Health Insurance Providers Respond to COVID-19 / HealthChoice

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hello everyone i'm vanessa grossel policy analyst at the council of state governments i serve as a staff liaison to csg's healthy state's national task force which is comprised of four subcommittees examining such topics as capacity preparedness and resiliency leveraging innovation state health systems return on investment and interventions to save lives i'm joined today by miranda kreviston

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mater senior vice president of state affairs and policy at america's health insurance plans to talk about how the health insurance industry has been responding to covet 19. miranda joined ahip as senior vice president of state affairs and policy in april a role in which she is responsible for ahip's state policy and advocacy agenda as well as a hips political engagement strategy

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with state officials regulatory agencies and key policy makers prior to joining ahip miranda was the president and ceo of the ohio association of health plans for over eight years where she provided thought leadership on policy initiatives that drove improvements for access to high quality affordable health care for more than 9 million ohioans covered by oah p's

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15 member health plans and prior to her work at oahp miranda practiced law for over 10 years and has served as staff to former governor george voidovich and former u.s senator mike dewine who is now governor of ohio welcome miranda tell us more about ahip thanks vanessa thanks so much for having me uh today um and i'm really excited about the

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opportunity to share with you today about a hip and some of the work that we are doing ahip is the national association whose members provide coverage for health care and related services to hundreds of millions of americans every single day uh who may be uh purchasing their health care through their employer um maybe um from you know individually on their own or they may be um accessing and

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purchasing health care through a public program uh like medicare or medicaid um and so it's really through these offerings through this health insurance coverage that we improve and protect the health and financial security of consumers families of businesses and communities across the country ahip and its members are committed to market-based solutions and public-private partnerships that improve affordability

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value access and well-being for consumers so let's dive in uh tell us how have health insurance providers responded to the covet 19 crisis thanks vanessa for that great question certainly responding to the growable pandemic has been paramount to what the health insurance industry has been focused on let me first start out by saying that we believe that every american deserves affordable comprehensive coverage that

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provides them with access to high quality health care it's critically important and i think the global pandemic has has really demonstrated this in a very clear way um and that it's essential to assure that americans coverage remain stable both from an access and affordability perspective as much as as possible that you know an individual can end the year with the same coverage that they started the year with and so understanding that health

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insurance providers responded very decisively very quickly to help americans overcome the coping crisis in february ahip and our member plans began working very diligently with the cdc and health experts across the nation to share information to mitigate health risks uh to americans and to actually keep americans informed and so what does that mean on the next level you know early on

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health plans were carefully monitoring the situation they were following their emergency preparedness plans which are essentially plans that are always in place to address situations that include global pandemics those plans include determinations about whether insurance policy changes are needed to ensure that people can get essential care so they may include things like easing network requirements prescription drug coverage referral requirements

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and or cost-sharing um relaxations plans at that time were also actively educating people on steps that they could take to prepare and stay healthy and they directed individuals um to the cdc for for that critically important information they began tracking symptoms and patterns that may have been apparent through data that they received on um and through electronic medical records and phone calls to nurse call centers and clinical physics

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um they were informing clinicians to ensure that they know what the symptoms and knew what the symptoms of covid19 look like and how to actually address those things early on and then very early on we begin collaborating with federal agencies and local public health officials to help contain um you know those outbreaks as they started so shortly thereafter that work began um and in early march um ahips board of directors um committed to helping america's

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powerful health care system meet the challenges so we are in a country that is benefited by a very strong um health care system and so very early on um we started that work and so with the health and the well-being of the people that we serve as our highest priority health insurance providers began on activating those strategies to ensure that americans had access to prevention to you know testing and to the

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treatments that were needed um so let me give you some examples of that work um health insurance providers were and and are currently as this pandemic continues um working with public and private sector partners to ensure that costs are not a barrier to people seeking testing for and treatment of covid so insurance providers they are actively covering diagnostic testing they have eased network requirements and

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referral requirements and prior authorization requirements they are waiving patient cost sharing you know health insurance providers are also making sure that patients have continuous access to their regular prescription medications while at the same time avoiding potential problems such as drug shortages which is you know very important health insurance providers are also partnering with doctors and hospitals and other care providers

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to ensure that effective treatment is available for those that are infected as i said earlier we continue to share information with clinicians they're mobilizing their network providers and coordinating through care management programs that health plans have to ensure that they have the best and most immediate data to help identify and diagnose and treat the infection um and i'll talk a little bit later on

