Posted on The Health Care Blog on Apr 9, 2020
By JEFFREY HOGAN and BRIAN KLEPPER
Among its less appreciated but more worrisome impacts, COVID-19 threatens to destabilize America’s health care provider infrastructure. Patients have largely been relegated to sheltering at home and, to avoid infection, are avoiding in-person clinical visits. The revenues associated with traditional physician office visits have been curtailed. Telehealth capabilities are gradually coming online, but are often still immature. The concern is that many practices will be financially unable to keep the doors open, compromising access and healthy physician-patient relationships.
Health plans have become health care’s bankers, controlling the funding that fuels larger care processes. Health insurance companies and health plan administrators rely on networks of doctors and hospitals to deliver health care services. They also rely on premium payments from employers to administer and pay for health care. In conventional fee-for-service, pay as you go arrangements, providers are paid after they have delivered care services. The stability of this approach, of course, assumes an unhindered flow of patients receiving care.
When the stability of that flow is disrupted, as it has been with COVID-19, physician practices become vulnerable. Solving that vulnerability would give members access to critical services – primary care, specialty care, urgent care and pharmacy coordination – during this epidemic. Without these resources, members will be forced to turn to overburdened hospitals, where they risk increased COVID-19 exposure.
To keep health care services readily available through this crisis and beyond, we need health plans to provide bridge financing, advancing operating funding for 120 days and paying for telemedicine at the same rate as in-person visits. Health payers can easily estimate payments to providers and simply front that estimated payment now. Payers wouldn’t exist without providers. Most important, members need access to these providers to get health services in their homes. Stable revenue flow is clearly an all-around win, in the interests of patients, providers, payers and employers.
Many health plans have already been pro-active in helping health care providers through the COVID-19 crisis. For example, United Health Care and Anthem have waived patient co-pays for care associated with COVID-19, a move that will provide considerable relief to employees and their families already under considerable financial stress.
Both Aetna and Anthem have announced that they now pay for telemedicine services at the same rate as in-person services. This is a huge step forward that encourages telemedicine as a first line of defense, limiting potential COVID-19 exposure in physician offices. Many innovative telemedicine companies have now found ways to facilitate services directly with a patient’s own primary care physician (PCP). Further, there are services that allow PCPs caring for patients with comorbidities access to specialists and pharmacists.
Blue Cross of Idaho has gone farther still, by committing to advance 3 months of payment to keep independent primary care physicians financially viable. We need to see more progressive arrangements like this.
If you’re an employer, write or CALL the payer President in your market. Make this personal and encourage your colleagues to do the same. We’re in a crisis, and employees and their families need these better services now. Feel free to copy and paste any of the language included here.
Let’s give our providers the resources they need to treat members remotely, to take providers off the sidelines and to reduce the tremendous pressures on our heroic frontline hospital workers.
Jeffrey Hogan leads Upside Health Advisors, a health care consulting firm in Farmington, CT. Brian Klepper leads Worksite Health Advisors, based in Charlotte, NC.