It may be too early to tell how COVID-19 will impact the healthcare system in the long-run. But leaders agreed that the early adaptations we’ve seen emerging out of necessity may point the way to future innovation.
Lansing-based Michigan Association of Health Plans and Crain’s Content Studio, the marketing storytelling arm of Crain’s Detroit Business, recently gathered leaders from public and private Michigan-based companies, public agencies and benefits consultants to discuss how health insurance is evolving — and what it takes to overcome the fear factor when it comes to switching health plan carriers. (See related story here.) During a 90-minute virtual roundtable, they also discussed how COVID-19 is impacting the industry. MAHP is a nonprofit organization that works to improve access to health insurance for consumers and to improve value, choice, affordability and competition in the health insurance market.
The most obvious change, leaders say, is the speed with which carriers, doctors and patients have embraced telemedicine.
“We’ve kind of been evangelizing the concierge medicine thing for the last four or five years. Teladoc, Nurse Navigators, things of that nature, you name it,” said Kareim Cade, President and CEO of Great Lakes Benefits Group. “It just wasn’t popular. We did not have buy-in. You had 2-5% of people that would actually engage or be involved. But now with COVID, those numbers have gone up significantly.”
After years of planting seeds that seemed to bear little fruit, Cade said he’s been inundated by HR professionals asking him how employees can avoid going to the hospital and urgent care. They want to know what those services look like, and how they can get involved.
“And so now we’re receiving calls where people are saying to us, ‘Hey, you were talking to us about this some time ago. We might’ve been a little bit deaf about this in trying to figure this out, but now this is very pertinent for us.”
Many insurers have waived fees for virtual care, something that has been made possible by rapid changes in federal policies governing health insurance.
“I don’t think I’ve ever seen the feds or anybody move that quickly to rewrite actual useful regulations with that level of speed,” said Jeff Romback, Deputy Director of Policy and Planning with the Michigan Association of Health Plans. “I mean, all of a sudden you could waive copay for telehealth for all sorts of reasons that were never applicable.”
A major benefit for providers has been changes that have allowed them to be reimbursed for the same amount they would in an in-person visit.
“During the pandemic, I think every insurer stepped up to say, ‘Yeah, we’re going to pay you to keep people out of your office, which I think has been a good thing for the community,” added Sokol. “They’re getting reimbursed for telehealth visits the same way as if it was a face to face, which is normally a lower reimbursement rate.”
And health care plans are adjusting rapidly to this new reality as well.
“There are some carriers that are waiving costs of virtual visits, and that’s not only relating to COVID, but anything else as well,” said Catherine Cooper, Legislative Director for the Michigan Association of Health Underwriters. “As far as the carriers adapting to virtual visits, usually they all have a certain partner that they use for telehealth, but they’ve also expanded it that if your own doctor does a virtual visit, you can utilize that doctor and that service through your primary care specialist, and those copays get waived.”
Cade sees this as a golden opportunity to get telemedicine right.
“For those of us that have been progressive in talking about these other ideas like bundle payments, ambulatory surgical centers — people are engaged now. And I think we’ll have more opportunities to really look at the true cost, the true containment opportunities and not just talk about carrier-specific issues.”
David Sokol, President of Wilshire Benefits Group, agreed.
“I had never had a virtual visit with my primary care physician and I’ve had three over the last three months,” he said. “We’ve done some utilization reviews with our larger self-funded clients and finally we see a huge acceptance towards that delivery model, which is really necessary given the shortage of primary care physicians in America and the importance of operating more efficiently and cost effectively.”
Some customers have been slow to adopt the internet as a means to enroll employees in health plans, preferring paper processes despite printing costs and snail mail delays. But that’s changed with COVID-19.
“In the past, where we’ve had a little pushback on people wanting to do the online enrollment services that we provide, right now it’s imperative that they’re using it,” said Stacey LaFay, President of Franklin Benefit Solutions. “So in the last three months, we haven’t skipped a beat. We’ve had everybody working from home, and open enrollment meetings have all been done online.”
The ease of online enrollment has actually helped take away some of the trepidation around switching carriers for some.
“You would think at this moment in time, people would be afraid to change carriers. But we haven’t necessarily seen that because the way that we’re doing the enrollment and the way that we don’t have to have paper, people don’t have to fill out enrollment forms. We’re able to do everything online and able to get that to the carriers in an efficient and timely manner.”
“Technology has just been so important,’ Sokol added. “We’ve got really nice commercial print capacities in our office. We usually spend on top of the rental cost, maybe $ 1,000, $ 2,000 a month on printing. My printing bill for April was $ 45. I was like, ‘yes!’”
Sokol offers a broker-sponsor technology platform to clients that can integrate with payroll-provided solutions.
“For companies that had that admin enrollment technology installed, this has been less painful, especially if you’re going through open enrollment right now or trying to make changes,” he said.
Health plans have begun to incorporate wellness incentives and initiatives into their programs in recent years, and that is becoming even more important as people consider their overall health, including mental health, during the stress of COVID-19.
“Many of our employees are dealing COVID-19 and other societal ills,” said Dandridge Floyd, Assistant Superintendent of Human Resources for Oakland Schools. “Social isolation, all these different things contribute to depression, anxiety, or things of that nature, that typically you dealt with via mental health care providers. We need to figure out how we can address those through our health plans as well.”
Many health plans have separate wellness programs that are typically add-ons, but Floyd said she sees a need for health plans to start thinking about a total wellness approach.
“They’re not necessarily included in the upfront cost,” she said. “And so we need to really start thinking about that.”
Like so much else in the COVID-19 era, much is uncertain. First and foremost, of course, is the uncertainty of future costs.
“What’s going to happen to insurance rates going into 2021? How do we account for this valley of claim activity from late March to mid May?” asked Sokol. “ I think many carriers are giving back some form of premium refund, probably because they anticipate some issues of getting past the medical loss ratio tests. So I think that’s a healthy thing for the economy.”
Another uncertainty is how to manage healthcare as people either transition back to working in in-person environments or continue working remotely.
“All employers are really looking for some relief of liability on how we get back to a working-in-person environment,” said Sokol. “That’s a real tough area that needs to get addressed.”
Education will continue to be important in changing times, added Floyd.
A lot of this is about managing behavior and really putting the data in front of them,” she said.
“And so we spend a lot of time educating our staff about their choices and just really human behavior to make sure they’re saving money.”
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