MA, Medicaid Plans Keep Members Up to Speed on Coronavirus
Reprinted with AIS Health permission from the March 19, 2020, issue of RADAR on Medicare Advantage
In the week or so leading up to the U.S. declaring a national emergency, Medicare Advantage and other insurers’ early response to the new coronavirus outbreak included waiving cost sharing related to testing, allowing early prescription refills and expanding access to and encouraging the use of telehealth services. But as more cases were confirmed in the U.S. — leading to school closures, restaurants shutting down, increased telework and so on — and conflicting messages came out of the White House, insurers at press time were having to take extra steps to protect the health of their most vulnerable members.
The World Health Organization on March 11 declared the coronavirus outbreak a pandemic. (The full name of the virus, which originated in China in late 2019, is SARS-CoV-2. The virus causes COVID-19, which stands for coronavirus disease 2019.) As of March 18, there were 7,038 known cases and 97 related deaths in the U.S., according to the Centers for Disease Control and Prevention. Symptoms include fever, cough and breathing trouble; older adults and people with serious chronic medical conditions are believed to be at higher risk for complications.
While managed care organizations can play a big role in keeping enrollees safe, including through addressing social determinants of health like food insecurity, they can make the largest impact by disseminating information to particularly vulnerable populations, suggests Jerry Vitti, founder and CEO of Healthcare Financial, Inc., a company that connects low-income, elderly and disabled populations with public benefit programs. “They are in a unique position to convey accurate and timely information about infection control to Medicaid enrollees who…are more susceptible to disease than the general population, especially the elderly and those with underlying health conditions. Moreover, because of the nature of their employment, Medicaid enrollees may be at greater risk of exposure to the coronavirus.” Rideshare drivers, restaurant servers and bartenders, for example, have daily interaction with the potentially infected public.
UPMC Works Quickly to Share Right Info
UPMC Health Plan, which waived testing-related cost sharing and prescription refill restrictions for enrollees of its MA, Medicaid/CHIP and commercial plans as of March 6, tells AIS Health it is “trying to get the word out” in as many ways as possible to its older and/or chronically ill members who may be at higher risk for the virus. “We recognize that this is changing by the day and we are pushing out information and support materials as fast as we can,” says Amy Helwig, M.D., chief quality officer and vice president of quality improvement and performance with UPMC. “Knowing that not all modes work for everyone,” the Pittsburgh-based insurer is using multiple channels of communication (e.g., email, post cards, letters, Twitter).
“And in all of these vehicles, we’re making people generally aware of the situation, like what coronavirus or COVID-19 is, what are the signs and symptoms, how they should reach out and when they should reach out — like reaching out to their PCP [primary care physician] or to our 24/7 care lines that have been set up specifically to answer member questions,” she says. And preventive guidance is included in all communications, she adds.
Telehealth Can Be ‘First-Line Screening’
UPMC is also “pushing telehealth as a first-line screening” and has waived cost sharing for all lines of business for 90 days when using the UPMC AnywhereCare virtual app, regardless of the diagnosis, says Helwig. “With an older audience, the first question is how many are going to use virtual, but there actually are a good amount who do.…We’re also very actively promoting guidance and tips on how to use [and download] the app.”
Meanwhile, the UPMC health system on March 14 said its virology team had developed a coronavirus test that it will use for diagnosing “select, symptomatic cases.”
“Testing capabilities for COVID-19 in the U.S. have been delayed and limited, creating anxiety for the people we serve and impairing our ability to optimally guide the public health response,” said Donald Yealy, M.D., chair of emergency medicine for UPMC and the University of Pittsburgh, in a March 14 press release. “By creating our own test and collection centers, we can both help our patients and the overall community. We seek getting a diagnosis in hours, not days.”
The health system added that it “plans to rapidly increase capacity at its central laboratory and, if there is a need, could test hundreds of patients per week in the near future, filling a critical gap before other commercial tests come online.”
“As the coronavirus becomes a more pressing concern for New Yorkers and Americans across the country,” EmblemHealth has also deployed a multichannel communications strategy to reach members, “especially those considered high-risk during this critical time,” according to a spokesperson for the New York-based Medicare and Medicaid insurer.
Communication methods include a dedicated microsite with regular updates, social media posts and a video featuring tips from EmblemHealth medical experts, email blasts about existing benefits and new offerings, and a “coronavirus facts” flier that has been translated into eight languages and distributed at locations across the tri-state area.
EmblemHealth Stresses Social Distancing
The insurer is also offering a “bevy of virtual and telephonic options to help reinforce social distancing and the fact that we know the elderly are a vulnerable population,” says the spokesperson. These include a 24/7 nurse line, telehealth options, a dedicated concierge line for Medicare members’ questions and a pharmacy delivery service though a partnership with Medly (in addition to its regular Express Scripts mail order option).
