Council Foundation Logo Leaders Edge
Health + Benefits Resources

This resource library is evolving and will be updated as content arises. Please check back for more soon!

  • Cost and Coverage

    6/9/20 | COVID-19 Tests Are For The Most Part Affordable
    Labs charging thousands of dollars for coronavirus diagnostic tests are the exception rather than the rule, according to data provided to Axios by a national health insurer. In-network labs, constituting 89% of the 63,378 claims, charged on average $163.91 per test. But the insurer actually paid a negotiated rate of $51.31 for each test, which is the price Medicare pays. Out-of-network labs that had posted their cash price charged on average $124.96 (244% of Medicare) per test, and made up 9% of claims. For claims above 200% of the Medicare price, the insurer attempted to negotiate the price.

    Calls For A Unique Patient Identifier Intensify As Coronavirus Reveals Gaps in Care Coordination
    Support for unique patient identifiers (UPI)–the numbers, codes or data that differentiate one person from another–has grown throughout the country largely due to the COVID-19 pandemic. Since the onset of the public health crisis, patient information like testing results has not being transmitted effectively across care sites. Congress has historically decided against appropriating the funds necessary to HHS to create a UPI, despite research that shows over 250,000 people in the U.S. die each year from medical mistakes, some of which are a result of incorrect patient data. The U.S. is currently the only industrialized nation in the world without a unique patient identifier.

    6/3/20 | Trump’s Drug Pricing Blueprint Kickstarts with Insulin Pricing
    The Trump administration brokered agreements with 88 insurance companies representing 1,750 Medicare prescription drug plans to curb the cost of insulin to $35 a month. The rule materialized as a way to allow certain Medicare drug plans offering additional cover to beneficiaries to receive full 70% discounts paid by insulin manufacturers. While the Trump administration has touted the new Medicare model as a win-win for patients and the healthcare industry in how it will bring some financial relief, experts argue that it won’t change actual prices. Medicare chief Seema Verma also acknowledged that beneficiaries and taxpayers will experience higher premiums. Insulin has been a politically charged medication because people have lost their lives struggling to ration the drug due to cost. This rule appeared to kick-start Trump’s drug pricing blueprint which promised to cap drug prices but has remained largely stagnant.

    A Public Option May Not Boost Number of Uninsured Americans
    A study by RAND indicates that while a public option could lower health insurance premiums, it would not substantially raise the number of uninsured. In four different scenarios introduced a public options for individual coverage nationwide, researchers found that premiums for public plans could fall between 10-27% lower than private insurance plans mostly because of lower provider rates. However, it did not impact the number of people with insurance. In addition, for many subsidized individuals, the introduction of a public option would not reduce out-of-pocket premiums. A potential solution according to the authors of the study would be to reinvest savings from a public option into programs benefiting lower-income people, such as providing them a larger tax credit when they buy individual health insurance.

    It’s Still Too Early To See The Financial Impact of COVID-19
    Health insurance premium requests are beginning to trickle in from states with early filing deadlines, but the potential impacts are still unknown. Early signs indicate that more plans will be offered on the exchanges created by the ACA than last year. Other variables are the ultimate cost of a vaccine, the unemployment rate—which would shift individuals away from the commercial market—and how quickly medical visits will resume.

    5/26/20 | COVID-19 Will Reduce Healthcare Spending in the U.S. For Now
    This year, the U.S. was on track to spend $4 trillion on healthcare, spurred by continuously rising prices. But recent reports estimate health spending could come in below that projection. Routine care that’s been postponed costs the system more than caring for those impacted by the global health crisis.

    5/19/20 | Consumer Study Reports Majority Don’t Feel Confident in Health Insurer
    A study  of close to 32,000 commercial health plan members indicated that consumers don’t feel confident in their health insurers. A quarter of those surveyed view their health plan as a “trusted partner in their health and wellness” and 60% say their health plan hasn’t contacted them with guidance or information related to the coronavirus.

    5/13/20 | Life Insurers Turn Away Business Amid COVID-19
    U.S. insurers are turning away business from some Americans who want a life insurance policy due to a slump in interest rates tied to the coronavirus and an expectation from insurers that rates won’t rebound significantly in the near future. Life insurers are suspending sales on some products, raising prices and scaling back policy sizes. For example, Penn Mutual Life Insurance Co., among others, has temporarily halted life insurance sales to people 70 and older and who are unhealthy. The move demonstrates the strain the healthcare sector faces in providing cover during a global health crisis.

    5/8/20 | UHG To Offer $1.5 Billion is Discounts to Fully Insured Members
    UnitedHealth Group will offer fully-insured employers and individuals about $1.5 billion of discounts as well as between 5-20% in premium credits. The insurer said it would also waive cost sharing, such as copayments, for specialist and primary-care doctor visits by people enrolled in its Medicare Advantage plans, through at least the end of September.

    5/4/20 | Dems Want To Expand Medicare, Inching Closer to Medicare for All
    30 House Democrats, led by Pramila Jayapal (D-Wash.) and Joe Kennedy (D-Mass.), introduced a bill to extend Medicare coverage to those set to lose their health insurance due to COVID-19. The architects of the bill view it as a more moderate version of Medicare for All. It will also extend Medicaid eligibility to 300% of the federal poverty level and prohibit insurers from charging out-of-pocket costs for care related to the coronavirus.

    With Largely Unaffected Balance Sheets, Insurers Step In To Assist Hospitals
    A handful of health insurers across the country are using their improved balance sheets to help struggling providers to navigate the financial turmoil of the COVID-19 pandemic. Blue Shield of California set aside $200 million to act as a guarantor on loans for providers, is working to transition certain fee-based providers to fixed monthly payments to ensure a steadier stream of income, and is underwriting some patients’ financial obligations to improve cash flow. On the east coast, CareFirst BlueCross BlueShield offered up $110 million to provide interest-free financial support to hospitals and independent providers. And, UnitedHealth Group has accelerated about $2 billion of payments to help alleviate pressure on doctors and hospitals.

    1 in 3 Americans Report Delaying Medical Care Due to Financial Stress

    Around one in three Americans reported delaying medical care due to the financial stress caused by COVID-19, according to a study by the Urban Institute. Thirty one percent of those surveyed said they have avoided medical care, or were unable to pay rent, mortgage or utility bills.

