How Health Plans Can Help Members Get the Care They Need in the COVID Environment


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Today’s environment is complicated to say the least. Consumers wrestle with staggering obstacles such as COVID safety concerns and record-breaking unemployment that leave households searching for guidance – especially in their healthcare journey. In his latest thought-piece published by Managed Healthcare ExecutiveAccessOne CEO Mark Spinner points to recent report that found majority of consumers are delaying non-emergency but medically necessary healthcare due to costs. Interestingly, households with high-income are more likely to delay care. Seventy-five percent of those with an income of $100,000 or greater are concerned they will lose their job due to the pandemic. 

Consumers face these unprecedented financial barriers with little access to assistance. However, health plans can help navigate this complex environment for their members. Spinner details four strategies all health plans should implement at their organization:  

Educate members on a new IRS rule that covers lifesaving healthcare products and services 

In 2019, the IRS expanded the “preventative services” rule that now allows consumers enrolled in a high-deductible health plan to pay for life-saving healthcare services and products with their health savings account.  To help educate members of this new rule, craft targeted messaging based on age group and use various channels to ensure policyholders with chronic conditions are aware of this rule and its benefits.

Run claims analyses to spot members who have not filled prescriptions for chronic disease 

When members do not fill their prescriptions, especially for those with chronic conditions, it leads to higher hospitalizations and greater healthcare costs. Unfortunately, it’s a common practice with one in three consumers skipping a prescription one or more times because of the expense. To help counter this effect, utilize claim data analysis to discover behaviors that point to unfilled prescriptions. From there, care managers can contact these policyholders, determine the right solution for the member, and overall help lower costs. 

Assist policyholders in finding lower-cost options for care 

Due to the complex nature of our healthcare system, consumers need help improving their health literacy which could lead to significantly lower administrative costs. Incorporating health literacy programs by incentivizing members to complete brief education courses is one channel that can prove to be effective. Additionally, consider implementing digital tools designed to help patients find lower-cost options for care quickly. 

Work with healthcare organizations to ensure members have multiple options for medical bill payment 

Encourage providers to help address financial barriers by improving price transparency and offering affordable payment options including zero-interest and low-interest payment plans. According to our 2019 survey report, 54% of consumers would use a low-interest or zero-interest financing option for a medical balance of $1,000 or less. With 64% of families saying they are very or somewhat concerned about their ability to pay for medical care following the pandemic, affordable payment plan options will be imperative.  

To learn more about how health plans can help consumers feel confident when pursuing their care, read the full article here: Getting Members the Care They Need—Despite COVID Cost Concerns  

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