CLINICAL EFFECTIVENESS & HIGH COST DRUGS AND COVID-19 FRAUD AND COVID-19 ‘Unprecedented’. That seems to be the description being most widely used to describe the times we’re living in, but more than enough has been written about that over the past few weeks. At iFHP we’re interested in how the Federation’s member companies are adapting to the crisis, what business strategies have been deployed to manage the risk, and what are the exit strategies that are being put in place when things finally start to return to normal – whatever the new ‘normal’ will be.
How are our members coping with the COVID-19 crisis? iFHP hosted three online expert panels over the past few days to allow members to share strategies, test thinking and learn from one another’s experiences. Two featured members of the Clinical Effectiveness and High Cost Drugs panel, and the third was the Fraud panel. Here are the main discussion points:
- The rise of virtual care – although hardly a new idea, many providers from a wide range of modalities (including physical therapies such as physio or chiropractic care) are turning to virtual consults to provide care for patients. Where insurers are broadly supportive of the shift and some have produced guidelines for providers, many are wary of doubling-up on consult fees where a virtual consult triages a physical visit. Some are also seeing high unit costs or volumes from one or two providers. This is a developing area for payers and providers and is rightly under scrutiny, though the move to virtual is likely to outlast this particular crisis.
- Claims are down – as elective surgeries are postponed and private hospitals lend beds or are requisitioned to provide care for COVID-19 patients, claims are down for every member organisation we spoke to. Some are returning premiums to members. Others are having to establish work-arounds to cope with the loss of offshore processing. However, everyone expects a bounce-back due to “pent-up demand” when lockdowns lift, with many insurers modelling the likely severity.
- Premiums on hold – across the world insurers are doing what they can to help customers as they face financial hardship. In Australia, premium increases have been postponed. ‘Premium-holidays’ are widely available as are policy suspensions. Where discounts are being considered most payers believe customers will be expecting more than can be offered.
- New opportunities for leakage – spikes in psychiatric claims, customer demand for COVID-19 testing (though at least in the UK “no private tests exist right now”) and new virtual health practices all have special investigations teams on increased alert. Given sensitivities, however, some are “going easy” on providers, particularly in mental health, though data is being gathered and interventions made. At least one insurer is wary of customers gaming annual limits if restrictions mean they can’t be used. Others are allowing them to be “rolled-over”.
- Testing times – how competently nations are responding to the COVID-19 crisis is viewed as one of the largest determinants of the outcome on insurers. Testing and vaccination programmes at scale are being prepared, however there is little experience with this virus. Will insurers have a role to play here? For many the answer is “not typically,” but these are unusual times and may demand further extraordinary measures.
- Exit strategies are unclear – how insurers exit this crisis and which of the changes stay with us is the predominant discussion at members’ top tables. Most believe their business continuity plans “have held up well”, however uncertainty around when lockdowns will be lifted and what behaviours and practices will extend beyond, or even survive the crisis as “the new business as usual” are not known. Some members are expecting to emerge from the crisis “smaller” as insured populations shrink. De-risking the exit from the crisis is top of the list for the next round of discussions of the panels.
One constant in all of this is iFHP’s global network which remains at the disposal of members. We will continue to proactively create opportunities for CEOs and other senior managers to share and discuss data, insights and strategies across an array of COVID-19 related topics. We will also be shortly rolling out a membership-wide survey to assess the impact of COVID-19 on members’ collective businesses.
Please note though, if there is anything we can do to help, if any connections can be made or if any insights can be uncovered more efficiently together, just reach out to any member of the iFHP team.
Chris Watney (CEO designate)
International Federation of Health Plans