Getting Back to Care

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A group of 11 payers, providers, and healthcare organizations recently launched an ad campaign to encourage patients to stop “medical distancing” and seek care.

“We are seeing a troubling pattern that people are avoiding medical visits in fear of contracting COVID-19,” Humana’s Chief Medical Officer of Humana, William Shrank, M.D. said in a statement. “While we understand the fears that many people have around contracting the virus, our country’s medical facilities have adopted CDC guidelines and best practices and even telemedicine options to make your visit as safe as possible to prevent the spread of the virus. The intent of the campaign is to let people know that protecting yourself against getting this virus does not need to come at the expense of your overall health.”

Getting back to care is critical for everyone

As our nation worked to flatten the curve, states were required to halt surgical and elective procedures to ensure they had the capacity and enough PPE to treat a possible surge COVID-19 patients, as well as taking necessary precautions not to spread the virus.

A report from Health Affairs found that in-person patient visits were down 69% in March and April. And, the CDC reported that emergency room visits dropped more than 40% in April. A recent study showed that pediatricians, pulmonologists, and various surgical specialties saw the most significant decline in visits, with pediatricians seeing the most substantial gap with visits 34% below pre-pandemic levels. Cancer screenings reduced by 94%, and medical imaging decreased by 50% compared to the past three-year average.

While more states begin lifting these bans, providers are struggling to recoup their losses from the spring, while working in a new normal.

Researchers have projected loss of nearly $68,000 in fee-for-service revenue per physician for 2020 and estimated $15 billion losses to primary care practices across the country over the calendar year. Furthermore, the American Hospital Association’s June survey of 1,360 hospitals in 48 different states found 67% of respondents do not foresee their health system returning to baseline volumes by the end of 2020, and 30% reported the timeframe was unknown. Based on their findings, The American Hospital Association estimates hospitals and health systems will lose at least $323.1 billion in 2020.

Providers are encouraging patients to get back to care. While visit numbers have started to rebound, they remain significantly lower from pre-pandemic levels as patients are reluctant to return to a healthcare setting.

While decreased patient volumes translate directly to a loss in revenue for providers, this trend will also harm patient care. Without seeking preventative care, testing, and delaying vaccines, patients could miss a critical diagnosis or life-saving treatment, leading to higher costs and worse overall health outcomes in the long term.


How are health plans are adapting, responding, and addressing changes during the COVID-19 pandemic?

Download the issue brief to learn how HealthEdge customers addressing business needs, adjusting their budgets, and ensuring providers get paid while simultaneously keeping their organizations running smoothly in a new work environment.





Hospitals, providers, and health systems are taking measures to support consumer confidence

For providers to begin to return to normal volumes, patients must feel safe and comfortable visiting a health care setting.

Providers across the country have invested in new safety protocols and training, including enhanced sanitizing and infection control procedures. Tasks as simple as scheduling appointments must be strategic, so waiting rooms can adhere to social distancing guidelines. Now, more than ever, providers must focus on adapting to patient needs and improving patient satisfaction.

In an interview with Becker’s Hospital Review, Cleveland Clinic CIO Matthew Kull said, “Embracing change is going to be critical for everyone. The same old way of doing things is probably not going to be the path forward. The adoption of digital technologies across healthcare accelerated four or five years as a result of COVID, and we’re not going back…we have to look at normal in a way that is going to help us reach more patients the way they are going to want to be connected with.”

How health plans are supporting getting back to care

Specifically, payers have the power to make a significant difference in what the future looks like for the healthcare industry. Providers, payers, and other healthcare organizations must work together to ensure this “new normal” puts patients’ needs first.

Before the pandemic, healthcare was reluctant to change care models. There now has been a willingness to embrace technology across the healthcare ecosystem, providing patients and providers with a hybrid of telehealth and physical visits, with multiple options to deliver and receive quality, convenient care.

Insurers require flexibility to design benefit offerings that meet their members’ needs, support their providers, and remain compliant with shifting government regulations.

With HealthRules® Payor, health plans can design and implement any benefit plan or provider contract in less time and at a lower cost than typically required with other systems. The ability to successfully embrace change gives HealthEdge customers a competitive advantage.  HealthEdge offers unparalleled flexibility that allows our customers to effectively respond, maintain business continuity, innovate, improve their offerings, and help everyone get back to care for the benefit of their members and providers.

Interested in learning more about HealthEdge? Contact Janet Barros to schedule a 15-minute introductory call and discuss your business opportunities and challenges.

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