    4/27/20 | Almost Half of All Physicians Offer Telemedicine Services
    Close to half of all physicians (48%) are treating patients through telemedicine, up from 18% in 2018, and nearly 300 U.S. vendors offer virtual care services. One in three physician services are eligible for reimbursement via telehealth based on existing and temporary federal payment policies put in place due to the COVID-19 pandemic. For certain specialties, 90% or more of Medicare payments are eligible for reimbursement via telehealth.

    Amazon Inches Closer to Insurance Offering
    Amazon recently sent a survey  to each of its 900,000 sellers asking about their current health insurance coverage and interest in alternatives, suggesting that Amazon is considering launching a health insurance product aimed at its sellers.

    4/24/20 | Coronavirus Calls Medicare’s Solvency Into Question
    Medicare’s solvency may be in question as the pandemic could deplete the program’s reserves faster than initially projected. In a high-cost environment, the Medicare Hospital Insurance Trust Fund—which pays for Part A inpatient hospital expenses—could run out by 2023, a full three years before the originally calculated 2026.

    4/22/20 | What Will Going Back To Work Look Like?
    Jumbo employers like Amazon and General Motors are exploring how to test workers for COVID-19 before the come into work in an effort to transition employees back to the workplace. While states and the federal government have ideas about how to do that, employers will ultimately decide when and how to reopen their businesses, saddling them with difficult questions and unprecedented challenges.

    Individual Insurance Market Won’t Feel As Much Financial Burden As Initially Projected
    Initially concerned about the amount of at-risk individuals (with chronic conditions) covered in the individual insurance market, actual COVID-19 treatment costs for the individual market could be as much as $3.37 billion less than anticipated. That market will experience the economic impact of coronavirus in three major ways, though, including through increased healthcare spending, shifts in healthcare service utilization, and a recession—which could prompt an influx of new enrollees who previously had group health insurance.

    4/20/20 | Private Insurers Could Pay $2.7 Billion in Rebates to Consumers
    A new analysis estimates that private insurance companies expect to pay a record of $2.7 billion in rebates to consumers this fall due to excessive premiums in recent years. Most of that money, about $2 billion, will be paid out to individual market consumers, with $348 million in payments for the small group market and $341 million in the large group market. Rebates for the individual market will be paid out to more than 4.7 million people, equaling about $420 per person. In the small group market, rebates would be $1,850 per member, while in the large group market they would total $110 per member, according to the report. The rebates are nearly double last year’s then-record $1.3 billion total and are a result of the ACA’s medical loss ratio provision.

    4/17/20 | The Economic Benefits of Social Distancing
    A study  from the University of Wyoming found that the economic benefits of social distancing outweigh the COVID-19 pandemic’s hit to U.S. GDP while also saving more than a million lives. The analysis used an epidemiological model to project the spread of the coronavirus and the monetary value the federal government assigns to a person’s life — $10 million. It found that the economic benefits of lives saved outweigh the value of the projected losses of GDP by about $5.2 trillion, and that the economic consequences of not practicing social distancing during the pandemic would be much worse.

    4/15/20 | Insurers and Employers Could Face More Than $200 Billion in COVID-19 Costs 
    Health insurance companies and employers are lobbying Congress for financial help, warning that COVID-19 treatment and testing may lead to large premium increases next year. Companies are asking Congress to fund a program in future COVID-19 bills that would help insurers and other employers with the high cost of claims associated with the pandemic. One analysis estimates insurers and employers could face $34 billion to $251 billion in costs related to COVID-19 testing, treatment and care.

    Despite Feeling the Financial Strain, Insurers Pledge to Keep Rates Static for 2021

    83% of health insurers plan to keep their rates static for 2021, while 17% of health insurers plan to raise rates to a maximum of 5%, according to a study by eHealth, a private online health insurance marketplace based in Santa Clara, Calif. eHealth received responses from 33 health insurance companies between March 30 and April 2. In addition to not raising premiums or at least not increasing them too high, 97% of respondents also said they were waiving out-of-pocket costs for COVID-19 tests. The other 6% said they would allow its members to defer premium payments. In terms of treatment, 58% said it will cover out-of-pocket costs.

    4/14/20  | Health Insurer COVID-19 Costs
    America’s Health Insurance Plans (AHIP) recently released survey results that estimated insurer costs could fall anywhere between $56 and $556 billion over the next two years. Many health insurers responded to COVID-19 by pledging free testing and waiving cost-sharing for treatment and hospitalizations. The Trump administration also announced that it will require health insurers to provide free antibody tests that could provide better insight into the scale of the coronavirus outbreak. In addition, insurers have pledged loans and advance payments to cover healthcare costs to providers. For example, Blue Shield of California said it would provide up to $200 million in loans and advance payments to cover anticipated healthcare costs.

    4/7/20  |  Where Employees Might Go When They Lose Their Employer-Sponsored Coverage
    Up to 35 million Americans could lose their employer-sponsored health insurance as companies shed jobs, according to a Health Management Associates projection. That could lead to a surge in Medicaid with as many as 23 million new enrollees (65% of the 35 million who face losing their employer-sponsored coverage), testing the program and tilting provider reimbursement toward government programs and away from the more lucrative private insurance.

    4/6/20  |  What the Future Holds for Self-Insured Employers
    While the majority of health insurers have waived cost-sharing requirements related to treatment of COVID-19 for their Medicare and fully-insured members, the guidelines for self-funded groups are less clear. A Mercer survey of 650 self-insured employers revealed that one third are likely to waive cost sharing, while less than one fourth said they were unlikely to waive it. What the self-insured population will have to consider: the costs associated with waiving member cost-sharing (there most likely wouldn’t be much increased financial exposure), how to cover mental health treatments, and in and out-of-network claims costs.

    4/1/20  |  Voya to Credit Members in Defined Contribution Plans for Costs Related to COVID-19
    Beginning April 1 through September 30, 2020, Voya will credit back to participants in its defined contribution plans fees associated with coronavirus-related distributions allowed under the CARES Act, hardship distribution fees and loan initiation fees.

