Electronic Health Reporter

By William Flood, MD, MS, chief medical officer/Eviti, NantHealth.

The COVID-19 crisis has created a perfect storm of challenges for payers as they adapt to a new normal that continues to evolve. It’s also opened up a host of opportunities for creating positive change that will enable providers and payers to run smarter businesses and provide more quality care for patients.

During a recent webinar, healthcare payers participated in interactive polling and unanimously agreed that COVID-19 has significantly changed the healthcare landscape, altering the routine day-to-day management of care and the operations that happen around it, including medical plans.

Here are some of the key aspects payers are tackling as they move forward:

Shifts in Plan Membership 

The economic downturn caused by the pandemic has led to significant increases in unemployment, As healthcare coverage is frequently tied to employment, this leads to significant increase in the number of uninsured. According to a May 2020 Kaiser Family Foundation study, 45 million Americas were unemployed at that time, and it’s estimated that about 27 million are uninsured because of that loss. 

While we won’t have exact numbers on how much membership has changed until open enrollment periods begin, likely in January 2021, we do know that this increase in unemployment has driven a shift from private to public plans.

It escalates the steady decline in private plans that we’ve seen for the past thirty years, putting increased pressure on government-sponsored plans like Medicare and Medicaid and providing opportunity for insurers who have not already done so to enter these markets. During a time of economic challenge, this requires reevaluation of current processes to construct more valuable and affordable approaches for stakeholders: payers, patients, and providers. 

Financial Ramifications

The COVID-19 crisis is far different from any other, yet we can look to historical data to shed light on financial ramifications and to predict recovery.

For example, it took more than five years for employment to rebound from the 2008 financial crisis. While the drivers of that crisis were much different than they are now, it remains unclear how long it will be until we recover the jobs lost due to COVID-19 and subsequent enrollment in private healthcare plans.

At the same time, the public options now present through the Affordable Care Act increase the burden on government-sponsored health plans; in 2008, those options were not yet in place. And in turn, return to the private plan memberships lost to Medicare and Medicaid.

In addition to membership loss, the healthcare system has taken on new expenses due to COVID-19. As more people become infected with the virus, we see two things. The first is an uptick in testing and treatment expenses, many of which are covered by plans as the industry works together to get through this crisis.  The second is a decrease in usual care expenses as patients shy away from treatment due to fear of exposure at medical facilities.  

America’s Health Insurance Plans (AHIP) estimates that the costs to the health care system from COVID-19 could range from $56 billion to $556 billion over the next two years. Sustaining plans and providers will require an evolution in the way care is managed and provided.

Pandemic’s Impact on Members’ Cancer Care

Cancer care is an area of medicine significantly impacted by the pandemic. The reasons are two-fold:

As stay-at-home orders and the limits on elective procedures keep patients from routine screening, cancer diagnoses are delayed. The director of the National Cancer Institute, Ned Sharpless, MD, recently said that interruptions in screening may lead to an estimated 10,000 additional deaths due to colon and breast cancer alone, by 2030.

In addition, studies have found that those with a history of cancer have worse outcomes from COVID-19. Since exposure to the healthcare system itself may be the highest risk for infection of cancer patients, one focus of cancer care has been decreasing these opportunities for exposure. For instance, out-of-office screenings are used prior to appointments, and temperature checks and assessments are done before patients enter providers’ waiting rooms.

Additionally, 98 percent of providers in a recent survey of 55 major cancer centers are relying more on telehealth, a mode of care that is quickly becoming a norm for providers and health plans as it’s likely here to stay in some fashion.

There are also shifts in treatment delivery, opting for systemic therapies that do not require a trip to a medical facility. Providers and insurers need tools for better assessing the available options and choosing the most beneficial route for patients.

They’ll also need resources for facilitating treatment and providing quality care to the backlog of patients who have deferred cancer screening or treatment due to COVID-19.

Looking Ahead

It would require a crystal ball to fully understand how the impacts from COVID-19 will alter the healthcare industry in the long-term. Yet, it’s clear that technology will continue to play a prominent role in helping payers and providers address the changes and financial concerns, manage new caseloads, and improve care–as well as play a role in delivering the key information we need to make timely decisions. We owe it to our patients and our businesses to continually adapt and rise to these challenges as together we help to create a new normal.