Health Plan Weekly

A previous version of this article incorrectly stated Cori Uccello’s title. She is a senior health fellow with the American Academy of Actuaries. This version has been updated.

An analysis by actuarial firm Milliman Inc. projects that net spending by the health insurance industry during the COVID-19 pandemic is likely to fall through the rest of 2020, but that pent-up demand for health care services — and potentially deteriorated population health due to delayed care — will likely drive a sharp escalation in costs in 2021. Patients have been obliged to defer elective and non-emergency procedures in order to comply with shelter-in-place directives, reducing claims costs even as insurers’ provider networks have been flooded with patients.

Since acquiring Aetna, CVS Health Corp. has touted its HealthHUB stores — which include expanded clinics, labs for health screening, and space for wellness pursuits like yoga — as the linchpin of its plan to stand out among other large, diversified firms that include a health insurer. Yet as one analyst pointed out during CVS’s first-quarter 2020 earnings call on May 6, that strategy could face new challenges amid the COVID-19 pandemic, “a time where the entire world is rethinking how much time they want to spend outside their house.”

CVS executives said that while the company is indeed seeing less foot traffic at its brick-and-mortar locations, it is still leveraging the power of having a vast retail footprint by offering testing for the new coronavirus — a use case that could persist long after the current public health crisis. As CEO Larry Merlo put it: “We’re focused on COVID testing today, but there is a broader universe of diagnostics and monitoring that we see becoming an important part of our HealthHUB strategy.”

Although use of telehealth services has surged in recent months, experts say that the permanence of a shift to virtual care is far from certain, unless regulations and the industry’s reimbursement model change dramatically.

Emergency measures adopted by the Trump administration and states have allowed telehealth providers to significantly scale up in recent weeks. Using waiver authority, HHS temporarily relaxed the rules surrounding Medicare reimbursement for telehealth, which had included limits such as requiring the patient to live in a designated rural area. The Coronavirus Aid, Relief, and Economic Security (CARES) Act includes a $200 million appropriation to the Federal Communications Commission to expand telehealth services, and in April the FCC announced a $100 million program to build out broadband capacity for health care providers. And according to a recent paper from two think tanks, the Brookings Institution and the John Locke Society, many states have moved to waive in-state licensure requirements for telehealth providers.

As the impact of the COVID-19 pandemic continues to reverberate throughout the U.S. economy, it’s become clear that there will be a major enrollment shift away from employer-sponsored plans and into Medicaid and the individual market. And while far more people are covered by Medicaid than individual plans, experts tell AIS Health that the effects on the latter market — and health insurers’ business strategies — are definitely worth watching.

In fact, one recent analysis suggests that there could be “unprecedented growth” in the individual health insurance market, where enrollment has remained static in recent years after Affordable Care Act-triggered expansion. “The impact of COVID-19-related job losses will likely more than double the current enrollment in Individual & Marketplace plans, with the potential for the Individual market to triple in size to over 35 million in a sustained and severe economic contraction,” states the analysis, which A2 Strategy Group released on April 16.