- Payers are in a unique position to respond to many aspects of the coronavirus from payment of testing and treatment to community education. But there is no playbook for appropriate or effective responses.
In such unique circumstances, payer success is directly linked to their pre-coronavirus strategies and investments.
“A lot of what we do day in and day out actually sets us up really effectively to help manage a situation like this,” Thomas Freeman, CFO of Alignment Healthcare, recently told HealthPayerIntelligence. “We’re just expanding our approach to how we think about this. It’s more about adapting as opposed to having to wipe the whiteboard clean and start from scratch.”
Alignment, like many other payers, had to leverage their existing infrastructure, engagement strategies, and provider network for an effective COVID-19 response. Having a business continuity plan or disaster recovery plan in place allowed these organizations to flip a switch when a state of emergency was declared – effectively meeting member and provider needs and moving their workforce remotely to continue business as usual.
“Our culture and business continuity plans really bode well for us,” added Matthew Collins, MD, MBA, executive vice president and chief medical officer at Blue Cross and Blue Shield of Rhode Island (BCBSRI). “The familiarity we had with each other allowed us to really come together quickly across all the different business areas and make good decisions together.”
So far, these payers and many like them have identified four key response areas: members, providers, employees, and the community at large. And an effective strategy responds to each of these areas.
Member engagement key to success
As of April 30, 2020, the United States reported over one million cases of coronavirus, according to information from the Centers for Disease Control and Prevention.
While this means that over a vast majority of individuals in the United States do not have the coronavirus, many have fears and anxieties about contracting the disease and spreading it.
Payers must, therefore, develop a strategy to manage sick members while also easing the anxieties and fears of the worried well.
One of the most common responses payers are employing is waiving all cost-sharing associated with coronavirus testing and treatment.
“We have a number of cost-sharing for not just the diagnosis of COVID-19 but for treatment,” Collins articulated. “We realized that treatment could be provided in a low acuity setting for about 80 percent of cases that are milder and not requiring hospital care.”
But this is not enough to also help the growing number of the worried well or members with chronic conditions who can no longer seek care in their provider’s office.
Payers needed to turn to further engagement strategies, educating their members about the coronavirus, prevention strategies, and how to safely seek care.
“There were lots of communications sent out particularly to our high-risk members informing them of their being at high risk and what they should do,” Collins said.
This communication included text messages, information in the patient portal, and even phone calls from a care management team.
“We have members of our care team called health advocates. They’re not clinicians necessarily, but they support the clinicians and help people get the resources in their community, whether its transportation or food or housing,” explained Collins.
Alignment had a similar approach. Their online risk assessment tool allowed their members to understand if they were at risk for coronavirus, symptoms they might be having, and how to receive appropriate care. They pushed this information through virtual town hall meetings, having as many as 6,500 members present for one meeting.
“We want to ensure people are not just going in [to the provider’s office] just because of what they hear on the radio or TV. We’re trying to talk them through things and calm the storm,” said Dawn Maroney, president of consumer and markets at Alignment Healthcare. “We’re trying to make sure that people feel connected.”
Part of their virtual town hall meetings includes a series on how to deal with loneliness, social isolation, and fitness at home. Alignment is sending fitness kits to their members, and their fitness experts can invite members to exercise during town halls. They are currently working on a series about nutrition next.
These town hall meetings are a way for Alignment members to stay engaged and understand the benefits available to them through their health plan. This includes an explanation of their expanded black card benefit, which functions like a debit card to allow members to purchase items at pharmacies or grocery stores. The plan recently expanded the card’s covered items to include online purchases and supplies such as disinfectant wipes.
“We don’t want money to stand in the way of the beneficiary,” Maroney emphasized.
BCBSRI is similarly ensuring its members are aware of benefits that could be particularly helpful during this time, including medication refills and telehealth visits.
“We extended early refills and reminded members that they could get mail delivery and extended medication refills for chronic medications,” explained Collins. “We made sure members knew part of their benefits was access to doctors online.”
But the payers could not have seen such high member engagement during the crisis if it were not for previous above-average engagement. Previously high member engagement rates set both organizations up for successful engagement on coronavirus-related benefits.
“Having an aggressive engagement strategy prior to the pandemic was critical,” Maroney articulated. “Every health plan in the country has a responsibility to their membership.”
Having established relationships prior to the pandemic fostered an environment of trust between members and payers. Payers already knew who was at risk and how best to reach them.
“The fact that we had forged strong relationships with our members prior to this specific episode is, in part, what allowed us to be successful when we really need to get that engagement up,” Freeman continued.
Source: Centers for Disease Control and Prevention
Alleviating provider concerns
Understanding provider needs is another key element to an effective coronavirus response strategy.
Providers are overwhelmed by the number of sick patients they are seeing. Some have shifted to focus entirely on patients with COVID-19, while others are trying to balance new patients with their existing patients with chronic conditions. All are trying to manage the worried well and keep themselves safe.
