respond to this pandemic?
- How can our plan offer more flexibility to providers to help them address or preempt Covid-19 outbreaks in their community?
- How can we prepare for members’ increased behavioral health and social needs as a result of Covid-19?
- What should we stop prioritizing in order to focus on this crisis? What are the burdens that can be shifted/deprioritized?
Access to Care
Payer and Regulatory Policy
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Use of virtual visits in response