    Health Care Service Corporation Launches Special Enrollment Period for Some Employers
    For the month of April, HCSC will offer a special open enrollment period for its fully-insured group customers who did not opt in for coverage during the regular enrollment period.

    3/31/20  |  The Standard Defers Rate Increases for Small Business Customers
    Standard Insurance Company announced that it will hold benefit plan rates stable for all groups up to 500 employees with renewal dates of May, June and July 2020.

    3/27/20  |  COVID-19 could Prompt Higher 2021 Insurance Premiums
    A new report released by experts at California’s ACA marketplace, Covered California, projects that the cost of COVID-19 testing and treatment could lead to higher premiums for the commercially insured in 2021. The report estimates testing costs at $8.4 billion for 40 million commercially insured people tested, and treatment costs at about $95 billion for 8 million people who test positive for COVID-19. The report estimates that insurers and employers could face up to $103 billion of coronavirus-related expenses in 2020, prompting insurers to increase premiums by anywhere from 4 – 40% in 2021 to recoup those losses.

    ACA Coverage Could Swell in Response to Coronavirus
    The ACA is likely to provide coverage for more people than ever due to the coronavirus. But there are limits to the ACA—it doesn’t protect patients from treatment costs when they occur outside their insurance network even though it does cap out-of-pocket spending for in-network services. S&P Global Ratings predict that out-of-pocket costs could top $16 billion under a severe coronavirus outbreak.

    3/26/20  |  First Estimates Peg Health Insurer Costs Between $140 and $560 Billion
    One health study released cost estimates predicting that health insurers could pay anywhere from $139 billion to $558 billion for care related to COVID-19. Total charges could reach $1.4 trillion, depending on how many people get sick and the severity of the infection. The findings are based on historical charges from influenza and pneumonia as well as estimates from public health experts on how much of the U.S. population is expected to be hospitalized from the virus.

    3/23/20  |  Health Insurers are Now Offering Support for Providers
    While pledging to alleviate cost-sharing responsibilities for much of its membership, some health insurers are now offering tools to support the provider community. United Healthcare, Cigna and Aetna are offering telehealth services at no cost for members, which has been one of the primary ways patients can simultaneously practice social distancing while seeking care. UHC has launched a home-based care management tool, further emphasizing the home as the center of care. Insurers are also working to enhance digital patient navigation capabilities. For example, Blue Shield of CA introduced a digital tool that hospitals can embed in their websites to assist patients in educating themselves about COVID-19 and the symptoms. The moves prioritize virtual care coordination between patients, care providers and insurance companies.

    3/20/20  |  The Impact of COVID-19 on Captives
    Captive insurers will likely feel short and long-term effects from the outbreak of coronavirus.

    • Companies who write medical stop-loss into their captives may experiences individual or aggregate losses. Those writing long-term care contracts—like Medicare and Medicaid—and covering at-risk individuals have a greater risk of exposure, especially if a large number of covered individuals need to be hospitalized. If the spread of the virus isn’t contained, there could be an impact of the cost of reinsurance and the ability of those captives to absorb any medical stop-loss costs.
    • Allegations could also surface about improper screening and treatment methods, which could lead to professional liability issues.

    Focusing on the Cost of Coronavirus Care for Employer-Sponsored Coverage
    The cost of healthcare was already a major pain point for Americans before the COVID-19 outbreak. Now, with the risk of a recession and an increased strain on the healthcare industry, we’re about to see the current care delivery system pushed to the brink. While most medical carriers have waived costs related to COVID-19 testing on fully-insured plans, there’s still the possibility that individuals could need in-patient hospital care to mitigate symptoms. One study examined claims from 18 million people enrolled in employer plans in 2018, and found that for individuals with private insurance who become seriously ill and need to be hospitalized as a result of the coronavirus, their out-of-pocket costs could surpass $1,300. Besides deductibles, plans could also charge copays and coinsurance.

    What to keep in mind:

    • The timing of this pandemic. Because it’s early in the calendar year, people most likely haven’t spent enough to satisfy their deductibles. 82% of workers with private insurance have a deductible and the average deductible is $1,396.
    • Surprise medical bills. Vice President Pence announced, on behalf of the largest health insurers, that patients would not receive surprise medical bills if they received care outside of their networks. America’s Health Insurance Plans (AHIP) clarified that the major health insurers will cover treatment for COVID-19 as they would any infectious disease. While most private health plans will likely cover services needed to treat COVID-19, there is not a specific federal requirement to do so.
    • Some experts believe that health insurers will raise premiums next year depending on the impact to their medical loss ratios. Costs relating to the seasonal flu are baked into premiums, reflecting insurers’ decisions to waive the costs of flu shots is because it’s easier to limit the spread of the virus and it costs less than hospitalizing a member for influenza.
    • What about self-insured plans? States are unable to regulate self-funded plans, which cover almost 60% of employees in the private sector. While some insurers are allowing employers to opt in or out of their policies to waive cost-sharing for coronavirus testing, this is not mandated across the board, leaving a gray area of negotiation between insurers and self-insured employers.

    Health Insurance Providers Respond to COVID-19 (AHIP)
    A breakdown of how most major medical carriers are covering tests and treatments related to the coronavirus. Different carriers are operating with varying degrees of flexibility in terms of what’s covered.

    What’s the same? What’s different?
    • Carriers are covering out-of-pocket costs for COVID-19 testing-related visits.
    • Carriers are prioritizing telemedicine.
    • Some carriers are encouraging the use of telemedicine by waiving copays and others directing patients based on their level of risk of developing more severe symptoms as a result of COVID-19.
    • Some carriers are allowing for early refills on prescription medicines, enabling members to receive an extra 30 or 90-day supply. Others are outlining their ability to be flexible with formularies and waive costs if there are shortages or access issues for patients if they need to obtain a non-preferred medication. Others are not offering early refills and opting to guarantee members that their medications will be delivered.
    • Some major medical carriers specify that self-insured employers can opt in or out of efforts to eliminate copays and other costs associated with diagnostic testing of COVID-19, telemedicine access, and early prescription drug refills.
  • Healthcare Delivery System

    5/28/20 | Hospitals Could Turn to M&A to Mitigate Financial Blow of COVID-19
    Hospitals struggling from COVID-19’s financial blow might pursue consolidation to regain their balance, but financial pain will need to be serious to have any chance of offsetting competition concerns, according to the FTC. Critics argue that hospital mergers have historically had an adverse effect, leading to substandard care and higher costs.

