Health Plan Weekly

Emergency room visits have plummeted since the onset of the COVID-19 pandemic, leading some health plans to consider how to capitalize on this trend to redirect non-emergent care away from the ER permanently, insiders say. Increased use of telemedicine and smart digital tools to provide real-time site-of-care options are on the table.

However, some analysts warn that fear of contracting the virus from a health care facility could lead some people to forgo necessary care, which ultimately could increase costs and lead to poorer health outcomes.

✦ 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.