Payer experts: Why COVID-19 will 'fundamentally' change care delivery

As the country begins to emerge from the COVID-19 pandemic, what will the “new normal” look like? 

Health insurance industry experts say to expect a continued focus on telehealth and a significant acceleration of the move to bring more care into the home. 

“Care delivery will be fundamentally reorganized in addition to telehealth,” said Sree Chaguturu, M.D., chief medical officer at CVS Caremark, during a webinar hosted by FierceHealthcare

Brett Lotito, vice president of insurance strategy and operations at Oscar Health, said the growing demand for virtual care options due to the pandemic “pretty much changed the landscape immediately.” 

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Oscar is built on technology, so its membership was already comfortable with digital health tools, with about 30% to 40% utilizing its telehealth tools—quite high for the industry overall. Overnight with COVID-19, Lotito said, that changed to interest from all providers and many patients seeking out these tools. 

In March, Oscar Medical Group saw 62% higher telehealth visits per 1,000 members than in March 2019. At the time, about 20% of those visits were related directly to COVID-19. 

Chaguturu emphasized that the pandemic is making the use case for other home health solutions beyond telemedicine. CVS, for example, offers home infusion and dialysis, both of which are attractive options as members are urged to shelter in place. 

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As providers begin to offer elective procedures when the pandemic wanes, there are several concerns for health plans: namely, that members have been putting off care that was necessary, as well as tracking what’s likely to be a crush in demand for elective services.

Glen Stettin, M.D., senior vice president and chief innovation officer at Express Scripts, said he and his team have been tracking data on members deferring care and have found significant numbers of people avoiding trips to the emergency room for potentially high-risk needs such as heart conditions due to COVID-19 fears. 

He said releasing the data has helped people understand they’re putting themselves at greater risk in an emergency by not seeking care and has also led some providers to make it clearer to patients that it is safe to come to the ER if they need to. 

“We saw that as a need to help reeducate the public,” Stettin said. 

David Weathington, senior vice president of health plan operations at Clover Health, said that as a Medicare Advantage insurer they're focused on tracking data on members with chronic conditions now to avoid potentially negative outcomes in the future. 

The means working with members individually and crafting care plans for their specific needs so they can get necessary care during the pandemic, he said. 

Clover’s team is “beginning to proactively work with those folks on treatment plans, both with the members directly and with their supervising physicians, to make sure as things begin to open up those folks who are not acute but at risk of suffering as a result of deferring care get treatment sort of quickly as things start to open up,” Weathington said.