More Women Avoided Care

health-blogThe Kaiser Family Foundation reports that more women than men failed to receive preventive care during the pandemic. Statistics show that 38% of women skipped their annual checkup compared to 26% of men and nearly one in four women failed to get a recommended medical test or treatment versus only 15% of men. Income did not appear to be a big factor, leading consultants to believe that fear of exposure to Covid-19 and the inability to access medical facilities were big contributing factors.

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What the Pandemic Has Taught Us

pandemicWhether you’re a TPA, broker, employer, plan member or healthcare provider, the past year has been unlike any other. While adapting has often been difficult, some of the lessons learned can have a positive impact on employee healthcare in the future. Here are a few to consider as you begin your planning for the coming year.

Open Enrollment

According to the IFEBP, 1 in 5 companies handled open enrollment differently in 2020, with many using virtual benefit events. Virtual benefits meetings can be viewed by members from any location at any time. In addition, members can easily share their benefits information with a spouse or family member, something that cannot be done with traditional in-person events. Many used short video introductions and important details were typically made available on secure online employee portals following the virtual event. Offering a dedicated email address, phone line or online chat option can make it easy for members to ask questions.

Telemedicine

Think for a moment that Cleveland Clinic delivered 1.2 million virtual physician visits in 2020, compared to just 37,000 in 2019. Even after resuming in-person appointments, 30% to 40% of all visits at Stanford Health Care are virtual and while physicians and patients say there is certainly room for improvement, nearly 3 of 4 patients say they are likely to choose a video consult over in-person in the future. While many physicians say they would prefer to use telehealth visits to manage chronic diseases, many cite low or no reimbursement and technology challenges on the part of their patients as the biggest obstacles to its continued use.

Health Benefit Value

One challenge that remains even as the threat of Covid-19 lessens is the rising costs facing employer-sponsored health plans. Research from the Kaiser Family Foundation and The Hartford show a decline in the perceived value of health benefits by plan sponsors and members. These trends can only change as personal service improves and the barriers standing in the way of healthcare cost transparency are overcome.

As an independent TPA, we place the needs of your health plan and members first by providing personalized service and striving to eliminate costly conflicts of interest that have plagued our healthcare system.

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Paying for Vaccinations

paying-vaccinationsFor the time being, the federal government is picking up the cost of the vaccine, with providers being able to charge an administration fee for actually giving the shot. Regulations require that insured and self-funded group health plans must cover the cost of the office visit associated with the vaccine as long as the primary purpose of the visit is to receive the vaccine. And regardless of whether the vaccine is provided in-network or out-of-network, there must be no cost sharing involved.

Plan documents must be modified to reflect the availability of COVID-19 vaccinations and the change must be communicated to plan participants. In the case of self-funded plans, ERISA disclosure rules allow 210 days following the end of the previous plan year for the plan sponsor to issue this notification. With all the questions surrounding COVID-19 vaccines, it is recommended that employers be proactive in letting participants know that vaccinations will be covered.

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Do You Have a Vaccine Strategy?

vaccineThroughout the past year, organizations large and small have taken many steps to protect their workers. While those that could have people work remotely likely did, others provided PPE and modified workspaces to achieve social distancing. As states continue to loosen their restrictions and more and more people become eligible to receive a Covid-19 vaccine, employers that intend to bring people back to the workplace are working to determine how best to proceed. While very few seem to be requiring that workers get vaccinated, many employers are providing incentives to those who do.

Employees are Looking for Guidance

For employers that place a high priority on wellness, deciding how to proceed with vaccinations is critical. Employees look to their employer for meaningful health benefits and are likely expecting guidance in this area as well. Some HR directors have responded with information about the safety of available vaccines. Because people consume information differently, companies are using many forms of media to encourage vaccinations. Whether you use emails, webinars or videos featuring co-workers, persistence is paramount. One announcement won’t do the job – it will take a consistent campaign to overcome the skepticism that still exists. If you want to reinforce communication with an incentive, you might consider time off to get the shot, gift cards or several extra hours of pay.

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Making Your Hotel Stay Safer

shiny hotel sign with starsBusiness and pleasure travel came to a serious halt in 2020, but industry representatives say bookings for later in 2021 are soaring. If you’re considering a hotel stay, a few questions suggested by the Infectious Diseases Society of America may be worth asking. For example…

  • Ask about current occupancy levels and limits the hotel or resort may have imposed.
  • What Covid-specific policies has the hotel or resort put in place?
  • Are face masks and social distancing measures required and enforced?
  • Are there limits on the number of guests allowed in the lobby and other public spaces?
  • How often are employees tested for the virus?