Moreover, EmblemHealth says it is providing care coordination and access to community resources as part of its Neighborhood Care (EHNC) and Cityblock Health, Inc. partnership. That effort seeks to connect members to meal delivery from food pantries, translations and in-language assistance, and other resources within their communities to help them stay healthy and safe at home, says the spokesperson. The insurer’s Neighborhood Care team will continue to assist those members remotely via phone, but the insurer has temporarily closed its EHNC locations, where seniors regularly attend classes and programs. “We are also making outbound calls to members to inform them of ways to protect themselves and the resources available to them during this time,” adds the spokesperson.
CareSource Supplies Food to Seniors
In what it called a “first-of-its-kind approach in preparing for the potential need to provide food for seniors who might be quarantined as a result of the coronavirus,” Ohio-based insurer CareSource on March 11 said it committed up to $128,000 in funding to allow The Foodbank, Inc. to prepare 1,200 supplemental food boxes to be distributed to seniors who have an income below 200% of the poverty line. Each home will be provided with a 14-day supply of food, covering three healthy meals per day for a total of 50,400 meals, according to a press release from the insurer.
CareSource added that the Foodbank was quickly working to purchase and prepare food boxes so that they can be distributed directly to seniors, “prior to any confirmed local cases, thereby reducing the possibility of unknowingly spreading the virus.” Before any cases were confirmed in the state, Ohio Gov. Mike DeWine (R) began cancelling events and recommending school closures, leading the Washington Post to hail his response as a “national guide to the crisis.”
Meanwhile, CMS on March 10 issued guidance to help MA and Part D plans respond to the virus. That memorandum highlighted certain flexibilities that insurers have to ensure Medicare beneficiaries have access to needed services, and echoed what many insurers at the time were already doing (e.g., waiving cost sharing for COVID-19 tests and treatments, removing prior authorization requirements, suspending prescription refill limits). America’s Health Insurance Plans, which is also doing its share of educating and informing the public, at press time estimated that nearly 70 health plans were offering some combination of these tactics. And the Association for Community Affiliated Plans says most of its member safety net health plans have adopted flexibilities such as relaxed rules around prescription limits and prior authorization.
Administration Extends Waiver Flexibilities
President Donald Trump on March 13 declared the coronavirus outbreak a national emergency, which means CMS can waive certain federal requirements in Medicare, Medicaid and CHIP to expand efforts to contain the virus. Under the emergency, states can seek waivers for their Medicaid programs to allow providers to treat coronavirus patients from other states, streamline provider enrollment requirements and ease licensing requirements to maximize the medical workforce treating ill patients. Consistent with the emergency declaration, CMS is also expanding Medicare’s telehealth benefits under 1135 waiver authority to allow patients to receive telehealth services in any health care setting (or their home) from a range of health care providers.
“With the CMS directives, MA plans have to eliminate cost sharing for testing and extend other emergency flexibilities to enrollees. However, the issue with the pandemic seems to be the insufficient availability of testing and ultimately the ability to receive care, not how it’s covered or paid for,” says Larry Kocot, a principal at KPMG LLP and a former top CMS official. “MA plans could theoretically work with local public health authorities to support expedited testing and other initiatives, but it seems unlikely they will be able to help create health care infrastructure and capacity in short order on their own, as it currently does not appear to exist.”
Testing Barriers Remain in U.S.
As such, a similar issue exists in Medicaid. While CMS is working with states to expand coverage and on March 13 extended certain program flexibilities to Florida through the first approval of an 1135 waiver request, “impediments to testing and other infrastructure capacity could still create barriers to effective diagnosis and treatment,” suggests Kocot, who leads KPMG’s Center for Healthcare Regulatory Insight.
Medicaid Health Plans of America in its statement issued March 9 urged CMS to “take immediate action to empower states to address the impact of COVID-19” and pleaded with CMS to “work with CDC to develop and provide states with sample written patient information on COVID-19 appropriate for Medicaid beneficiaries” that could, for example, be shared employees of MCOs such as case/care managers and disease management staff.
“Through letters and brochures, or more directly and immediately via plans’ front-line staff of call center employees and case managers — basically anyone who is talking to a member — plans can influence what members are doing to prevent the spread of the virus,” adds Vitti. “However, as is the case with plans and communications about public charge [the regulation that allows immigration officials to consider use of Medicaid coverage when approving applications for legal residence], the states are key. Medicaid MCOs can be very effective vehicles for the communications but won’t be able to implement them fully without partnering with the states.”
Visit https://upmc.me/38OCVYA. Contact EmblemHealth spokesperson Kwame Patterson at KPatterson@emblemhealth.com, Kocot via Bill Borden at email@example.com or Vitti via Joe Reblando at firstname.lastname@example.org.
By Lauren Flynn Kelly