    5/7/20 | Cleveland Clinic Develops Remote Patient Monitoring Tool
    The Cleveland Clinic developed an Electronic Health Record (EHR)-based remote patient monitoring tool for COVID-19 patients with chronic conditions. The daily symptom questionnaire allows patients to track their conditions online, and alerts their doctors if symptoms worsen. The tool transitions chronic care to the virtual space, paving the way for telemedicine to influence the practice of preventive medicine post-coronavirus.

    4/24/20 | First At-Home COVID-19 Testing Approved By the FDA
    The FDA approved  the first COVID-19 test that allows people to collect their own sample at home, a new approach that could help expand testing options in most states. The test from LabCorp will initially only be available to healthcare workers and first responders. Each kit will cost $119. The kits will not be available in Maryland, New Jersey, New York and Rhode Island, as those states have laws prohibiting testing with at-home sample collection kits, according to LabCorp.

    CMS Calls On Quality Programs To Combat COVID-19
    The CMS is encouraging clinicians who participate in the Quality Payment Program, such as physicians, physician assistants, nurse practitioners, and others, to contribute to scientific research and evidence to fight the COVID-19 pandemic, signaling that the Trump administration wants to use value-based healthcare as a way to combat the virus. The suggestion comes after CMS temporarily eased quality reporting requirements for those participating in quality reporting programs after they expressed concern about whether they could meet certain quality standards as a result of the coronavirus.

    4/22/20 | The Impact To The Healthcare Workforce
    A recent study predicts that over one million “non-essential” healthcare workers will lose their jobs this month, making this the worst month for the healthcare sector in at least three decades, according to the Department of Labor. Much of the financial strain on hospitals comes from the fact that most coronavirus inpatients are elderly and lower income who are on either Medicaid, Medicare or are uninsured. Medicare pays about 40% of what private insurers do, leaving hospitals to cope with surging demand and potential under-compensation for care.

    What COVID-19 Is Doing To Mental Health
    Close to half (45%) of U.S. adults say that worry and stress related to the coronavirus pandemic are hurting their mental health, signaling that the health and economic crises is likely to increase mental health problems and further stretch the system’s capacity. This research brief explores the impact of social distancing, business and school closures along with other protective measures on those living with or at risk for mental illness and substance abuse. Another study  says unemployment will lead to a 20% drop in life satisfaction around the globe. Plus, each percentage point increase tied to unemployment will eventually lead to a 3.5% increase in opioid addiction.

    4/20/20 | What Will It Take For Hospitals To Perform Elective Surgeries Again?
    The CMS released guidelines for hospitals to restart elective surgeries while maintaining their ability to treat COVID-19 patients. Elective surgeries are typically hospitals’ biggest profit centers. Health systems will have to implement phased plans to reopen, much like state governments, as they begin to look past the peak of the pandemic.

    4/15/20 | Physician Practices Feel Financial Strain of COVID-19
    Physician practices are facing a 25% reduction in visits across the country and as much as an 80% reduction in epicenters like New York. Vulnerable to the financial strains of the COVID pandemic, physicians are turning to small business loans and enhanced telehealth visits to provide needed revenue, though for some telehealth is a completely new service. The American College of Physicians outlined steps insurance companies could take to help support physician practices facing financial strain, including expanded telehealth coverage and greater credentialing flexibilities.

    Medicare’s Value-Based Payment Models Are In Jeopardy
    A recent survey of risk-based Accountable Care Organizations (ACOs) found 56% are likely to leave the cost-saving Medicare program due to concerns about having to repay losses stemming from the COVID-19 outbreak. The reason for the departures is that COVID-19 “has upended normal utilization and care patterns, disrupting ACOs’ ability to employ successful population-health strategies and causing tremendous uncertainty about costs.” Almost 20% of Medicare beneficiaries and nearly 500,000 clinicians practice in an ACO this year making the Shared Savings Program the largest value-based payment model in Medicare.

    Social Determinants of Health Take Center Stage
    The health system, Centene, announced a series of investments to address the social determinants of health for vulnerable populations during the COVID-19 crisis. The investments include: 1) Donating 1 million meals a month for 12 months in partnership with Feeding America’s network of food banks; 2) expediting the rollout of FirstNet that will streamline access to affordable, high-speed wireless broadband services for primary care providers in rural and underserved communities; and 3) purchasing 50,000 gift cards, each with a value of $35, for use on essential items.

    4/7/20  |  CMS Waives Rules On Telemedicine Access, Allowing Providers to Connect with Patients by Phone
    CMS will begin to offer access to telemedicine visits by phone only to its 140 million members it covers. According to Pew Research, nearly 35 million Americans do not use the internet, rendering low income Americans unable to take advantage of telemedicine. This temporary regulatory waiver calls into question how states and private health insurers will choose to cover telehealth once the waiver is no longer in effect.

    4/6/20 | Blue Shield of California Offers Financial Support to Healthcare Providers in Response to COVID-19 Crisis
    Blue Shield of California is working with financial service partners to provide up to $200 million in direct support to healthcare providers and hospitals through financing guarantees, advance payments and restructuring of contracts. This cash infusion will support health professionals dealing with the pressures of the coronavirus pandemic.

    4/2/20  |  Care Delivery Moves Across Specialties and State Lines
    A GOP senator introduced a bill that would grant legal immunity for healthcare providers treating patients outside their specialties for the duration of the national health emergency. Hospitals have already started to redeploy specialists to the frontlines of the fight against COVID-19. And federal officials announced that they would allow healthcare providers to practice across state lines. The relaxed guidelines will temporarily redefine how providers deliver care and bring up questions on coverage, the future of care delivery, and the level of exposure providers may experience if they deliver care outside of the traditional boundaries.