Support from payers is critical for providers to treat their patients and elevate the use of telehealth and other effective solutions for the novel coronavirus.
“We are empowering providers with the power of telemedicine and hosting conference calls initially three times a week just to make sure that they were getting all the right information about payment policies, the pandemic in general, and what benefits their members had,” Collins explained.
Many organizations are leveraging telehealth as a solution to the outbreak as it allows providers to still see patients while minimizing patient and provider risk of contracting the coronavirus. Traditionally, these services were not reimbursed at the same competitive rate as an in-person visit, but payers are quickly realizing this needs to change in order to fight COVID-19.
Other technology aiding coronavirus response strategies is population health management tools. These tools were initially used to identify members with chronic conditions and connect them with clinical care, medication adherence, and care management programs. Now, the tools are identifying the patients most at risk for contracting coronavirus and communicating this information with providers to inform clinical decision-making.
“We are deploying this to the point of care with many of our primary care providers in our network,” Freeman said. “We’re trying to make sure we share that information freely to help them do their job.”
But providers who are in a non-traditional payment model such as value-based reimbursement arrangements could be at risk if their contracts have delayed payouts. Those who are being paid based on quality metrics are at risk for not receiving payment as the standard of care today looks very different. Many elective and preventive care treatments are being delayed so that providers can focus on emergency and COVID-19 cases.
To overcome this obstacle, BCBSRI made funds for their accountable care organizations available earlier than expected so these organizations can continue to work without risk of a minimal payment.
This move is alleviating provider concerns about keeping their business open to patients when they need care the most.
Enabling employees to work from home successfully
In addition to managing their members and their provider networks, payers must also manage their own workforce. Federal stay-at-home orders have forced payers to quickly enable a remote workforce and coordinate which employees are still essential.
Payers have needed protocols in place to keep their essential workers safe while ensuring all have access to the infrastructure necessary to work from home.
“We’re trying to be proactive on our front and make sure we create a safety net on the backend,” Freeman pointed out. “From an operational standpoint, we moved to the cloud. That allowed us to move 99 percent of our workforce remote in a one to two-week period as a part of our COVID-19 response.”
Alignment decided to invest in cloud technology prior to the coronavirus outbreak.
“It underpins a lot of what we do operationally and makes us a lot more agile and efficient in our approach to our day to day operations,” Freeman stressed.
The upfront investment allowed Alignment to respond quickly when they needed to move their workforce remotely. The kinks had already been worked out to the broader infrastructure, so the movement to remote work was nearly seamless.
“Having the ability to lift and shift to move them home without skipping a beat is great from a productivity standpoint. Having the tools in place to have real-time transparency and understand how we’re doing has been critical over the last couple of weeks,” continued Freeman.
Similarly, BCBSRI had an established business continuity plan they were able to initiate in response to the COVID-19 outbreak. While originally built for incidents like snowstorms, the plan needed to be adapted in order to be fully operational, but the barebone structure allowed for a less scrambled response.
“We’ve been really surprised at how resilient everybody is and what a sense of team spirit they have,” Collins emphasized. “We’ve always had that, but people are really supporting each other. There’s a great spirit of camaraderie. We came together very early around a business continuity plan because we could see this on the horizon.”
Both organizations credit strong leadership and organizational values as the reason for a successful response.
“This has reinforced the value of culture,” Freeman articulated. “The broader executive team does a good job of trying to engage the employee base on a regular basis outside of the current epidemic. But the value of trying to create a culture of kindness and member-first really shows up in a time of crisis.”
Maintaining community ties
Many payers are some of the largest employers in a community. They can be central to a community, sponsoring events, putting on health fairs, and broadcasting healthy life choices. This responsibility did not disappear at the start of the pandemic.
Both BCBSRI and Alignment still feel a responsibility to their communities to spread information about COVID-19 responses and help not just their members during this challenging time.
For example, Alignment has delivered over 4,000 meals to seniors and BCBSRI is using their van to drive supplies such as personal protective equipment and meals to homeless shelters and food banks.
“There’s a lot of volunteerism that we always do, but a lot of Blue Cross associates answered the call to volunteer,” Collins pointed out.
The list of community efforts goes on: BCBSRI partnered with the Rhode Island Department of Health to staff their surveillance call line, working with the department’s epidemiology team on contract tracing and surveillance of COVID-19; BCBRI’s provided resources to the United Way fund and Rhode Island Foundation; Alignment made their COVID-19 risk assessment available to everyone and pointed respondents to the proper care.
This sense of community did not emerge when the coronavirus did. It, like the essence of both health plans’ responses, has been ingrained in their organizational structure and function for a while.
“One of the things that has enabled us to be successful is because this didn’t all start because of COVID,” Freeman concluded. “All the things we’re doing would have happened regardless.”
For more coronavirus updates, visit our resource page, updated twice daily by Xtelligent Healthcare Media.
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