Here are five pieces of advice from Health Data Decisions to help health plans respond to COVID-19.
Health Data Decisions (HDD) is sharing its initial observations to help health plans develop a strategic response to the novel coronavirus.
The analysis covers recommendations for member outreach, provider outreach, model of care changes, telehealth and eVisits, quality of care, and the financial impact of the crisis.
Plans can no longer focus on regular wellness activities and health maintenance as beneficiaries are already experiencing challenges to accessing care, getting medications, and obtaining groceries. As a result, it will be difficult for providers to treat the conditions that drive HEDIS®, Star ratings, and risk adjustment payments, the publication reports.
“HDD expects significant disease progression for pre-diabetes, diabetes, mental health, substance abuse, cardiac and pulmonary conditions regardless of hospital bed shortages. We anticipate decreased member satisfaction and confidence as most non-essential procedures will be postponed for many months, if not an entire year or more,” the publication writes.
The three-page document contains more than 20 recommendations for payers. Here are five of them:
For member communications: Create a dedicated COVID hotline and online chat functionality; members may need their plan’s help to locate health care providers with capacity as the pandemic progresses.
For telehealth and e-visits: Help vulnerable members get technology set up in their homes to enable eVisits.
To address model of care changes: Engage with CMS and local regulators on any waiver or exception process that will allow the plan to make changes to their care delivery model. Expand paid at-home services via vendor or in-house.
To maintain quality of care: Use telehealth to triage members to the most appropriate mode and level of care and help limit unnecessary procedures or encounter.
To address the medical economic impact: Start developing new benefit and pricing models to adapt to the new economic landscape that the pandemic will drive in the next 6-12 months and beyond.