Industry News
Industry transformation: A silver lining of COVID-19

Looking back at a slide outlining Americans’ top health care concerns in January was disorienting on Day 1 of AHIP Institute & Expo Online. As part of the Institute Influencer Series, Avalere Health Founder Dan Mendelson set the stage for a conversation about the impact of COVID-19 on the health insurance industry by briefly walking back to the start of the year. Health care was top of mind in politics.  Affordability was the primary concern. 

Fast forward to now, and it’s all about security, access to coverage and recovery from major financial fallout among health care providers – even as the pandemic continues. 

While a lot has changed, much has stayed the same, speakers said, although themes have been magnified by the lens of COVID-19.  Data sharing matters more now. Health care providers need streamlined administrative processes more than ever. Social determinants of health are more potent.  And the need for a delivery system rooted in value and not volume feels more pressing.

Progress, accelerated

Health system transformation might ultimately be one of the more important and consequential silver linings of the pandemic, experts said. Health care providers have been hit hard by the deferral of care and the demands of COVID-19 caseloads. Mendelson said smaller organizations that were most heavily dependent on fee-for-service care have suffered the greatest losses.

Health insurers have committed to supporting providers in a variety of ways, but Mendelson said they can target their assistance to facilitate investment in tools – like the data infrastructure providers will have additional difficulty affording now – needed to support the transition to a more efficient, risk-based model.  Data is foundational to such a model.  “You can’t manage what you don’t see, and anything not being managed by data, you’re not seeing it,” Mendelson said.

Former CMS Administrator Dr. Mark McClellan echoed those themes, noting that some health systems have fared better than others during this crisis, and progression toward advanced payment models seems to be a differentiator. Smaller organizations might benefit from investments that help them navigate COVID-19 today, while moving them toward a more resilient model tomorrow. He noted the CMS could use regulatory tools to encourage this type of investment.

COVID-19 has shown how much can change in a short period of time when it has to. Take, for example, the rapid uptake in telemedicine. Not all care that went virtual will stay that way, but some can – and Mendelson urged insurers to revisit benefit design with wider use of telemedicine in mind, as well as other ideas that seem more practical in a pandemic. Consider home administration of chemotherapy. It holds clear appeal for reducing the risk of infection when a novel virus is circulating, but wider use of chemotherapy at home also holds promise for patient satisfaction and lower costs in ordinary times. “A lot of what is rational comes out at a time when things are strained,” Mendelson said.

Public programs in particular – along with their private industry partners -- are likely to play a role in integrating the lessons of COVID-19, Mendelson said. Following years of battering, the Affordable Care Act marketplaces are likely to see coverage gains moving forward as out-of-work Americans turn toward public exchanges. And Mendelson predicts enrollment in Medicare Advantage plans will overtake enrollment in traditional Medicare by 2025.

This public-private interface might be exactly the place to address other challenges laid bare during COVID-19, such as health care disparities. When incentivized to unravel racial and other disparities, “the health insurance industry will rise to that challenge,” he said.

Melissa Turner is director of health care and life sciences content at SmartBrief. She edits science, medical and health care delivery newsletters and oversees development of content marketing pieces for SmartBrief’s health care clients.

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