Managed Care Payers During the Pandemic

Scott Breidbart, MD, MBA
Chief Medical Officer, Affinity Health Plan
Matthew Eyles
President and CEO, America’s Health Insurance Plans (AHIP)
Steven Peskin, MD, MBA, FACP
Executive Medical Director of Population Health and Transformation, Horizon BCBS

Dr Peskin, Dr Breidbart, and Mr Eyles gave an overview of the changes the novel coronavirus has prompted for managed care payers. They agreed that the unprecedented set of circumstances surrounding the pandemic has led to an opening of the floodgates to questions without immediate answers, leaving providers and payers in unfamiliar territory in a rapidly changing environment with few guideposts.

One of the major efforts has been trying to support member providers and their patients through the dramatic expansion of telemedicine. According to Dr Peskin, his organization, which serves more than 3 million insured members, has seen a 7000% surge in telemedicine since the outbreak.

Finding ways to accommodate this tremendous increase in demand has been his focus since the beginning of the COVID-19 crisis. Measures to simplify the delivery of telemedicine have included relaxing or curtaining certain policies and restrictions, such as allowing telephone visits in addition to synchronous video visits and cutting down on preauthorizations.

Although telehealth is expanding to absorb the needs of patients and practices alike, managed care payers are seeing the impact the virus is having on their independent practice partners in other ways.

Dr Peskin noted that because of restrictions on elective surgery, many practices have seen their business shrink to 10% of their former capacity, which will have a profoundly negative effect on their ability to remain viable.

“We are looking at the impact on our clinical partners who have been decimated by no longer being able to do elective surgical procedures,” said Dr Peskin.

Discussing the “devastation for our members and the tremendous suffering,” Dr Breidbart said, “For the last month, COVID-19 and its ramifications are all I’ve been working on.” In addition to postponed surgery, providers and patients also experience delays in screenings and follow-ups, and failure to deliver home care to patients. Some patients are afraid to go to the hospital, and many hospitals have a shortage of ventilators; at the same time, healthcare providers do not have adequate personal protective equipment (PPE), and those on the front lines are fearful for their lives and the lives of their loved ones for lack of PPE.

According to Mr Eyles, “COVID-19 is threatening to overwhelm the healthcare system.” But he stressed that no one should hesitate to get tested because of cost. His organization has waived all costs for tests and treatment related to COVID-19 infection, and this is a rapidly developing trend across the industry.

Mr Eyles’s organization is helping to influence policy on a number of issues, including working with Congress to ensure the continuation of coverage for 10 million Americans who have lost their jobs, and reducing barriers to care for patients across the board.

Despite the overwhelming number of challenges, Mr Eyles said, “The community of health insurance providers are committed to providing coverage and care to all patients.”

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