Key payer actions to support the COVID-19 response—and what they should watch for

By Natalie Trebes and Tabiya Ahmed

While most COVID-19 attention right now is rightfully focused on clinical front lines, supply chains, and evolving government directives, health plans have a huge role in supporting the emergency response now—and will have a lot to consider moving into the future.

Above all, the biggest thing most plans must focus on immediately is shifting many of their normal services to remote work. That includes claims processing staff to make provider payments, but also the many customer service call center representatives who aren’t typically familiar with or equipped for remote work—and who will be dealing with a surge in call volumes over the coming months.

Telework is surging amid coronavirus. Here's how to do it right.

Beyond their essential functions, many payers are stepping up to ease safe access and financial burden for members. Here are the biggest trends we’re seeing—and some of their strategic implications for plans in the future:

1. Waived cost-sharing for coronavirus diagnostic testing continues to grow—but surprise billing may still crop up.

At a March 10 White House meeting, many large plans committed to covering all diagnostic testing for COVID-19 and eliminating any copays, other cost-sharing, and prior authorizations that can deter patients from receiving testing. Most plans are presenting these benefit options to self-funded clients, though some are instituting them as an “opt-out” rather than “opt-in” design. The IRS clarified that COVID-19 testing and treatment can be fully covered by high-deductible health plans (HDHPs), without jeopardizing their tax-preferred status. CMS also permitted flexibilities for similar cost-sharing changes in Medicare Advantage, and clarified mandatory coverage under Essential Health Benefits regarding coronavirus diagnostics and treatment.

While Vice President Mike Pence assured the public that there would be no surprise billing for the testing itself, it’s important to clarify that treatment services are still subject to in-network and out-of-network coverage terms, which commonly lead to surprise bills for patients. To combat this, CMS recently informed Medicare Advantage plans that states may declare emergencies and require plans to cover out-of-network care with providers participating in traditional Medicare.

Given that such a range of options are possible, plans should aim to coordinate with other payers in their market about their changes and messages, to help eliminate patient confusion about coronavirus coverage.

2. Payers are pushing telehealth more than ever—and patient use today can boost prominence tomorrow.

Many plans are hoping to increase access to telehealth by reducing or eliminating member cost sharing. Aetna, AmeriHealth NJ, Humana, Oscar, Optima and the BCBS plans of Arizona, Massachusetts, Nebraska, and New Jersey, have all temporarily eliminated cost-sharing on telemedicine virtual visits, to encourage members to get urgent and acute care without risking being in a public space. More broadly, most other plans and the BCBS Association are expanding their telehealth service capacity and encouraging members to use it. And the House’s recent coronavirus legislation includes around $500 million to allow Medicare providers to administer telehealth services so that more elderly patients, who are at greater risk from the virus, can receive care remotely.

Broader telehealth use also allows providers to triage limited tests and treatments to those who need it most, keep shared spaces like communal waiting areas and the ED reserved for true emergencies or for more vulnerable populations such as chronic care patients, elderly patients, and those with compromised immune systems, and prepare for a potential COVID-19 patient to come into the clinic.  Rush Medical Center recently knew to clear ambulance bays, equip providers with preventive gear, and prepare an isolation plan, after conducting a virtual visit with a COVID-19 patient.

Dramatic promotion of these services now may spark continued use after the crisis passes. The government's emergency telehealth support could result in a more permanent expansion, as CMS has now broadened virtual care payment to include visits on smartphones from patients’ homes—and we expect to see further support from Congress. Advisory Board’s research on virtual visits also show that potential first-time virtual patients are most motivated by a free visit—and plans waiving costs today may be the exposure tipping point needed to make virtual visits the new widespread norm.

Is your plan working to encourage virtual visit use or equip providers to integrate telehealth into their practice? We’re currently researching plan initiatives here, and would love to hear about your pain points and priorities. Contact AhmedT@advisory.com if you’d like to participate.

3. Plans are in a unique position to creatively support healthy social distancing and quarantines.

Beyond the chaos of access to testing and treatment, the rest of the country must focus on minimizing physical interaction with others to reduce the virus’s spread. Plans sit in a unique position to help, with broader knowledge of member care needs, connections to community organizations, and additional resources and bandwidth.

A few highlights that caught our eyes:

  • Geisinger, Cigna, and most BCBS plans are waiving early medication refill limits on 30-day prescription maintenance medications to address any drug shortage or access issues as more members remain home. Most are also not charging patients for receiving a non-preferred medication.
  • CVS Health, parent company of Aetna, is sending any member diagnosed with COVID-19 a care package with OTC medications to ease symptoms and cleaning supplies to help avoid further spread.
  • CareSource is partnering with The Foodbank, Inc and committing $128,000 to allow The Foodbank to prepare 1,200 supplemental food boxes to distribute a 14 day supply of food to seniors with an income below 200% of the federal poverty line.
  • Cigna is offering a webinar to the general public about tools and techniques for stress management during the epidemic and providing access to telephonic mindfulness sessions.

As with telehealth expansion, payers have a unique opportunity to build member familiarity with newer types of services they can offer—potentially paving the way for expanded engagement in the future.

4. Special coverage options are expanding, but employer-sponsored insurance will likely decline.

While it feels like a long way off, ultimately a shifting business line mix will be one of the biggest impacts on payers and the health care ecosystem in the future. States like Washington, Maryland, and Massachusetts have already announced limited-time special enrollment periods for the uninsured on their individual marketplaces, to help enable access to care and mitigate hospital uncompensated care.

Given the economic disruption, we should be prepared to expect growth in the uninsured population in the event of a string of layoffs. Many may ultimately shift to Medicaid, where possible—and many states are now exploring enrollment waivers. We also might start to see employers more aggressively pursue last year’s new individual coverage HRA (ICHRA) option, allowing them to pay individual market premiums for specific employee segments.

In the year ahead, plans will need to prepare for financial swings in their books of business, changes in their negotiations with providers, and communication with members about product options.

Webinar this Thursday: Where the coronavirus outbreak stands now

Join us this Thursday at 1 p.m. ET as we examine the spread of COVID-19 around the world, assess the readiness of the U.S. health care system, share strategies and resources to prepare--and look at what to expect when the outbreak subsides.

Register Now

Next, Check Out

Your top resources for coronavirus readiness

Learn More