How Will the COVID-19 Pandemic Affect the Health Insurance Industry?
Table of Contents
- [Music] hello I'm Matthew vidya as part of our...
- Coverage has really emerged at the forefront for the next election what...
- There's bipartisan agreement that health plans offer predictability and stability...
- An incredible bright spot here and you know it's it's been it's been years...
- Understand what is being delivered to make sure that that fraud does not occur...
- 19 in addition to trying to deliver care remotely one of the other things that...
00:00
[Music]
hello I'm Matthew vidya as part of our
coverage of a hips Institute Expo 2020
virtual conference American Journal of
managed care's please welcome Dan
Mendelssohn founder of Adler Health will
speak on his session the impact of co19
on the health insurance industry you
just introduce yourself and benchwork
sure I'm Dan Mendelson I founded a
Valier in 2000 and grew the business as
CEO for many years I'm now an advisor
with the business at a private equity
investor notably the affordability of
00:38
healthcare served as a primary consumer
concern back in January 2020 in the
mid-nineteen pandemic how concerned
amplified or any priorities now the
forefront of consumer requests yeah it's
amazing how much things have changed
actually since the beginning of the year
and when you look at the polling results
for the beginning of the year what you
saw was that consumers were primarily
concerned with the cost that they were
paying out-of-pocket the cost of drugs
for example surprise medical bills those
01:09
kinds of unanticipated costs in
particular were of concern to consumers
now the priorities have shifted
completely consumers are concerned about
job loss they're concerned about the
recession they're concerned about
coverage so with that shift coming into
the election coverage becomes incredibly
important and part of it is is just this
feeling of wanting stability part of it
really is just the the reality that so
many Americans have have lost their jobs
so in addition to the crisis itself
01:41
coverage has really emerged at the
forefront for the next election what
implications has the Penn Democrat on
state budgets and may continue to have
on health care cost as a year progressed
yeah
so this is this is also a very important
point so one of the things that has
happened is that there has been a
dramatic increase in the number of
people eligible for Medicaid and again
this really stems very directly from
from job loss as well as from employers
deciding that they can't
02:12
afford to to continue to offer health
insurance which is another reason why
people sometimes end up on on Medicaid
so there are millions of new new
Medicaid enrollees in some states
actually there are millions of new
Medicaid enrollees and so the Medicaid
rolls are swelling and what this does is
it really stresses state budget it's you
know states unlike the federal
government actually have to balance
their budgets every year and so they
will tend to look to health plans to
help them square that out so there's a
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lot of growth in in Medicaid managed
care and there's a lot of growth that
that you know ultimately will enable the
states to to better address the needs of
their population and that's really kind
of the goal in an election year there's
a flurry of new ideas and proposals
being generated by Republicans and
Democrats to address health care
coverage he discussed some growing
trends to observe and how government
presence has grown and mentor yeah well
first I think for starters there's
03:16
there's bipartisan agreement that health
plans offer predictability and stability
in government programs and one thing
that I find really remarkable is how
much they're the the in the Medicare
program and the Medicaid program the
presence of managed care has grown you
know I worked in the Clinton White House
and when I was running on be health we
had about seven percent of Medicare
beneficiaries enrolling in Medicare
Advantage now it's over thirty five
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percent and by our estimates it'll
continue to grow double digits over the
next few years and and it has been
growing double digits really in the
first quarter as you can see from the
earnings reports from from a lot of the
larger companies and what this means is
that by the Year 2024 which is a scant
four years away it's likely that managed
care is going to be the dominant form of
Medicare Medicaid also managed care is
growing really rapidly so that's a place
where frankly I think that there's
04:19
there's a fair amount of agreement then
you know with new going forward into the
election
first we have we're gonna have a
relatively centrist debate here and what
I mean by that is with Bernie Sanders
out of the race and with Joe Biden
appropriately focused on the economy and
kovat 19 and many other kind of really
front burner issues for the American
public we're not going to be having a
debate about Medicare for all in this
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election it's just not going to happen
so it's really going to be about
centrist approaches to increasing the
amount of in this country and that's
really where I think frankly you know
from my perspective I think that's a
productive discussion and if we can
drive towards full coverage in this
country that will have been you know a a
really significant accomplishment over
the next four years can you discuss the
growing influence of telehealth amid the
pandemic and are any services seeing
increased usage yeah telehealth has been
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an incredible bright spot here and you
know it's it's been it's been years
since the tools and the methods of
telehealth have been available to plans
and to providers and this this pandemic
I think was kind of the kick in the
pants that we all needed to bring
telehealth into the mainstream patients
prefer it it's it's broadly applicable
in a lot of situations it it uses less
gas
you know it's environmentally beneficial
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and I think you know from from really
all accounts it's going well you know
that that if you have video and audio
you can have a meaningful interaction
with a patient and in many cases address
their needs now it's not a panacea there
are many things you can you can't touch
a patient through through a video and
then that's something that and then you
know in addition we're not configured to
have vital signs read accurately through
telehealth at this point so there's
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there's a ways to go but the thing that
is going to change and the durable
change will come out of this is that
telehealth is coming into the mainstream
the government is going to have to pay
for it so you know tell
help is covered right now by managed
care plans generally and has been for
for some time the federal government has
given a fair amount of latitude to do
that and now it's being covered in fee
for service now going forward the the
Medicare program particularly is going
to have to figure out better ways to
06:58
understand what is being delivered to
make sure that that fraud does not occur
in billing relative to tell how and
ultimately that that that the federal
government is paying an appropriate
amount for these telehealth business it
is definitely the case that it's less
expensive to to to see a patient
virtually than it is to see a patient in
the office and you know again our tax
dollars should not be paying you know
the full cost of a visit if the cost of
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a visit is now actually coming down so I
think that these are that these are
issues and will be addressed over the
coming years they'll be active policy
debates that will happen but but
telehealth is definitely not going away
in the managed care pipeline can you
discuss some projections for healthcare
and changes precipitated bykova 19 in
the next decade
yeah so telehealth you know this is kind
of first among equals which we just
discussed but then there are many other
ways in which code 19 is going to change
08:02
plans kind of on a going-forward basis I
think you know first is just growth in
enrollment because as the recession has
come in polling of beneficiaries says
that they care really deeply about
predictability of expense and plans
offer that and fee-for-service does not
and so that's something where I think
that that that growth will be kind of a
lasting and durable effect generally I
think it's fair to say that during koba
08:32
19 in addition to trying to deliver care
remotely one of the other things that
that has happened is that state
licensure rules have loosened up a bit
in many cases to allow medical
professionals to to be practicing at the
top of their licenses so for
you don't need in most states have
relaxed the rule that you needed to have
a respiratory tech to adjust a
respirator and that's something that can
09:03
be done by by a capable clinician that
is not a respiratory attack and so some
of those protective rules if you will I
think are being pulled down which is
which is productive nurse is able to
prescribe is another another one there's
no reason why nurses should not be able
to prescribe and if a patient has
obvious signs of a respiratory infection
that that patient shouldn't be able to
get immediate antibiotic through a
television so it's just a much less
expensive and frankly less germ
09:34
intensive way of practicing medicine
that I think really will be will be with
us for a long time then I'd say lastly
that Copa 19 will accelerate the shift
to pay for value you know because
because a lot of hospitals have we have
a hospital consulting practice and a lot
of the hospitals are coming to us and
saying you know if there's one thing
that I've learned in this crisis it's
that the fee-for-service model is not
serving us in the long term and that we
10:05
really need to move towards more of a
value-based model so I think that that
koban 19 will in a lot of ways
accelerate the interest and engagement
from providers in pursuing value-based
models