How healthcare payors can be proactive in a pandemic

COVID-19 has turned the healthcare industry upside down. At MultiPlan, we’ve been analyzing data, looking for trends and making observations. Because even during a pandemic, we think payors can take steps to tackle their healthcare cost challenges.

The situation is fluid

As COVID-19 cases decline in one area, they spike in another. While elective procedures and routine visits are resuming in some areas; they are pausing (again) in other places. The first wave ebbs and flows, and a second wave could be looming.

► What MultiPlan is seeing

We’ve seen this up-and-down scenario reflected in the claims we receive. During the first two months of the pandemic, claim volume was less than normal, yet began to climb steadily back. While elective and non-urgent procedures and office visits claims dipped, claims related to telehealth and COVID-19 were up significantly.

► How payors can take action

With the situation changing daily, a payor needs a partner who moves just as quickly. At MultiPlan, we leverage technology, data analytics and our expert team, allowing us to manage new developments, facilitate fair and prompt provider payments, and keep our clients informed.

Telehealth is growing

Temporary policy changes have made it easier to access healthcare remotely, leading to a surge in telehealth services during the pandemic. According to the CDC, short-term benefits include adherence to social distancing, less risk of infectious exposure and less overcrowding at healthcare facilities.1 However, telehealth is poised to take a greater role in the long term.

Medical groups, such as the American Medical Association and the American Hospital Association, are embracing these services.2,3 Many providers and lawmakers would like to see some of the temporary policy changes become permanent.

► What MultiPlan is seeing

We saw a rapid increase in telehealth claims beginning in April and continue to see higher amount of telehealth claims each month. The most frequent telehealth codes relate to “Evaluation and Management Services” and “Mental Health.” We have also flagged some suspect claims, such as an setting a broken arm via telehealth.

► How payors can take action

Payors should start thinking about how telehealth can fit into their long-term strategies. They also need to consider whether they can properly handle telehealth claims — and the possible challenges that come with them.

Premiums to rise

While payors have had unexpected costs related to COVID-19, some may actually see an overall reduction in costs this year due to delayed or canceled care. But these savings will be short lived. Premiums are expected to rise in 2021. According to the Harvard Business Review, this increase is partly due to the uncertainty of the future.4 Patients could start getting those delayed procedures en masse, driving up demand and costs. Or a second wave could shut down communities again, delaying care even longer. We just don’t know.

► What MultiPlan is seeing

We are beginning to receive more claims for routine procedures, but some of these may be due to providers not submitting their claims right away. In turn, we do expect the volume of claims to continue to rise due to the backlog of these submittals.

► How payors can take action

Payors need to re-evaluate their claims reimbursement strategy — both in-network and out-of-network — to achieve savings now and to preserve their enrollment in 2021. MultiPlan remains flexible and can help our clients develop customized solutions. We identify the greatest room for savings and implement those strategies quickly.

Learn more

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1 Centers for Disease Control and Prevention (CDC), “Using Telehealth to Expand Access to Essential Health Services during the COVID-19 Pandemic,” June 10, 2020: https://www.cdc.gov/coronavirus/2019-ncov/hcp/telehealth.html#anchor_1591719562438

2 American Medical Association, “AMA supports Telehealth Initiative to improve health care access,” March 19, 2020: https://www.ama-assn.org/press-center/press-releases/ama-supports-telehealth-initiative-improve-health-care-access

3 American Hospitals Association, “Telehealth is changing care delivery in communities across America,” accessed July 24, 2020: https://www.aha.org/telehealth

4 Harvard Business Review, “U.S. Health Care Is in Flux. Here’s What Employers Should Do,” June 15, 2020: https://hbr.org/2020/06/u-s-health-care-is-in-flux-heres-what-employers-should-do