Insights From Terri Kline: Tracking the Coronavirus and Its Implications on Health Plans

Terri Kline, MPH, former president and chief executive officer of Health Alliance Plan, former executive vice president of Henry Ford Health System and current Medecision Advisory Board member, shares her insights on the spread of the coronavirus and its implications on health insurers.

If you’re like me, then you’re glued to the television, waiting for the latest update on the coronavirus outbreak in the United States and abroad. As of the time of posting on April 21, the worldwide count is more than 2.4 million cases, and here in the United States, there are more than 787,000 confirmed cases, according to data compiled by the Center for Systems Science and Engineering at Johns Hopkins University.

The virus has spread rapidly through the United States—in part because we were a bit slower to declare it an epidemic and emergency than other countries. But it’s also important to think about this as multiple outbreaks and geographic hot spots. Every state will be affected differently. New York, of course, is a hot spot. But we also see hot spots in New Orleans, which was hit hard by the Mardi Gras celebration, and Florida, after spring breakers descended upon the state. California locked down early on, and it’s doing incredibly well, but it still has hot spots in Southern California and San Francisco. However, in my home state of Georgia, we’re not expecting the apex or surge to happen until late April. In some states, it may happen in May. This outbreak will continue for a while, and it won’t be uniform across the country.

Why We’re Flattening the Curve

Although the outbreak is happening at different speeds across the country, everyone needs to do their part in flattening the curve. Our healthcare system is not equipped nor prepared for a nationwide surge in cases. For example, look at what is happening in New York City—there aren’t enough beds (both ICU and med/surg beds), appropriate personal protective equipment, ventilators or even healthcare workers. Many communities and cities are actively planning for when the surge will hit and thinking strategically about how many beds they’ll need and what supplies they need to obtain—and many are working to build relationships with companies in their areas to start producing these supplies.

There are calls for retired physicians and nurses to join the workforce again, and some hospitals in hot spots like New York are offering high salaries and bonuses for nurses willing to leave their current nursing jobs and staff hospitals there. Of course, this creates extra pressure in the markets those clinicians leave.

One phrase you may hear is called “the hammer and the dance.” The hammer means we’re really coming down hard on social distancing and isolation—that helps the healthcare industry and government get the virus under control. Then, as restrictions loosen and people go back to work and resume normal life, we’ll start to see small outbreaks pop up again. That’s the dance—because we then have to figure out how to control this virus until we have a vaccine.

Implications for Health Plans

We know, of course, how the COVID-19 outbreak is affective physicians, nurses and other frontline workers. But it’s impacting health plans as well. Here are a few reasons how:

1. Many payers are deploying their medical management teams to perform different tasks and have also transitioned to remote workforces, which has proved to be challenging. For example, one payer I work with has deployed its nursing staff to touch base every single day with their most vulnerable patients. They’re implementing remote monitoring in homes to ensure the safety of their members.
2. Medicare has loosened restrictions and expanded services in response to the crisis, such as waiving copays and deductible amounts for tests and associated services like physician visits or hospital observations. Medicare enrollees who need to be transferred to a skilled nursing facility will also be covered, regardless of whether they were previously hospitalized.
3. I also believe we’ll see a lot of disruption in the commercial market, as more people lose their jobs and health insurance. Data from the Economic Policy Institute estimate that 3.5 million workers lost their employer-sponsored health plans in the last two weeks of March. In states that expanded Medicaid coverage, more individuals will qualify for coverage and fewer will likely become uninsured, according to the Kaiser Family Foundation.
4. A recent article in Modern Healthcare suggests that the cost of COVID-19 testing and treatment may “squeeze U.S. health insurers’ profits, which could lead to higher premiums in 2021.” Furthermore, a report from Covered California suggests that commercial insurers and employers across the nation may face a bill ranging from $34 billion to $251 billion for coronavirus testing and treatment.”Covered California’s analysis shows the impact of COVID-19 will be significant, and that absent federal action, consumers, employers and our entire health care system may be facing unforeseen costs that could exceed $251 billion,” said Peter V. Lee, executive director of Covered California, in a press release. “Consumers will feel these costs through higher out-of-pocket expenses and premiums, as well as the potential of employers dropping coverage or shifting more costs to employees.”

Looking Past COVID-19

Despite these challenges, I think this crisis will change how we approach healthcare moving forward. I think about physicians now having licensure that allows them to treat patients across state lines.

I also think we’ll see changes in our supply chain. Right now, we’re having trouble getting masks and other basic supplies, and we don’t have production here in the United States for a lot of these necessities. We’ve off-shored production for many of our basic medicines and supplies, and I think we’ll begin to rethink how we do that.

At the end of all this, when we come out on the other side, I hope we have a stronger public health system—and I think we’re on the right path.

 

Want to hear more? Check out Terri Kline’s podcast episode on COVID-19 and implications for health plans.