    4/1/20  |  Government and Industry Shift Care Delivery Away from Hospitals
    CMS launched the “hospitals without walls” program, granting hospitals new flexibilities to combat the novel coronavirus. Hospitals can now transfer patients to ambulatory surgery centers, inpatient rehabilitation hospitals, hotels, and other outside facilities, while still receiving hospitals payments under Medicare. Besides regulatory flexibility, the insurer community is also transitioning sites of care outside the hospital setting. Blue Cross Blue Shield of Oklahoma is delivering services to the homes of its members to prevent overcrowding in emergency rooms. Amplified by COVID-19, government and insurer efforts reflect the growing trend to shift sites of care delivery away from the hospital.

    3/30/20  |  J&J Partners with the Administration in their Quest for a COVID-19 Vaccine
    Johnson & Johnson has signed a $1 billion deal with the U.S. Department of Health and Human Services with the goal of creating more than one billion doses of a vaccine it’s developing against the novel coronavirus.

    COVID-19 Will Accelerate the Use of Virtual Medicine
    Over the next few years, uses of virtual health could generate an economic value of approximately $10 billion annually across the U.S. healthcare system. One of the reasons is because the home is becoming the most important real estate in healthcare. Technological advancements, like wearables and motion sensors, give patients a way of assessing their health without stepping foot in a doctor’s office. What’s the catch? People want answers to their health problems, but not many consumers want the responsibility of treating themselves at home.

    3/23/20  |  Defining Quality of Care during Coronavirus
    The Center for Medicare and Medicaid Services (CMS) announced it will be easing reporting requirements for the over one million clinicians participating in its Quality Payment Program for the time being. Those participating raised concerns over accountability penalties and the potential of not sharing in performance-based savings this year because of COVID-19. CMS acknowledged that data collected during this time may not reflect the “true level of performance on measures such as cost, readmissions and patient experience during this time of emergency.” The relaxation in reporting requirements attempts to provide some relief to the struggling U.S. healthcare system, but it also calls into question how providers define quality of care and if that may change moving forward.

    Expanding Telemedicine During a Global Pandemic
    Telemedicine is being deployed as a first line of defense against the spread of COVID-19. To “flatten the curve,” multiple major medical carriers are waiving costs and copays related to virtual care in an effort to promote care coordination and protect individuals who are at a greater risk for developing severe symptoms as a result of the virus.

    What to watch: if and how the telemedicine providers launch online COVID-19 clinics to triage and treat patients across the country, and if this reshapes care delivery in general moving forward.

    To learn more about best practices around telehealth as well as federal, state and local legislative activity to provide access to telemedicine, take a look at the American Telemedicine Association’s upcoming free webinar series and other tools and resources.

    A Snapshot of the Healthcare Delivery System
    Caring for a surge of COVID-19 patients could push the U.S. healthcare system to the brink.


    • The U.S. has almost one million (924,000) hospital beds—less than three beds per 1,000 people.
    • When it comes to care delivery, hospital capacity ranges depending on the community where it’s located. One Harvard simulation revealed that if half of all currently occupied hospital beds were emptied—combined with a large portion of the American population being infected—the U.S. would need at least three times more beds to care for individuals than it has right now. In addition, lack of supplies and medical staff will exacerbate existing weaknesses in the system.
    • More than 105 million adults in the U.S. are at a higher risk of developing a serious illness as a result of COVID-19 based on their age (over 60) or pre-existing health condition.

    Cost and Coverage

    • Of those who are at a greater risk of serious illness, almost 6% (5.7 million) are uninsured. In addition, an estimated 1.3 million people are enrolled in short-term policies this year. Those plans are not required to abide by federal coverage standards, so the newly passed coronavirus package—offering free COVID-19 testing—does not necessarily apply to them.
    • Both self-insured and insured group health plans (which cover an estimated 181 million individuals) must comply with the coverage requirements laid out in the second COVID-19 relief bill, meaning free testing for the virus.
    • Many large hospitals have asserted that they survive financially by collecting commercial insurance rates. This global pandemic is threatening that model.
    • Cost-sharing is already largely unaffordable for many in private health plans (Half of workers who receive health insurance through their jobs reported that they pushed off or forewent care because of the cost). That puts pressure on the system from the coverage and delivery sides when it comes to costs.

    Check out this interactive model made by Penn to see how the number of confirmed COVID-19 cases in a region impacts hospital capacity, including number of ICU cases, ventilators, the length of hospital stay, and how social distancing affects all of those factors.

  • Healthcare Technology & Data

    6/9/20 | Virtual Care Could Digitize $250 Billion In Healthcare Spending
    Up to $250 billion in healthcare spending could be digitized, according to McKinsey & Company. That’s roughly 20% of all estimated Medicare, Medicaid and commercial outpatient, office and home health spending for 2020. McKinsey’s claims-based analysis suggests 20% of emergency room visits could be avoided via virtual urgent care, 24% of office visits and outpatient volume could be done virtually and another 9% could be done “near-virtually.” McKinsey researchers think telemedicine utilization will persist for the next 12 to 18 months at least, until a vaccine is widely available.

    6/5/20 | Insurtechs Offer Back to the Workplace Solutions
    Via Dave Kerrigan at BenefitPitch , a software tool aggregating tech-focused solutions for benefits executives: Child care and family support, COVID testing, payroll, business continuity planning, onsite nursing, and other insurance-fueled technologies rolled out tools and resources to help transition employees back to the workplace. Here’s a snapshot:

    • Family care support: Wellthy, a caregiving concierge service, offers support for families navigating the healthcare system and working parents transitioning back to the workplace, including personalized childcare navigation.
    • COVID-19 testing: UDoTest, a B2B at-home health screening software platform, provides testing for the workplace. TouchCare, a health concierge service, is offering care navigation, virtual doctor’s visits and COVID-19 antibody testing.
    • Payroll: Rain—a financial wellness benefit—will offer free on demand/instant pay services and eliminate the transaction fees for employees during the month of June.
    • Business continuity planning: 2ndMD is a second opinion solution, connecting users with top specialists for educational consultations and care navigation support. It’s offering employers decision-making support as they transition back to the workplace, including in-office protocols, return to work guidelines and referrals to vetted on and off site screening services. o Onsite clinical services: Primary and preventive healthcare provider, CareHere, is facilitating the implementation of onsite health stations and nurses.

