MA, Medicaid Insurers Employ More Strategies to Protect Members

by Lauren Flynn Kelly

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 the virus continues to spread in the U.S., insurers are having to take extra steps to protect the health of their most vulnerable members.

While managed care organizations can play a big role in keeping enrollees safe by addressing social determinants of health, they can make the largest impact by disseminating information to particularly vulnerable populations, suggests Jerry Vitti, founder and CEO of Healthcare Financial, Inc. "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."

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, says it is "trying to get the word out" in as many ways as possible to its older and/or chronically ill members.

The insurer 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, says Amy Helwig, M.D., chief quality officer with UPMC.

"As the coronavirus becomes a more pressing concern for New Yorkers and Americans across the country," EmblemHealth has deployed a multichannel communications strategy to reach members, according to a spokesperson for the insurer. It 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."

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.

"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.

From RADAR on Medicare Advantage