Our Take: Insurers offer rebates and assistance to their members as the ranks of the uninsured swell
May 18, 2020
Editor’s note: We are aware of the anxiety and uncertainty that account teams are experiencing as they prepare to get back to meeting with customers this summer and fall. The question that everyone is asking is, “How do we re-engage with our customers?”
To answer this question and more, we’re launching a quarterly tracking study with 150 health system pharmacy and medical directors to help market access executives and customer-facing teams prepare for re-engagement.
You can download a Fact Sheet about the initiative here.
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Insurers offer rebates and assistance to their members as the ranks of the uninsured swell
Several weeks ago, many insurers waived out-of-pocket costs for members who need treatment for COVID-19. Some also followed CMS’ lead and offered accelerated payments to providers to help with cash flow. Recently, a few have said they are taking additional steps to ease access to care for members during the pandemic.
For instance, UnitedHealth Group announced that it would provide its customers with more than $1.5 billion in financial assistance. Some of that amount will go to customers in fully insured individual and employer plans, who will receive credits of 5% to 20% on their June premium bills. The company is also waiving cost sharing for members of Medicare Advantage (MA) plans for all specialist and primary care visits through at least September. (As we reported last week, Humana is waiving its MA plan members’ costs for in-network primary care and behavioral health visits through the end of the year.) In addition, UnitedHealthcare said it is expanding certain programs that serve members in Medicaid plans.
Michigan’s Priority Health made a similar announcement several days after UnitedHealth’s, saying it intended to return any revenue above its 10% administrative rate to employers and members. Specifically, the company is issuing a 15% premium credit for the months of June and July to MyPriority individual plan members and small group employers, and is waiving cost sharing for in-person and telehealth primary care visits for its MA plan members through year-end. Large, fully funded employers may also receive premium credits later in the year, the company said.
Cigna, meanwhile, launched a new program to protect its customers against unexpected costs for COVID-19 care obtained from out-of-network providers. The program aims to ensure that those providers are promptly reimbursed at “reasonable, market-based rates” and will assist customers in resolving surprise or balance billing issues.
On a different note, MetroPlus, a subsidiary of NYC Health + Hospitals that offers health plans to New Yorkers, teamed up with Amazon Web Services and Bain & Co. on a project to reach out to vulnerable members to see if they needed medical or social services, including assistance with food or unemployment benefits.
Our Take:
Billionaires like Bill Gates and Dr. Patrick Soon-Shiong are devoting huge sums to help combat the coronavirus, and top executives at a number of large health systems are taking temporary salary reductions (or forgoing their salary altogether for a few months) to help workers who’ve been furloughed, so it’s heartening to see these insurance companies — some oqf which are still reaping billions of dollars in profits — step up as well. UnitedHealth and Cigna both noted that the volume of care being delivered is lower than they anticipated when they set their pricing, so it seems only fair that they should be returning part of the premiums their customers have paid. Still, they’re under no obligation to take any of the goodwill measures they’ve implemented so far, so we’ll refrain from casting aspersions.
We will make mention, however, of a point that Karen Pollitz, a senior fellow at the Kaiser Family Foundation (KFF), raised in a MarketWatch article. Although insurers are waiving out-of-pocket costs for COVID-19 treatment — costs that could add up to more than $1,300 for a severe case, even with employer-sponsored insurance, according to a recent analysis by the Peterson-KFF Health System Tracker — patients could still wind up with bills for their care. Why? Because many insurance companies, including all of the country’s six largest insurers, are allowing self-funded employers to opt out of waiving their employees’ cost sharing. Plus, as Pollitz pointed out, patients could receive “dozens” of bills from out-of-network specialists after being hospitalized — which is what Cigna is attempting to address with its new program. Under the CARES Act, hospitals are not supposed to accept relief funding unless they agree not to balance bill patients for COVID-19-related treatment, but it’s not clear how that stipulation will be enforced.
The MarketWatch article also noted that unless the end dates are extended, five of the six largest insurers are only waiving members’ cost sharing until May 31 or June 1. It’s possible, though not likely, that the number of new COVID-19 cases will drop drastically in the next two weeks, so odds are they’ll be compelled to move those dates out.
Of course, none of this speaks to the issue of people who face losing their health insurance after losing their job. A report by KFF states that more than 31 million people filed for unemployment insurance between March 1 and May 2 (which doesn’t take into account those who lost their job but didn’t file for unemployment). KFF estimates that, as of May 2, nearly 27 million have lost their employer-sponsored insurance and become uninsured. As we reported last week, the Urban Institute estimates that figure could rise to 43 million in the months ahead.
At least residents of Maine who find themselves newly unemployed and uninsured have access to a program through MaineHealth that can connect them with resources to get new coverage and affordable care. MaineHealth said in a press statement that more than 100,000 of the state’s residents are out of work because of the pandemic.
Other states most likely have similar programs — and if they don’t, they should be working frantically to create them. Even with insurers, health systems, drug companies, charitable foundations, mega tech firms like Amazon, Google, and Microsoft, and, yes, billionaires like Bill Gates working in concert to confront the coronavirus pandemic, it won’t be enough to prevent people from falling through our health care system’s cracks.