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that health insurance providers are also encouraging the use of telehealth at home care other technologies that expand access to care but at the same time are helping americans avoid um being exposed to or at risk for catching the infection health insurance providers continue to educate and inform the people that we serve we continue to work directly

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with the important federal agencies so the cdc and other task force and our essential partners and the states and the cities and the communities across the country which are doing such important work coordinating efforts and sharing information and and really mitigating the health uh risks and keeping the americans uh informed and safe um the other thing that i will will mention in terms of our work um you know certainly as it has focused on prevention and testing and treatment

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work that i just talked about you know the other work that health insurance providers have been doing is ensuring that you know the americans can continue to get the care and the medications that they need to address maybe some health conditions that they currently have so it's not only been focused on making sure that um americans get the care that they may need if they get infected um or helping them to prevent getting infected from the covet virus but health plans have been

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working very diligently to make sure that americans that may have a chronic condition or may have um another disease that they have been dealing with to make sure that they can continue to get that care and the medications that they need um so we are pleased and we're proud uh to be standing alongside of our partners and devoting resources and insights and collaborating with key partners to confront and resolve this challenge together so how has a hip worked with

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medicaid programs in the states as well as other stakeholders to ensure access to affordable high quality care leading up to and also during the pandemic yeah so that is a great question as well because you know medicaid and medicaid programs are such an important critical access point uh to so many americans for their health care coverage um you know medicaid helps millions of americans every day we know that

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um it is the largest healthcare program in the united states um currently covering more than about 20 percent of the u.s population what we do know is that medicaid programs are the lifeline um for about one in five americans including children and pregnant women elderly adults and individuals living with disabilities we all know that medicaid programs need to be there to support uh these medicaid enrollees um

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across the country is is the question that you asked in terms of how have um we been helping medicaid programs and how has the industry been helping medicaid programs leading up to cobed you know across the country states are increasingly relying upon medicaid plans um in private industry to help promote high quality coordinated care for their growing populations more than about 56 million low common co

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low income individuals um actually rely upon private health plans so medicaid managed care plans to provide their medicaid coverage today and those plans have been and continue to provide a variety of services to meet the new unique needs of individuals in our medicaid programs across the country those programs include coordinating care for individuals that may have multiple chronic conditions so they may need

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care coordination and help managing through multiple conditions and multiple providers those programs also include outreach and education initiatives to promote prevention and healthy living and efforts to actually help beneficiaries access what we would consider non-medical support so actually helping individuals get transportation to get to that doctor's appointment or food to make sure that they have healthy

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lifestyle or healthy living that will help them better and improve that health care need that they may have so that being said in terms of the work that we have been doing up to um coved you know let me also sort of take a step back and say that um you know our governors across the country have taken um widespread bold actions to respond to this coded crisis um and we know that their strong actions

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have helped businesses and workers and patients and in providers um you know now as governors are turning their attention to um you know reopen their states and try to rebuild their economies we really believe the health insurance industry really believes that access to affordable healthcare coverages is critical to restoring a state's health and economy and we also believe um that medicaid programs are uniquely situated

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to serve and help boost state's economic engines so as businesses reopen we know that employers want to have access to healthy workforces and that means unemployed citizens need to have access to health care and health care coverage health insurance coverage and so um you know we believe that medicaid safety net programs are really providing this access to care and in in our important linchpins but at the same time we also know that

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states are being pushed to the brinks despite temporary enhancements of federal matching dollars which you may have referred to as fmap federal assistant percentages dollars that the federal government provides states to help them operate their medicaid programs um was really probably not enough in terms of helping them cope with the numbers of individuals that states are seeing come

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on their medicaid programs significant unemployment and losses in tax revenue and increasing medicaid enrollment are all taking a heavy toll um so so that being said um you know a lot of the work that we have recently been doing to help support medicaid programs to make sure that there continues to be access to affordable coverage to not only those medicaid recipients that have been on medicaid

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but also those individuals across the country that may have lost a job ahip has been really active and helping some efforts to make sure that we have a financially viable stable medicaid program across the country just a couple of examples of that work we have recently requested congressional support for a number of recommendations that would would ensure that state medicaid

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programs were financially sustainable we also joined a number of national organizations representing patients and health care providers health insurance providers and other stakeholders to urge congress to support additional federal financing for state programs to help them continue that sustainability and that support that we know that we need we also continue to work with governors and insurance commissioners and state

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medicaid directors across the country to regularly engage with them on med covet related concerns um talking to them about best practices um providing policy recommendations that again would help to assure and go a long way um in making sure that those programs are strong and financially viable and really value-driven state programs