    6/3/20 | Apple and Google Unveil Contact Tracing App, Diving Deeper Into Public Health Arena
    Apple and Google teamed up to release technology to aid governments in tracking the spread of the coronavirus. Mobile device users are notified through an app that they have been exposed to someone COVID-19 positive. This exposure notification technology is unparalleled, with only select academic researchers and private companies having previously taken on the challenge. Both Apple and Google have leaped into the healthcare industry in multiple ways; this tech-fueled collaboration diversifies the companies’ efforts and brings them one step closer toward establishing a foundation in the public health arena.

    CVS Experiments With New Prescription Delivery Service: Self-Driving Cars
    CVS Health will try delivering prescriptions with self-driving vehicles in a test that begins in June. The drugstore chain will partner with Silicon Valley robotics company, Nuro, to deliver medicines and other products to customers near one Houston-area store. Customers will have to confirm their identity in order to unlock their delivery after the vehicle arrives.

    5/26/20 | Microsoft Unveils Interoperability Tool For Hospitals
    Microsoft is pioneering a cloud-based software designed to allow hospitals to keep healthcare data throughout all provider interactions with a patient. Creating a mechanism to follow patients over time throughout their entire healthcare experience provides the opportunity for better care coordination and enables patients to more easily share and access their own health information.

    5/11/20 | Amazon Moves Into Social Determinants of Health Space
    Amazon Web Services, NY insurer MetroPlus, AirNYC and Bain & Co. collaborated on a social determinants of health (SDOH)-focused project, building a chat bot that could reach particularly vulnerable MetroPlus members by text and direct them to social services. The NY insurer reached 54,000 members through its efforts. This cross-industry partnership highlights the role for multiple stakeholders in managing population health and is one of Amazon’s first attempts to jump into the healthcare space via SDOH.

    The Renewed Push For Health Data Interoperability
    Pew Charitable Trusts pushed Congress to tackle digital patient matching, arguing that contact tracing and vaccine administration efforts would be useless without having correct patient demographic data and the ability to share it.

    4/27/20 | Tech Giants Dive Into Provider Space
    Google’s sister company Verily Life Sciences is now offering COVID-19 screening tools that hospitals can add to their websites. Hospitals across the U.S. have been implementing different types of chatbots to provide users who visit their websites with information about COVID-19 or to triage patients with symptoms to the right site of care. The mechanism resembles a virtual care experience in the way that it directs patients to specific resources and types of care, a potential sign that tech giants want to move closer to developing a telemedicine product.

    4/24/20 | Google Unveils New Tech To Enable Health Data Interoperability
    Google announced the availability of new technology, Google Healthcare API, that is designed to make it easier for patients to access their own health information via third-party apps. Healthcare systems will soon have to comply with looming government mandates requiring them to make it easier for doctors and patients to share health information. Although the implementation of those rules has been delayed due to the coronavirus, health and technology officials argue that the virus has made it all the more apparent why health data interoperability is critical for coordinated care.

    4/20/20 | CDC To Launch New App
    The CDC is planning to launch a clinical reporting app for COVID-19, accelerating the adoption of interoperable electronic medical record systems (EMRs) to deliver data to public health agencies.

    Insurtechs Make Moves to Assist During Coronavirus Pandemic
    Via Dave Kerrigan at BenefitPitch, a software tool aggregating tech-focused solutions for benefits executives: HR-focused, mental health, prescription drug and other insurance-fueled technology solutions have ramped up efforts to support users during the coronavirus pandemic. Here’s a snapshot:

    • Mental health: Total Brain—an app-based platform that measures the 12 brain capacities defining mental health—is offering free three month corporate subscriptions of its mental health and wellness monitoring and support platform

    • Cancer care: Cancer Guardian, the flagship solution from Wamberg Genomic Advisors, created resources for cancer patients that helps educate them on the ways to say safe during this pandemic.

    • Population health management: Springbuk, a data analytics software, developed COVID-19 specific insights for at-risk populations

    • Financial wellness: Best Money Moves, a mobile-enabled financial wellness service, is offering three months free for new customers

    • Prescription drugs: Scripta, a PBM-agnostic pharmacy analytics firm, is offering the first 90 days free for new three-year contracts

    • Family care services: Torchlight, a child and elder caregiver support solution, is offering a free “caregiving in a time of crisis” toolkit

    4/15/20 | Google Partners with Major Health System to Build Patient Data Portal
    HCA Healthcare is partnering with Google Cloud to open up a COVID-19 data portal that pools hospital metrics on ICU beds, testing results, and patient visits. The National Response Portal will provide the information to healthcare providers, policymakers, and the general public as a “one-stop-shop” for all health data related to COVID-19.

    4/14/20 | Big Tech Creates COVID-19 Patient Tracking Tool
    Google and Apple teamed up to launch global phone-based contact tracing, enabling the U.S. government and those abroad to provide apps and other tools for users when they’ve crossed paths with individuals who have tested positive for COVID-19. The tech giants say they had user privacy in mind when designing the system, which combines geographic data with patient health data. The idea is supported by academic and former government officials as well. This paper advocates for a surveillance system to mitigate the impact of COVID-19 and future outbreaks on the economy.

    New Tech Support to Help Hospitals Go Digital
    The American Hospital Association (AHA) and AVIA launched “AHA Digital Pulse,” an online tool to help hospitals quickly roll out virtual capabilities to combat COVID-19. The tool contains a framework of 13 critical capabilities to show hospitals where they have gaps in digital capabilities and offers specific steps that can be taken now to prevent the spread of the virus, allocate resources, care for the sick, and protect clinicians. After an assessment, hospitals and health systems receive aggregated data-driven insights into how their organization compares to peers that are also responding to COVID-19.

    Health IT Heavy-Hitters Join Forces for COVID-19 Healthcare Coalition
    A new private-sector health IT collaborative, including the likes of EPIC, Microsoft, Amazon and Mayo Clinic, is crowdsourcing innovation to help healthcare organizations gain better data insights to combat COVID-19. The cross-industry initiative wants to speed up the development of data-sharing tools, betting that healthcare data is one of the keys to stopping the spread of the virus.

    The digital health industry joins the fight against COVID-19
    Almost $9 billion in funding was injected into the digital health space in 2019. It’s a booming industry built off of virtual connections, a practice the world is emphasizing right now to slow the spread of the virus. Learn where digital health can make a difference on Leader’s Edge.