What else you need to know
The FDA has given Emergency Use Authorization (EUA) to new types of COVID-19 tests. Among them is the first antigen test, developed by San Diego-based Quidel Corp., which detects fragments of proteins found on or in the coronavirus, rather than detecting its genetic material like PCR tests do. The antigen test uses samples swabbed from a person’s nasal cavity and can give results in minutes, the FDA said. The test’s positive results are extremely accurate, but it also has a higher chance (relative to PCR tests) for false negatives — which means negative test results might need to be verified with a PCR test.
Cambridge, Mass.-based Sherlock Biosciences developed the first FDA-authorized test that uses CRISPR technology. The SHERLOCK test kit works by programming a CRISPR molecule to detect the genetic signature of the SARS-CoV-2 coronavirus in patient samples taken from the nose, throat, or lungs and can provide results in about an hour, the company said in a press release. SHERLOCK is designed for use in CLIA-certified laboratories, but the company is also developing an instrument-free, handheld CRISPR-based diagnostic test it calls INSPECTR for use at home, similar to a home pregnancy test.
Yet another newly authorized test is one developed at a lab at Rutgers University; it’s the first FDA-authorized diagnostic test that has the option of using home-collected saliva samples. Patients use a designated kit to collect a saliva sample and then send it to the Rutgers lab for testing. The FDA noted that this test is available only with a prescription. Rutgers’ saliva test reportedly generated fewer false-negative results in severely ill patients, as compared with swab tests, and no false-positive results.
Alexion Pharmaceuticals is planning to buy Portola Pharmaceuticals for $1.4 billion, the companies announced earlier this month, but at least one investor isn’t happy about the deal. The two firms, based in Boston and San Francisco, respectively, signed a definitive merger agreement and the boards of both companies unanimously approved the merger, with the intent to close in the third quarter. However, Elliott Advisors, a London-based fund manager and a “significant and long-term investor” in Alexion, sent a lengthy open letter to the chairman of Alexion’s board of directors last week. The letter lambasted the board for its decision to acquire Portola, saying it was the latest evidence of misdirection by the board and Alexion’s management team, and calling attention to the deal’s “profoundly negative impact on shareholder value.” Alexion lost approximately $1.7 billion in market capitalization within 24 hours after the agreement was announced.
Gilead Sciences has begun to expand remdesivir manufacturing capacity. The company signed non-exclusive voluntary licensing agreements last week with five generic drug manufacturers based in India and Pakistan to supply remdesivir for 127 countries (not including the U.S.). Under the agreements, Gilead will share information about its manufacturing process for the intravenous drug — which the FDA approved on May 1 for emergency use in treating severe cases of COVID-19 — thereby enabling the drugmakers to scale up production of their generic versions more quickly. The licenses are royalty-free until the World Health Organization declares an end to the COVID-19 public health emergency or until an alternative to remdesivir or a vaccine becomes available. The drug companies can set the price for their generic versions of remdesivir.
The number of patients seeking evaluation for acute stroke appears to have decreased nearly 40% during late March/early April, suggesting that patients have avoided emergency hospital care even for life-threatening conditions during the COVID-19 outbreak. Doctors from the Washington University School of Medicine and Stanford University used a neuroimaging database as a surrogate for the quantity of care that hospitals provide for acute ischemic stroke. They compared the daily numbers of patients who underwent imaging during the month of February (an “ostensibly prepandemic … epoch”) versus the two weeks spanning March 26 to April 8 (the “early pandemic epoch”). They observed a 39% decrease, from 1.8 patients per day per hospital to 0.72 patients. The findings were published online May 8 as a Letter to the Editor in The New England Journal of Medicine.
Several groups representing payers and providers filed amicus briefs last Wednesday in the Supreme Court case regarding the Affordable Care Act (ACA). Among them were the American Medical Association (AMA) and 20 other physician organizations, the American Hospital Association and three other national hospital organizations, 36 state hospital associations, and America’s Health Insurance Plans. They hope to convince SCOTUS that invalidating the ACA — particularly now, during the pandemic — would be disastrous to patients, physicians, hospitals, and the country’s overall health care system. The AMA said eliminating the ACA now would be a “self-inflicted wound that could take decades to heal.”
Mount Sinai Health System has launched a care center for patients who are recovering from COVID-19. Noting that the disease affects different systems in the body and that the long-term effects remain unknown, the webpage for Mount Sinai’s Center for Post COVID Care says the center’s interdisciplinary team includes a broad range of specialists, such as pulmonologists, cardiologists, nephrologists, neuropsychiatrists, infectious disease doctors, and behavioral health specialists, as well as physiatrists, physical and occupational therapists, radiologists, primary care physicians, social workers, and pharmacists. The center will also have a COVID-19 registry.
Dr. Atul Gawande is stepping down as CEO of Haven, the health care-focused organization formed in 2018 by Amazon, Berkshire Hathaway, and J.P. Morgan. Moving forward, Dr. Gawande will serve as chairman of Haven’s board of directors, the company said in a press statement, adding that Chief Operating Officer Mitch Betses will oversee day-to-day operations while a search is conducted for a new CEO. Dr. Gawande said the change in his role at Haven will allow him “to devote time to policy and activities addressing the immediate and long-term threats to health and health systems from COVID-19.”
What we’re reading
Interpreting COVID Findings: Avoid These Dangerous Mistakes. Medscape, 5.13.20
Quality Measure Development and Associated Spending by the Centers for Medicare & Medicaid Services. JAMA, 4.28.20 (Subscription required)
Finding The Sweet Spot: When It Comes To Medicaid MCOs And Payment Reform, One Size Does Not Fit All. Health Affairs, 5.11.20
