Health Plan Weekly

✦ A joint report by the Robert Wood Johnson Foundation and Urban Institute found that “despite millions of Americans losing their job due to COVID-19, changes to people’s health insurance coverage might not be as widespread as anticipated.” The report is a meta- analysis of four studies on pandemic- related health insurance losses conducted over the course of spring and summer by the Urban Institute, Kaiser Family Foundation and Families USA. All four studies found or anticipated job losses in amounts approaching or exceeding 22 million people, and anticipated loss of coverage for at least 2.9 million people. The meta-analysis observes that “we probably will not fully understand actual shifts in insurance coverage until 2021, when results from large federal household surveys conducted in 2020 are released. Even then, some of the effect of the economic disruption due to the coronavirus pandemic may continue through 2021, and not be evident until 2022.” Read the report at https://rwjf.ws/32rAYjA.

✦ A new analysis by America’s Health Insurance Providers (AHIP) highlighted the issue of price gouging in COVID-19 testing. The report, based on a survey of health insurers, found the average COVID-19 test was billed to commercial payers at a cost of $130. The analysis also found that 9.4% of claims for COVID-19 tests were from out-of-network providers. According to AHIP, “health insurance providers proactively eliminated patient cost-sharing for COVID-19 diagnostic testing and treatment” at the beginning of the crisis. The Coronavirus Aid, Relief, and Economic Security (CARES) Act requires health plans to provide medically necessary testing without cost sharing. See https://bit.ly/3b4ePMb.

Although federal relief legislation tied to the pandemic required health insurers to waive cost sharing for COVID-19 testing, not treatment, many plans opted to do both anyway. In fact, a recent analysis from the Kaiser Family Foundation (KFF) found that 80% of enrollees in the individual and fully insured group insurance markets were in plans that voluntarily waived out-of-pocket costs for COVID-19 at some point during the pandemic.

Yet with the public health crisis ongoing and the race to develop and distribute an effective vaccine far from over, a considerable portion of the commercially insured population may be exposed to hefty hospital bills due to health plans’ cost-sharing waivers expiring. According to the Peterson-KFF Health System Tracker analysis, published Aug. 20, 20% of individual and fully insured group plan enrollees are in plans where a cost-sharing waiver for COVID-19 treatment has already expired, and another 16% are in plans where the waiver is scheduled to expire by the end of September.

As health insurers try to improve members’ health — and lower their costs — by tackling the social determinants of health, it has become commonplace to see efforts that connect members to stable housing, healthy food and reliable transportation to medical appointments. But some insurers that serve vulnerable populations are branching out even further, addressing social factors that may be less typically linked to health status but can nonetheless make a big difference in members’ lives.

One such effort comes from Minnesota-based UCare, which rolled out a program in mid-2019 that pays for its Medicaid enrollees to obtain their General Educational Development (GED) credential. UCare partnered with an organization called GEDWorks to provide members with the resources they need to prepare for and earn a GED, including personal coaching, bilingual study resources, and no-cost practice and official tests.

Even as the COVID-19 crisis continues, public health officials are warning that an influenza pandemic might emerge this fall or winter. A double pandemic would kill even more people than COVID-19 on its own and strain the already overworked health care system. To prevent that deadly combination, plans have stepped up their usual flu-season member outreach programs, particularly for seniors.

The public health community has issued stern warnings about the danger of a double pandemic. An Aug. 14 clinical update published on the Journal of the American Medical Association website called the “looming threat of concurrent influenza and COVID-19 epidemics” a “major concern for public health officials and clinicians.” The article urged health care leaders to take a proactive approach to getting the public vaccinated for influenza.

While a small proportion of people who have behavioral health conditions in addition to physical conditions account for 44% of all health care spending, most of that spending is on physical rather than behavioral treatment, according to a new study by Milliman, Inc., commissioned by The Path Forward for Mental Health and Substance Use. In fact, 50% of all patients with behavioral health conditions had less than $68 of total annual spending for behavioral health treatment, and another 25% had very limited spending on behavioral treatment — between $68 and $502 per year. “While the Milliman report did not study the effect of COVID-19 on mental health, its analysis of 2017 claims data provides a baseline for estimating the potential subsequent impact of the pandemic on the treatment of behavioral conditions and medical spending,” Andy Keller, Ph.D., president and CEO of Meadows Mental Health Policy Institute, said in a press release about the findings.