  • Plan Design

    COVID-19 From The Actuarial Perspective
    Claros Analytics, an actuarial consulting firm and software solution, hosted a webinar unpacking the financial implications of COVID-19 for employers. It covers financial forecasting, short-term and long-term effects on plans design costs, and using data to create an early warning sign system. Claros predicts reduced claims and plan costs in the short-term.

  • Prescription Drugs

    5/4/20 | Drug Companies Struggle To Innovate Beyond COVID-19

    Some pharmaceutical companies are struggling  to continue clinical trials for products that will treat diseases other than COVID-19 as they brainstorm new ways to keep patients safely enrolled in trials while ensuring the results are still up to safety and efficacy standards needed for FDA approval. However, drug companies will likely see multiple revenue streams disrupted. While the R&D side of the industry faces unprecedented challenges, sales will also be impacted by a reduction in patient visits and prescription volumes.

    4/24/20 | Potential Price Hikes On The Horizon As Generic Drug Supply Chain Strained
    The Congressional Research Service has predicted that U.S. drug companies will continue to have trouble accessing the active pharmaceutical ingredients needed to make generic drugs, which could lead to price hikes, according to a recent report from Inside Health Policy. Nearly 90% of all prescriptions in the U.S. are generic drugs, emphasizing the need to ensure that the supply chain is adequate.

    4/20/20 | NIH Partners With Prescription Drug Companies to Hone COVID-19 Vaccine
    The National Institutes of Health plans to launch  a public-private partnership between federal researchers and 16 pharmaceutical companies, aimed at coordinating and accelerating the development of COVID-19 treatments and vaccines. The move brings together unlikely allies to provide researchers with the ability to easily share and access data to ensure different companies and researchers are judging potential medicines by the same criteria.

    The Race To Combat COVID-19
    There are currently 70 COVID-19 vaccines in development across the globe, with three of those candidates already being tested in human trials. Progress to develop a vaccine for COVID-19 is happening at unprecedented speed, with the pharmaceutical industry looking to decrease the drug development timeline from its standard 10 to 15 years, down to one year.

    Mental Health Medication Use Increases With Spread of COVID-19
    According to new research from Express Scripts, the number of prescriptions filled per week for antidepressant, anti-anxiety and anti-insomnia medications increased 21% between February 16 and March 15, peaking when the coronavirus was declared a pandemic. The greatest increase was in prescriptions for anti-anxiety medications, which rose 34.1% during that time. In addition, the number of prescriptions filled for antidepressants and sleep disorders increased 18.6% and 14.8%, respectively.

    The Role of Generic Drugs in the Fight Against COVID-19
    The former global head of intellectual property at Novartis wants to start a public benefit entity to repurpose generic drugs in the fight against the novel coronavirus. The plan is to collect research data, submit whatever looks promising to regulators, and permit existing generic manufacturers to add COVID-19 use to their labels under terms that would require affordable pricing. Generic drugs have already surfaced in conversations among lawmakers looking to propose solutions to ease supply chain reliance on China and other countries.

    The Frontrunners for a COVID-19 Treatment and Vaccine
    Over 100 drugs are in testing in the race to treat coronavirus. Experts predict it could take between 12-18 months before a vaccine is widely available. In comparison, it took five years to create an Ebola vaccine, which was considered a modern science miracle. It’s not uncommon for new vaccines to take 10 to 15 years to develop. It’s important to note that timeline of 12-18 months assumes the first few vaccines that enter the development phase will be successful. On average, only one in 10 experimental vaccines reach FDA approval status. The two frontrunners in the race to combat the novel coronavirus are Gilead and Moderna.

    Gilead: Currently conducting late-stage clinical studies evaluating remdesivir in treating COVID-19.

    What to watch: Almost immediately after filing for and being granted orphan drug status for its potential treatment, Gilead rescinded its request. The move brings into question the role of the government in creating access to new therapies and providing financial assistance. Separately, Gilead is a massive, well-established manufacturer that has maintained a pretty attractive dividend (approximately a 3.7% yield). Because it’s in a strong position financially, that could impact its chances of success.

    Moderna: Delivered the first COVID-19 vaccine into human volunteers during the week of March 16. It predicts making the vaccine available to healthcare workers as early as fall 2020.

    What to watch: The FDA would only have initial data on the vaccine’s safety and ability to produce antibodies to the virus, meaning there most likely wouldn’t be direct evidence it protected against COVID-19. In addition, Moderna is a small biotech who is competing with other major pharmaceutical companies that are several times larger. Nevertheless, the biotech is the only company who has made it to the trial phase with its potential vaccine.

  • Retirement

    401(k) Contributions Threatened by an Uncertain Economy amid COVID-19
    The economic crisis sparked by the coronavirus has damaged retirement account balances and prompted some employers to cut the contributions they make to employees’ 401(k) accounts. Amtrak, Marriott, and Macy’s are among the first in an expected wave of businesses suspending or reducing matching contributions to employees’ 401(k)s. The CEO of the American Retirement Association said his organization estimates, based on surveys of members who oversee retirement plans, that more than 200,000 retirement plans sponsored by small companies are at risk of being permanently terminated.

  • Return to Work

    5/28/20 | Employers Implement New Risk Mitigation Tactics as Employees Come Back to Work
    Large employers, like Ford and UnitedHealth Group, have begun implementing COVID-19 testing for asymptomatic employees in an effort to transition their workforce back to the workplace, but the logistics have proved challenging. Companies are unsure who to test and how often. Tests cost around $100 each and have raised concerns over employee privacy. Without a vaccine, traveling to and from work will remain a risky activity for most individuals, forcing employers to focus on mitigating new risks.

    5/26/20 | Silicon Valley Rethinks Returning to the Workplace
    Silicon Valley tech giants are implementing  temporary and in some cases permanent telecommuting policies. Twitter was the first company to announce that employees would have the choice never to come back to the office. Amazon extended its work from home policy through the fall, while Facebook and Google have extended it through the end of 2020. The moves bring to bear questions about the future of the workplace, the risks tied to that space (think: worker’s compensation) and the potential shift in the workforce demographic.

