How COVID-19 Will Swamp Your Health Plan (And What You Should

Author: Cory Busse, Vice President, Performance Strategy at NovuHealth

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. In fact, the RISE Association recently published a survey that indicated 46% of all non-COVID communications had been suspended over the past weeks. This member engagement dry spell has had some unintended consequences for members:

1. Members cancelled their screenings and routine visits

NPR reported that in just the first month of this pandemic, more than half of Americans 70 or older put off medical treatment. Much of that was out of necessity. As states braced for an overwhelming number of COVID cases, elective surgeries and non-essential office visits were put on hold:

  • Cancer screenings – According to Epic, a leading electronic medical record (EMR) vendor, breast and cervical cancer screenings fell by 94% in March, and colorectal cancer screenings were down 86% when compared to 2017-2019 averages. 
  • Diabetes screeningsThe same study showed that HbA1c testing was down by 65%, and cholesterol and lipid panels fell by 67%. For both the cancer and diabetes screenings, the numbers were drastically higher in COVID-19 hotspots like New York and Massachusetts.
  • Annual wellness visitsA Hill-HarrisX poll recently found that 30% of respondents had already skipped an annual visit. Not only are these visits important to getting members the care they need, they’re also required for proper coding of hierarchical condition codes that go into a plan’s risk adjustment payments.

This extreme downturn in utilization should have health plans worried. As a health plan leader, you already know that cancer is two to four times less expensive to treat when caught early compared to advanced stages.  And members who are screened for diabetes cost $1,100 less per year to manage than those who are not screened.

2. Members are skipping urgent and emergency care

Even more alarming is the fact that members are forgoing emergency care, too. Kaiser Permanente reported that emergency visits have dropped by more than half, and state officials in California report that patient transports by ambulance have fallen by 20-30%. That’s not just because traffic is light and there are fewer accidents. Distressing stories abound about members having strokes and heart attacks and not seeking care. Fear of the virus and confusion about when and where to be seen for such conditions is leading your members to hold off on care that could save their lives.

3. Well-child checkups and immunizations are way down

As the scientific and healthcare communities race against the clock to find treatments and, ultimately, a vaccine for COVID-19, it’s ironic that vaccination rates for diseases we can control have plummeted. The New York Times recently reported, “As parents around the country cancel well-child checkups to avoid potential coronavirus exposure, public health experts fear they are inadvertently sowing the seeds of another health crisis.” Data collected from 1,000 independent pediatricians around the country found that during the week of April 5, measles, mumps and rubella shots dropped by 50%, diphtheria and whooping cough shots by 42%, and HPV vaccines by 73%. These are frightening numbers that could put millions of children and hard-fought gains for herd immunity at risk.

4. Your physician networks are at risk of going out of business

Much of the above has had the unintended consequence of putting additional financial strain on your provider networks. We’re not just talking about elective surgeries, which can make up 75% of a hospital’s surgical schedule. The deprioritization and outright prohibition of routine office visits has resulted in revenues for some providers dropping 50-90%. Health plans should care because the effects are disproportionately hitting small and independent practices. That means that the work you’ve done to build and maintain your carefully cultivated physician networks is in serious trouble. If even more of the smaller players give way to additional consolidation or outright closure, plans will find themselves negotiating with larger and more powerful health systems next year.

All of those canceled visits, missed immunizations and stress on providers are not only costing your members precious time to diagnose and treat these conditions, they’re going to cost your plan more to manage them. So, what’s a health plan to do?

Engage your members. Right now.

It’s clear that members desperately need to hear from their health plans today. Remind your members that they must still be seen for emergency conditions. Educate them about when and where to go for care that can’t wait. Encourage them to use telehealth options, now allowed by CMS, for more routine and preventive care (more below). Restart your Medicare and Medicaid Quality programs that you may have paused. Humana announced this week that they’re 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.

You can also capture up-to-date addresses, email addresses and cellular phone numbers from members—as well as the opt-in consent—so you can use them in the future. Most of all, let them know that you’re still there and that you genuinely care about their health and wellbeing. They need to hear from you, and now is the time. Interestingly, direct mail volumes from other industries are down by up to 60% right now, so your communication to members have a high chance of making an impact.

Recommend telehealth visits where appropriate

CMS has allowed for more than 80 covered telehealth services, including many of the kinds of visits and screenings, listed above, that your members are skipping. Coverage applies both to telehealth solutions offered by your existing provider networks as well as third-party vendors. Communicating to members now that they don’t have to put off their Annual Wellness Visits, colorectal cancer screenings, diabetic screenings and immunizations will keep them healthy, and will help ensure chronic conditions are not progressing uncontrolled while they wait for the all clear.

Reward and incent positive member behavior

Many Medicare and Medicaid quality programs already use rewards and incentives to drive healthy member behavior. Now is the time to leverage these investments fully, when members may welcome such rewards in the face of unemployment and economic uncertainty. In the coming weeks and months, even your members who have historically closed their care gaps like clockwork might be uncertain about whether it’s safe to go see their doctor, or confused about how to complete activities virtually.

Conducting highly personalized outreach to members and ensuring that you’re being clear with them about what’s okay and even what’s encouraged will help head off member confusion, dissatisfaction and gaps in care during this pandemic.

To learn more about what your plan can do, schedule time to chat with one of our engagement experts

To learn more about what your plan can do, schedule time to chat with one of our engagement experts

About NovuHealth

NovuHealth is the leading healthcare consumer engagement company, driven to improve consumer health and health plan performance. NovuHealth motivates consumers to complete high-value healthcare activities by leveraging its sophisticated engagement platform, proven loyalty and behavioral science strategies, and deep industry and regulatory expertise. Headquartered in Minneapolis, NovuHealth has worked with nearly 40 health plans and served nearly 15 million consumers across all 50 states. Learn more at novu.com.

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