Finally, you may want to ask if the hotel’s HVAC system has hospital-quality filters and how long the hotel keeps a room empty between guest stays. Doing so for at least 24 hours is recommended as a way to clear the air of any aerosol transmissions. Other small measures to look for include sealed water glasses and strapped toilet seats in your room as well as self-parking, automated check-in and check-out, no-touch elevators and easily accessible staircases.

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The Value of Medication Adherence

Encouraging members and their dependents to take their prescriptions as directed by their doctor or pharmacist has long been a concern for health plans. As the Covid-19 pandemic continues to spike in most parts of the country, the problem has intensified, with experts estimating that the increased cost to our healthcare system may be nearly $300 billion annually.

Traditional challenges of rising costs and a failure to read and understand health information have been exacerbated by the fear of in-person doctor visits. Overcoming these issues requires increased communication and support because there is no doubt that when people fail to take their medications as prescribed, health plans often end up dealing with higher claim costs down the road.

A Higher Level of Support

Providing a high level of support can help many members avoid serious medical
complications in the future. Collaborating with a PBM or member advocate to send a
text message when a refill is due can be a big help. Some plans offer a lower copay as an
incentive to fill prescriptions on time.

Taking the time to understand a member’s needs and concerns can go a long way in
increasing medication adherence. While concerns about using generic alternatives,
copay assistance programs and transportation are common, addressing language barriers,
disabilities and other social factors are measures that can make a big difference.
Providing a higher level of support will not only produce higher quality outcomes, but
lower pharmacy benefit costs as well.

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Technology and Diabetes Care

diabetesAs COVID-19 has made medical office visits challenging, CDC has recommended digital diabetes care supported by connected continuous glucose monitoring (CGM) systems. According to CDC, when remote monitoring is combined with proper medication adherence and personalized coaching, employees with diabetes are able to receive the constant, long-term oversight needed to maintain a higher quality lifestyle.

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Regulating Off-Duty Conduct

When you consider that laws governing travel and social distancing vary from state to state, with a couple having no such laws at all, determining how your organization will regulate and discipline off-duty conduct is very challenging. And when an employee travels to another state that has different laws, which take precedence? Some experts have compared this debate to employer’s efforts to regulate employee use of social media, but it seems that how you regulate social media activity is much different than carrying out your responsibility to keep employees and working conditions safe during a public health emergency.

Given the fact that states have established their own guidelines, an example of an employee who traveled out of state to participate in a large public gathering can present a big challenge. While one employer might decide to quarantine the employee upon return because the gathering violates laws where the person lives and works, another might prefer to act in accordance with a less restrictive law that exists in the state where the gathering took place. Given the complexity of the COVID-19 pandemic, many will likely look beyond the laws and act in a manner consistent with their duty to keep their workplace safe for all employees.

One thing most employers and attorneys seem to agree on is that like so many employment issues, determining an appropriate course of action in matters such as these often comes down to whether or not your organization has a policy in place and how that policy has been communicated to employees.

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Approving a Vaccine

vaccineGuidance recently released by the FDA outlining conditions for approving a Covid-19 vaccine includes a 50 percent benchmark, meaning that any vaccine must be at least 50 percent more effective than a placebo in preventing the disease. This is the same benchmark used annually to approve flu vaccines. In the announcement, Commissioner Stephen Hahn told a Senate panel that the FDA would not approve a vaccine for the general public without clinical evidence that it is both safe and effective.

In accordance with established FDA guidelines, an emergency authorization can move much quicker than a typical full approval, but would still require the vaccine maker to show through clinical studies that the vaccine produced lower levels of disease. Several clinical studies are underway, with one manufacturer having just initiated clinical testing by 60,000 adults.

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Should You Be Doing More About Mental Health?

woman at deskThere is little doubt that the COVID-19 pandemic has taken a toll on the mental well-being of many Americans. In addition to dealing with fear of the virus and social isolation, economic pressures have continued to grow. Many who have continued to work have been forced to balance working remotely with caring for children who would normally be in school.

A survey by telemedicine giant Teladoc recently showed that nearly half of American workers say their mental health has been negatively impacted. The more disturbing statistic is that only 27% say their employers are taking steps to provide help.

What Others are Doing

While larger employers have long made employee assistance programs available to those in need, the expansion of telemedicine has enabled employers of all sizes to provide access to behavioral health professionals. These appointments traditionally were held by phone, but many are now conducted by video using computers or smart phones.

As the pandemic has continued, onsite employers’ clinics have shown a significant increase in mental health and stress-related cases. Some health systems have placed mental health providers inside workplaces to provide quicker access to treatment. For more information or to strengthen your health plan in this critical area, contact your account representative today. systems have placed mental health providers inside workplaces to provide quicker access to treatment. For more information or to strengthen your health plan in this critical area, contact your account representative today.

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