Before the coronavirus disease 2019 (COVID-19) pandemic, the health care industry was largely headed toward a value-based system that was shifting to focus on social determinants of health, according to Bruce Japsen, health care contributing writer at Forbes, during the General Session at the Pharmacy Quality Alliance (PQA) 2020 Annual Meeting.

During the current COVID-19 pandemic, these prior efforts are now being put to the test. The companies who made investments in areas such as telehealth, home delivery, and other quality initiatives before the pandemic are now reaping the rewards of this infrastructure already being in place at the time of the outbreak. Some of these companies are also making efforts to ensure these resources continue to be available to those who have lost their job, and thus potentially their medical insurance, as a result of the pandemic.

In this way, the key resources being tapped in regard to establishing a value-based system and focusing on social determinants of health prior to COVID-19 are being validated as necessary components of the health care industry moving forward.

These resources will continue to be necessary, as the Kaiser Family Foundation estimates that 20 million people who have lost their job and lost their coverage will be eligible for coverage under the Affordable Care Act (ACA) through Medicaid or marketplace tax credit. A value-based system that examines social determinants of health will be critical in order to support these individuals at a time of great need, with the system being thoroughly tested in the process, according to Japsen.

With these shifts and trends, many health care companies are also fearful of the economic impact to come, especially in regard to a potential lag in the effects of COVID-19, explained Laura Cranston, RPh, CEO, PQA.

However, a lot of publicly traded health insurance companies are financially quite strong coming out of the first quarter. Now, they are working to stay ahead of the potential economic effects of COVID-19 in the near future.

“The key is going to be the differences out there. Whether people are furloughed and keeping their benefits, losing their job and going to COBRA, or checking out the healthcare.gov website to see what they’re eligible for, there are some key differences in what people will need. So, to prepare for this, a lot of the health insurance companies are already starting to shift to make sure they’re covered themselves by introducing new benefit offerings and benefit packages,” Japsen said.

An example of this can be seen in the current efforts of the insurance company UnitedHealthcare, according to Japsen. UnitedHealthcare got out of the individual coverage business following the ACA and were among the major health insurance companies to do so. Now, following the COVID-19 pandemic, they are already discussing getting back into that market.

“They have a big small group business, and small employers and other employers are dropping their coverage. The insurance companies don’t want to lose that business. So, you’re going to see health insurance companies that might lose on one end, try to make it up on the other because they want to keep that business. It’s in their best interest to not just let people lose their coverage,” Japsen said.

Japsen explained that because of this, providers and pharmacists will need to pay close attention this summer to existing contracts with health insurance companies. These contracts may be changing due to new offerings and benefit packages that the insurance companies will want to provide.

“The policy makers and Congress are realizing that this pandemic has triggered depression-era job loss. So, the private sector and the government sector are wanting to make sure that people get access to care, with co-pays and deductibles not getting in the way of that,” Japsen said. “There are hurdles that are being broken down both in the private sector and the government sector to make sure that people are able to get access to care they need.”

REFERENCE
Cranston L, Japsen B, McNabb B. General Session: The Business Impact of COVID-19. Presented at PQA 2020 Annual Meeting, May 13, 2020.