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and earlier you mentioned telehealth with covet 19's rapid onset a dramatic shift to telemedicine and telehealth for behavioral health services and many other services has occurred what has ahip done to facilitate that transition so i'm glad you asked about telehealth as you said this has been an area of dramatic growth we have seen that really since the start of covid i will

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tell you that health insurance providers um have have long promoted the use of telehealth because it is effective it is convenient and it's really a safe way for um many americans to receive their health care um i think as um as we've seen um coven 19 has really demonstrated quite frankly how valuable coven is and can be um early on um insurance

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health insurance providers um began waiving and have waived cost sharing for telehealth um so that that cost is not a barrier to that service many health plans also expanded telehealth programs so that more individuals and more types of services could be available um via telehealth um and so we're really excited to facilitate the care and that type of care for so many

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americans um you know it's it's interesting so you know telehealth is as you probably know is is especially beneficial um particularly during culvin for patients um who may be at higher risk um you know and are nervous or are sensitive and are concerned about leaving their home to to go to a doctor's office you know for doctors um um during kobit

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expanding telehealth has eased the burden on the health care system it has allowed for hospitals to care for those people who need it while limiting the exposure of health care workers those you know heroes and those front line workers from additional individuals that may be coming into those facilities and that you know the other thing is that it is also met is that for providers um and some hospitals they have been able to stay in business

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because they can continue to see patients who need care um you know during the covet pandemic so again we're really excited to see how the technology is being used um how it has really just exploded and from a health plan health insurance provider perspective um you know we have really been using it from you know addressing mental health issues from reducing opioid misuse and abuse

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to supporting seniors and others with that may have you know mobility transportation issues um and so it's it's really an exciting um model to see develop and being used you know i will tell you that that during this crisis ahip and our health health plan members have really supported a number of the policy changes um that were made by both the federal

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government and in states by state policy makers to encourage the use of telehealth and to speed its adoption and so um you know now we're really excited about this conversation and as uh we're beginning to come through um kobet and i think is hopefully once we get to covid we can really look at what our health care system looks like and and how telehealth has really transformed that um and really take away i think some of the

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um the really the a lot of the value that we have seen through telehealth begin to bring telehealth into the environment when you think about value-based purchasing and really using telehealth to drive outcomes and the way that we have so many other types of um delivery systems so we're really excited about that continued use great thanks and could you explain how ahip has worked in the field of covet 19

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testing including advocating for its affordability yes so um testing has been incredibly important um and and i appreciate the um you know the the question about advocating for its affordability um so um as i said you know i think you know during this unprecedented time we all recognize

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and all acknowledge that widespread testing um that is safe that is effective and that is accurate is just incredibly important it's it's so necessary and and there really are two essential components that we have seen um to testing um first we really must be able to quickly diagnose the virus and then second you know we really must be able to screen and prevent

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and mitigate the spread of the virus um and so we see that you know early on i think the testing was was primarily being used for um diagnostic purposes and i think we have quickly um sort of seen testing now being conducted for um three different kinds of purposes uh the first um for diagnostic meaning to guide care and treatment um the second type of testing um that we have really seen

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being used across the country by governors and states and and localities is for public health surveillance purposes and then lastly for occupational health so as individuals are returning to work um as um you know with with hopefully schools opening in the fall and return to school um we see and hear about testing being used for those purposes um so looking at the sort of different purposes

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let me say that we also believe that access to testing should not be dependent upon anybody's ability to pay to your question about affordability you know health insurance providers are committed and have been committed to re removing cost barriers um for covid 19 diagnostic testing and plans have a result and plans have been very proactive in eliminating uh co-pays and co-insurance and

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deductibles for that type of testing health insurance providers have also uh waived primary or prior authorization requirements those requirements that may have been in place those have been waived for patients that are seeking testing or treatment of coded so that they can actually get you know faster access to that care but let me say that um knowing the scope and the breadth of the testing that is needed across the country as we look at the other two types of

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testing so for public surveillance and occupational health um you know the exceptional scale and scope that is required um you know public health testing efforts and public tests and public um health and occupational testing really needs to have it needs to be a national priority um be federally funded but locally administered

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and so to that end as we have been making sure um that our members have access to diagnostic testing for care and treatment we have also been active as part of a number of other national stakeholders in seeking additional guidance and additional federal investment in states for testing for public surveillance and for

