March 03, 2020
HRI spoke with PwC partner James McNeil about what health insurance companies are weighing in these early days of COVID-19 in the US. [Note, this information was last edited on March 3, 2020.]
We hear a lot about what the government and our public health system is doing to prepare for a potential COVID-19 pandemic but we haven’t heard as much about the industry perspective. How are health insurance companies approaching the potential disruption?
The same kinds of thinking should be done for prior authorizations of certain procedures and testing. Is there a point at which the step of prior authorization is a barrier to better health in a public health emergency? Also, when do you start postponing certain types of procedures, like cosmetic ones, keeping people out of hospitals? When do you start pulling these levers? And which ones will be most effective?
HRI: What about member management?
James McNeil: The first area is communication. There is so much information out there—some of it wrong—about how to stay healthy. There’s a lot of confusion. So health plans have the opportunity to cut through the noise with fact-based recommendations.
Also, members are going to ask about health benefits. They are going to be more interested in telehealth, where they should go to get tested for COVID-19 and under which circumstances they should be tested.
There may be surges in requests for 90-day prescriptions and prior authorizations. There may even be more questions around what is paid for and where the member is in their plan year deductible. So plans should expect member communication to swell; capacity needs to be available to get people the right information at the right time.
HRI: What are some insurers not thinking about, but should be?
James McNeil: In a pandemic, the rules that are in place regarding coverage may need to be more flexible. Some plans are weighing increasing prescription lengths and moving more people to mail order prescriptions.
Why would they consider these changes? During a pandemic, it may be more risky to have the elderly and people with compromised immune systems out in the general public, exposing themselves to their infected neighbors, friends and family.
It simply may be safer to make it easier for people to stay home with longer supplies of prescriptions, or to have medications delivered to their doorsteps to reduce interactions in a retail setting. Do you want an 80-year-old standing in line at the pharmacy with six other people, three of them coughing and sneezing as they wait?
The same kinds of thinking should be done for prior authorizations of certain procedures and testing. Is there a point at which the step of prior authorization is a barrier to better health in a public health emergency? Also, when do you start postponing certain types of procedures, like cosmetic ones, keeping people out of hospitals? When do you start pulling these levers? And which ones will be most effective?
HRI: Why is taking a look at vendors important right now?
James McNeil: One of my clients has more than 400 vendors that they work with and manage. Health plan vendors sometimes manage the provider network, handle claims management, support data analytics and handle myriad specialized services. Some of these vendors are offshore, some in the US.
It becomes an interesting dance to even communicate with all of your vendors and better understand what their capabilities are and what their contingency plans are vis-a-vis COVID-19. So now it is about assessing the vendors and answering this question: How many functions can I turn off—if I need to—and still deliver the health insurance product?