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The trough and the tidal wave: How health insurers can get ahead of the looming demand


 

The uncertainty surrounding the Covid-19 pandemic has hit all sectors of our economy, but perhaps none so hard as healthcare. Take health insurers, for example. Instead of encouraging members to get to the doctor for the care they need, health plans have pulled back (like most other industries) on their communication with members. That dry spell has had some unintended consequences.

For one thing, a new study from J.D. Power found gaps between how commercial plans communicate with members and what members expect, particularly during the pandemic. A full 48% of plan members said they feel their plan has not shown concern for their health since the pandemic reached the U.S.

Not only are these numbers concerning for health plans working to keep members happy and healthy, but they could also be related to an alarming increase in deferred healthcare services.

Screenings, routines visits and vaccinations are way down
According to the electronic medical record vendor Epic, breast and cervical cancer screenings fell by 94% in March compared to 2017-2019 averages, while colorectal cancer screenings were down 86%. The same study found that HbA1c testing for diabetic patients was down by 65%, and cholesterol and lipid panels dropped by 67%. Meanwhile, a Hill-HarrisX poll found that 30% of respondents have skipped annual wellness visits this year.

Well-child visits and immunization rates have fallen significantly as well. As scientists race against the clock to find a vaccine for Covid-19, it’s ironic that vaccination rates for diseases we can control have plummeted. During the first full week of April, the administration of measles, mumps and rubella shots tumbled by 50%, while HPV vaccines fell by 73%, according to information from the pediatric electronic health records company PCC.

These are frightening numbers that could put millions of children and hard-fought gains for herd immunity at risk.

Urgent and Emergency Care Not Immune
Perhaps even more alarming is the rate at which Americans are forgoing emergency care. Emergency visits have dropped by more than half, according to Kaiser Permanente, and state officials in California report that patient transports by ambulance have fallen by 20% to 30%.

We’ve all heard stories about patients suffering strokes or heart attacks and not seeking proper care due to fear of the virus and confusion about when and where to be seen. The situation is causing people to hold off on care that could save their lives.

What Health Plans Can Do Right Now

All of this deferred care will lead to additional stress on the healthcare system in the very near future. This backlog is creating tremendous pent-up demand that will be difficult to meet once consumers can visit their practitioner again. The delays also cost consumers precious time to diagnose and treat their conditions, costing health plans more to manage them. Many cancers, for example, are two to four times less expensive to treat when caught early compared to advanced stages. And care for members who are screened for diabetes costs $1,100 less per year than care for those who are not screened.

Consumers can’t defer services forever, and plans can’t wait any longer to connect with their members. Here are three immediate steps all health plans should be taking:

  1. Engage members right now. Plans should remind their members that they must still be seen for emergency conditions. They should educate them about when and where to go for care that can’t wait, like immunizations and chronic condition management. They should encourage them to use telehealth options for more routine and preventive care. And they should promote behavioral health care options for at-risk populations. Humana and Blue Cross Blue Shield of Michigan recently announced that they are waiving copayments, deductibles and other out-of-pocket costs for the rest of the year for all Medicare Advantage members who see in-network primary care providers or behavioral health specialists.
  2. Recommend telehealth visits where appropriate. Before Covid-19 hit the U.S., just 9% of commercial health plan members had used telehealth services, according to the J.D. Power study. Educating members now that they don’t need to put off an annual wellness visit, colorectal cancer screening, diabetic screening or immunization will keep them healthy and help ensure chronic conditions are not progressing uncontrolled while they wait for the all-clear.
  3. Reward and incent positive behavior
    Many health plans already use rewards and incentives (R&I) to motivate healthy member behavior. For government-sponsored Medicare Advantage and Medicaid plans, CMS recently revised its previous guidance and now allows any plan without an R&I program to start one between now and the end of the year — and expand existing programs. In a time like this, plan consumers may welcome such rewards in the face of unemployment and economic uncertainty.

In addition to incentives, highly personalized outreach to consumers is more welcome now than ever. It gives health plans the opportunity to convey to their members what is acceptable and even what is encouraged to help head off member confusion, dissatisfaction and gaps in care during this pandemic. It also benefits plans themselves — the J.D. Power study found that proactive efforts by plans to engage with members drive significant improvement in overall customer satisfaction, meaning taking action now can be a win-win proposition.

Photo: Oakozhan, Getty Images



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