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return to work return to school so that occupational health health so that we can make sure that all americans again have access to the critical testing that they need and it can be available to them in an affordable way all right thank you and um how have considerations such as social determinants of health influence the work of ahip yeah so social circumstances um have had a huge have a huge

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impact on um a person's health so i'm so glad that you asked that question um you know we hear lots of times that not every health issue can or quite honestly should be addressed with a prescription pad um you know i think health insurance providers have really known this for years um and really is why we have focused on um programs to take care

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of the whole person so what does that whole person care mean or look like it really means looking at caring for that person from a few food security or a healthy food perspective from taking care of that person from a transportation perspective so making sure that you know they may have a doctor's appointment that they need to get to for a health care issue but if they don't have the transportation to get there um that becomes a real gap in that

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person's health care um to um for safe housing um you know safe housing can be just as critical if not more critical than that person's underlying healthcare condition and so um you know in the midst of covid um you know with so many americans being isolated in their homes and millions being unemployed i think the need and i think we believe as an industry that the need to address

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you know issues like i talked about from food security insecurity to housing instability and social isolation is you know unfortunately greater than ever before we also know that disadvantaged and minority communities are experiencing higher rates of infections and death from the disease as well as greater economic impact from social factors that are challenging in normal times and unfortunately have been amplified

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during you know the global health crisis so um to that end um you know health insurance providers are and have been um you know very actively engaged with local health care and social service providers to address social economic needs um again food security employment and housing issues um you know we we really believe that these programs are just fundamental

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to our commitment uh to improve the health and well-being of you know the americans that we serve and um i'd be happy to um you know point the the listeners to a variety of materials that i do know that we have on our ahab website we have a number of recent briefs that we have done that pers that really describe at a very specific plan and program level some of the really unique

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and neat things that health plans are are doing to make sure that their members have food that their members have jobs and can get connected to employers um and you know make sure that they are um you know getting the services that they need if they're in isolation or in recovery sites so we're really excited about that work again i'm i'm so happy you asked about that question because um you know we really understand and

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truly believe how important it is to a person's overall health so you have shared so much great information and i'm just wondering um what does all of this mean for state policy makers and what kind of policy considerations would ahip like for legislators to bear in mind as they work toward state solutions in the months and years ahead well thank you for that question to vanessa um

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we really appreciate the work and the partnership that we have um working um both with our state policy makers and leaders uh that are on the front lines of this and in addition with the federal leaders from everything to you know our work and support um from you know supporting our healthcare heroes on the front lines to you know supporting

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testing and treatment strategies and helping businesses and their employees continue coverage um and so you know the the question about um sort of what's next in the policy and the regulatory um solutions that we may need uh moving forward um you know i think there are a couple of important things to keep in mind um you know i think first um we should really seek to adopt improvements

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for care and access while improving affordability wherever we can and you know sometimes i think um you know it's just so important to make sure that you keep both access and affordability in mind when you're thinking about policy solutions um you know because sometimes if a if a service isn't affordable um it means that it's not accessible right and so those two things go hand in hand

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i think a perfect example of that is is telehealth when you think about policy changes for telehealth patients and doctors um you know we know are all realizing the benefits of expanded telehealth and as we talked about earlier as i said growth in telehealth has exploded during this pandemic um and and moving forward as we look at policy changes and and and policy reforms i think it's just so important that we need to make sure that we continue to promote

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innovation that we continue to embrace the cost-saving potential of those services and effectively leverage telehealth to deliver that outcome-based value care that i talked about earlier um you know i think the other thing we need to do is to really begin instituting important safety and affordability measures that were waived to speed care during the pandemic but are critically important to patients and employers and in taxpayers so

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you know making sure that we continue to to fight against fraud waste and abuse um and you know some of those um important tools are continued use of medical management and prior authorization and you know really looking to how do we incorporate some of those important tools um back as we um come out of coped um so the only other thing i would just say is to just you know really be cautious about some of the short-term policy

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decisions that may have um long-term unintended negative impacts um and so we just we stand ready at ahip and um through our work in the states and at the federal level to partner with policymakers um and you know we're really excited i think about um opportunities that we see in the future to make sure that we can continue to provide access and affordable high quality care for the americans that we serve

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thank you for joining us today miranda we appreciate you for making time to share your expertise with us it will help greatly to inform the work of our healthy state's national task force i'm vanessa grossel at csg headquarters in lexington and i've been speaking with miranda mater senior vice president of state affairs and policy at america's health insurance plans

Health Insurance Providers Respond to COVID-19

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