  • Surprise Billing

    6/3/20 | White House Renews Calls for Surprise Billing Fix
    The While House renewed calls to end surprise medical bills, suggesting a fix be folded into the next coronavirus rescue package that would outlaw healthcare providers from putting patients on the hook for exorbitant, unanticipated bills. The plan wouldn’t mandate how doctors and hospitals reconcile those costs with insurers, instead envisioning resolutions happening on a case-by-case basis. Without a consistent dispute resolution process, we will most likely see increased provider rates and premiums. Insurers and employers have raised concerns over a potential wave of lawsuits that could land in their laps without an easy way to handle billing disputes. Surprise billing was the sole item expected to have an easy political fix last year. So far, Congress hasn’t been able to resolve the standoff involving some of the most powerful groups in the industry because while everyone agrees patients shouldn’t be paying large bills, nobody else wants to be on the hook either.

    5/28/20 | Hospitals Refrain From Sending Patient Bills
    Hospitals around the U.S. reportedly have been afraid to send out thousands of bills related to COVID-19 testing because Congress mandated there would be no copays and no out-of-pocket costs for patients. Prominent health systems, such as NYU Langone Health and Cleveland Clinic, said they won’t bill patients any cost sharing for testing, even if that means they have to bear the cost. At Vanderbilt, the medical center has held back more than $6 million in billing since mid-March. The billing delay has created a bottle neck in potential surprise medical bills.

    4/22/20 | Surprise Billing Practices Disrupted For Good?
    The Department of Health & Human Services (HHS) included surprise billing language in its emergency funding terms and conditions that could disrupt the longtime practice of balance billing. Federal officials offering funding to hospitals, clinics and doctors’ practices have included this stipulation: They cannot surprise bill COVID-19 patients. But within eligibility language laid out by HHS is language that could carry much broader implications. It says “HHS broadly views every patient as a possible case of COVID-19,” the guidance states.

    3/20/20 | Surprise Billing During Coronavirus: Amid the development of a third government relief package, provisions to prohibit surprise medical billing and establish a drug price overhaul have resurfaced. Lawmakers remain split on both issues. A host of conservative groups cited COVID-19 as reason to reject a bipartisan surprise billing fix opting for a local benchmark rate setting approach, arguing in a letter to congressional leaders that it would only further strain the healthcare system.

  • Unemployment

    4/22/20 | What COVID-19 Is Doing To Mental Health
    Close to half (45%) of U.S. adults say that worry and stress related to the coronavirus pandemic are hurting their mental health, signaling that the health and economic crises is likely to increase mental health problems and further stretch the system’s capacity. This research brief explores the impact of social distancing, business and school closures along with other protective measures on those living with or at risk for mental illness and substance abuse. Another study  says unemployment will lead to a 20% drop in life satisfaction around the globe. Plus, each percentage point increase tied to unemployment will eventually lead to a 3.5% increase in opioid addiction.

    As Unemployment Rate Rises, Trump Administration Vows to Pay Hospitals for Uninsured
    Roughly 3.5 million Americans likely lost their health insurance just in the past two weeks, according to an analysis of state and federal data from the Economic Policy Institute. That’s over one-third of the people who have filed unemployment claims. A Phase 4 stimulus package could include COBRA subsidies to support furloughed or terminated employees keep their employer-sponsored coverage. Something to note: A portion of the $100 billion in federal funds earmarked to help hospitals cope with the virus will cover bills for the uninsured, Vice President Mike Pence said.

    3/25/20  |  Snapshot of Jumbo Employer Response to Unemployment Threat
    A recent survey of business owners revealed that almost a quarter (24%) plan to downsize if the outbreak worsens. In addition, The Labor Department reported 281,000 new claims for unemployment insurance between March 9-13, a one-third increase over the previous week that it attributed to COVID-19. Ed Hyman of Evercore ISI Group, a top economist on Wall Street, believes that U.S. unemployment claims could top a stunning three million.

    Many businesses will have to scale or shut down operations, but there are notable efforts from the jumbo employer space to financially stabilize their workforce, support small businesses and inject capital into the market. Here’s a snapshot:

    • CVS plans to hire 50,000 people to fill full-time, part-time, and temporary roles across the country. In addition, the company plans to issues bonuses of $150-$500 to pharmacists and others “on the frontlines” of their business.
    • Automatic Data Processing (ADP) is providing employees one-time payments (estimated at $51 million) in order to help with the unexpected hardships they are facing due to the COVID-19 pandemic.
    • Dollar General is implementing a hiring blitz, nearly doubling its normal hiring rate and adding up to 50,000 employees by the end of April to support its operations.
    • Amazon is temporarily raising its overtime pay for U.S. warehouse workers. Hourly workers will receive two times more for overtime pay as the company tries to meet the online demand for consumers stuck at home.  Jeff Bezos has also invited up to 100,000 laid-off workers to come work for Amazon until they are able to go back to the jobs they held.
    • Walmart announced that effective immediately through Memorial Day, it is temporarily raising minimum wages in e-commerce warehouses by $2 an hour as it struggles to keep store shelves stocked.  In addition, just last week, Target raised wages by $2 an hour until at least May 2 for its hourly workers.
    • PepsiCo plans to add staff and boost pay. The company also plans to provide benefits to its 90,000 U.S. frontline employees with a minimum increment of $100/week for full-time employees over the next month.  In addition, the company plans to hire 6,000 new, full-time, full-benefit frontline employees across the U.S. in the coming months.
    • JPMorgan Chase joins several other credit card issuers, including Citi, Apple, and American Express in offering assistance to card members who have become financially hurt by the coronavirus pandemic.  They all have agreed to waive fees, extend due dates for cards, auto loans and mortgages and/or increase credit lines for consumer and small business customers.  In addition, J.P. Morgan announced $1,000 bonus for its front line employees.
    • Bank of America in a bid to counter the surge in customer service demand due to concerns about the coronavirus outbreak is adding 1,700 workers to its consumer division in critical support roles. The bank is also paying an additional $200 per pay period to frontline workers in branches, call centers and operation centers, and enhanced overtime pay, effective immediately.  Also announced are several relief measures for small businesses and consumers, including deferred payments on credit cards, auto loans and mortgages, as well as refunds for checking account fees.