Changes in Coverage

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By mid-April, Catherine Ratcliffe knew something big was about to happen. The partner and chief operating officer at Sullivan, a benefits consulting firm in Riverview, Florida, watched the ominous television reports—but the data she was reading pointed to even more upheaval.

“It’s been all over the place, in terms of how [COVID-19] has impacted [benefits],” Ratcliffe says. “It’s impacted them in every possible way. And members are concerned. They’re not sure what to do, and there’s still a level of fear of what accessibility is going to look like.”

As the pandemic ramped up around the world, so did the reactions at home and in the workplace.

Early prescription refills skyrocketed. Patients began postponing treatment of ailments from colds to cancer.

And as businesses furloughed or sent employees home to work, normalcy was out the window.

A month later, Ratcliffe and her husband were working from home, their kids were on permanent spring break and the Sullivan phone was ringing off the hook with concerned clients.

“People are very much alone in their fears,” Ratcliffe says. “They’re sitting at home, working from home. They’re bombarded with whatever they’re seeing on social media or in the news.

“We were all in this nightmare together trying to figure this thing out.”

Many companies began opening up mid-year enrollment windows, to allow for employees to scramble to make changes ranging from providers to health care spending accounts.

“In some ways, I think that made employees feel better because they felt like they were in control a little bit, but I think it was also scary,” she says. “I think there was a lot of trepidation.”

And uncertainty regarding coverages.

Under existing health plans, COVID testing was covered 100% for exposure or for workers displaying symptoms. But if companies wanted to test employees as they brought them back after shutting down, there was no benefit.

Wrinkles like these needed ironing out. And one of the most notable changes was in the health care delivery model.

“From a telehealth perspective,” Ratcliffe says, “providers who were never on board with telehealth … all of a sudden, everyone started doing telemedicine because it was the safest way for them to practice in the moment.”

Telemedicine has grown exponentially in 2020 at Fort Myers-based Lee Health. The local health care system encourages patients to use its Lee TeleHealth service in place of in-person urgent care visits. Not only can patients safely use the service from the comfort of their homes, but they can log on anytime, day or night, without the need of an appointment.

“Part of the ramp-up has been demand but, also, we’ve been able to build up capacity. So I think we are in a good position on a go-forward basis to be able to continue to provide this level of support and more. And I think, typically, once patients do it that’s how they want to do it,” says Kris Fay, chief administrative officer, Lee Physician Group, Home Health & Physician Services.

Averaging nearly 1,000 visits a day, Lee TeleHealth has become mainstream. Quickly building up the hospital system’s infrastructure to handle the demand is what truly allowed the convenient feature to grow, Fay said.

“Although we did have capacity to do visits virtually prior to the COVID pandemic, what we realized is that we needed more computers, more bandwidth, more microphones, more cameras, and so we quickly partnered with ITS and built out that infrastructure so that all physicians within Lee Physician Group could offer the service,” she says.

Clinton Baird, CEO of Cura TeleHealth and Wellness, a telemedicine provider in Florida, Texas, Pennsylvania, California, Colorado and Nevada, said call visit volume has increased “tremendously” through the company’s contracts with third-party administrators who sub-contract through existing health plans.

Cura also has direct contracts with hospital facilities and schools, and offers direct-to-consumer services, as well.

“I think it’s made a pivot, more than an iteration,” says Baird. “We’ve been iterating on telemedicine for the last 15 years, but it’s been slowed by regulatory barriers and adoption.”

Both barriers crumbled this year with shelter-in-place orders and President Trump ordering the Centers for Medicare and Medicaid Services to expand reimbursement for telehealth visits. Prior to the pandemic, approximately 13,000 Medicare beneficiaries received telemedicine each week. The last week of April saw nearly 1.7 million beneficiaries receive telehealth services.

The regulatory change alone added 45 million potential Medicare patients for Baird and telemedicine providers.

Ratcliffe said uncertainty will likely remain in the marketplace as end-of-year enrollments begin to open.

“Every day, you hear numbers are up,” Ratcliffe says. “‘Do I really want to start orthodontic treatment or do I really want to start something like a knee replacement and not feel 100% comfortable? … I’ll be able to go in and get care when I need it.’

“We call those gaps in care. What are we doing for those people?”

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