Health Plan Weekly

Though COVID-19 has put significant pressure on the health care system at large, payers have not yet felt the financial pain confronting hospitals, since utilization for chronic and elective care is at unprecedented lows. But an anticipated spike in utilization (HPW 5/11/20, p. 4) as stay-at-home restrictions relax has led some in the health policy community to examine how the federal government might help mitigate that risk.

According to a May poll conducted by the Kaiser Family Foundation, 48% of Americans have skipped or postponed medical care due to the pandemic, and 32% of that group say they will seek to resume their care in the next three months. Among the people who delayed care, 11% reported their condition worsened because of the delay. That pent-up demand could combine with some level of ongoing need for care to drive claims above anticipated 2020 amounts.

CMS has finalized a set of proposals for Medicare Advantage and Part D plans that encourage MA plans to increase their telehealth benefits and give end-stage renal disease (ESRD) patients the right to enroll in regular MA plans. CMS also said it is moving forward with plans to increase the impact that patient experience and access measures have on plans’ overall Star Ratings.

The finalized rule, slated for June 2 publication in the Federal Register, gives MA plans more flexibility to count telehealth providers in certain specialty areas — including dermatology, psychiatry, cardiology, ophthalmology, nephrology, primary care, gynecology, endocrinology and infectious diseases — toward meeting CMS network adequacy standards.

As the COVID-19 crisis tightened its grip on the U.S., industries from restaurants to retail turned to technology to better serve customers who were sheltering at home. Health insurers were no exception, as tech played a major role in their response to the public health crisis. In fact, some insurers took the opportunity to develop new virtual apps or reconfigure existing ones in order to help members face the myriad challenges posed by the new coronavirus.

Two such insurers worked with Microsoft Corp. to bolster their efforts. Most recently, UnitedHealth Group partnered with the technology company to launch a “return-to-workplace” protocol, supported by a smartphone app called ProtectWell, which aims to help companies safely transition their workers back to the office as state restrictions loosen.

To recover from addiction, people with substance use disorders (SUDs) need support from providers and their peers. As quarantine has become a way of life, and gatherings have been banned in most states for the foreseeable future, both are hard to come by. One possible solution is telehealth, but experts say that remote, tech-aided treatment for addiction is still largely unproven — and most payers and providers don’t have experience with it.

“Because of the unexpected nature and unprecedented nature of the situation, there are very limited data on evidence-based approaches on how to treat patients under these circumstances,” said Carlos Blanco, M.D., during a May 18 webinar about continuity of care for SUD patients, organized by the National Institute for Health Care Management (NIHCM), a health care think tank. Blanco is the director of the Division of Epidemiology, Services, and Prevention Research at the National Institute on Drug Abuse, a branch of the National Institutes of Health.