Don Hall

Don Hall, a former health plan CEO, is principal, Delta Sigma LLC, in Littleton, Colo.

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As we all now know, SARS-CoV-2is an extremely communicable, novel virus with the potential for death and long-term disability that’s spread through respiratory droplets. Wearing suitably protective masks and social distancing are critical to stopping its spread. Yet a significant number of Americans refuse to wear a mask, guaranteeing the pandemic will rage on.

For managed healthcare executives, the lack of mask wearing isn’t surprising because they know how difficult it is to engage people with their own health and well-being. Those of us who work in healthcare sometimes lose track of the fact that health and healthcare are on a long list of concerns that people have: personal finances, housing, work, children, aging parents and even food — people live complicated lives. There are also those who cope with health problems by denying them.

But for health plans, getting people to care about — and be involved in — their healthcare is critical to their improved health outcomes. And for high-risk members, engagement can be a lifesaver, literally.

lndeed, care and disease management programs are a core competency critical to a health plan’s success, starting with health risk appraisals, and then identifying high-risk members and engaging them in appropriate care-focused activities.

If we’re fortunate, a COVID-19 vaccine will become available fairly soon. Still, healthcare executives must view this disease as a long-term issue. Many of them have knowledge and experience with managed care techniques that could be helpful as the pandemic drags on, such as:

Stratification methodologies for member risk levels based on demographics, social determinants of health and health status.

Engagement strategies that improve compliance with current guidelines from the CDC and include information on staying safe, early identification of symptoms, and minimizing the risk of transmission.

Home care services for members with chronic conditions or COVID-19 to keep them away from hospitals, clinics and long-term care facilities where transmission could be especially harmful.

Guidelines for mask usage and distribution of free reusable masks with easy-to-understand instructions on their use and cleaning.

Public health messaging about the seriousness of COVID-19 and reinforcing the steps necessary to reduce exposure and
transmission.

COVID-19 is now woven into the fabric of our lives, yet the consequences are unpredictable. Managed care organizations can help by stepping up and bringing to bear the expertise they have in dealing with members with chronic illness and applying it to COVID-19 care.

Hope resides in the short- and medium-term responses to the epidemic, especially in the progress being made toward the development ofa vaccine. Clinicians and researchers are also making headway in the treatment of the disease. But there’s a long haul ahead, and for that we’ll need planning, implementation of those plans, an abiding sense of purpose — and each other.

Don Hall, M.P.H., and Sherry Rohlfing are principals of DeltaSigma, LLC, a consulting firm that specializes in strategic problem solving for managed care organizations.

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Principals of DeltaSigma, LLC , Don Hall, M.P.H., and Sherry Rohlfing provide Managed  Healthcare Executive an opinion piece on how managed care organizations can address COVID-19 transmission.

Opinion: 5 Ways MCOs Can Address COVID-19 Transmission

Not since the H1N1 virus pandemic of 1918-1919 (Spanish flu) have healthcare providers and institutions faced a crisis as massive and uncharted as the COVID-19 pandemic. Beyond the widespread healthcare implications, it also has disrupted our financial security, our workplaces, and virtually every aspect of our lives, including how we interact with each other. The sense that we are only at the beginning of the pandemic with no clear answer as to when or how it resolves, coupled with the lack of clear information or management at the federal level, only exacerbates an already frightening situation.

It is not an understatement to say that we are close to a panic situation throughout the country.

Health plans-which were nonexistent during the Spanish flu pandemic-can and should play an enormous role in their communities as we confront the COVID-19 fears and challenges facing members, providers, and the soon-to-be overwhelmed public and non-profit resources.

There has never been a more important time for healthcare executives to step up and play a major role in guiding their communities through this crisis using every resource at their disposal to provide timely, accurate information and access to testing and care.

Five Things You Should Know About COVID-19 Today

To accomplish this, we recommend establishing an internal COVID-19 management team that communicates daily with an objective of managing the flow of information, ensuring access to medications and providers, and portraying a sense of calm and control through the crisis.

In this time of crisis, health plans should be a trusted source of Information. Err on the side of providing too much information rather than too little. Remember to use plain language and avoid acronyms. Use feedback from your staff, including but not limited to, customer and provider services, and include details that will answer the questions posed by your members and providers.

Here is some of the information that health plans should be providing: 

When and how to wash hands. Consider providing videos to make the recommended details clear.

Symptoms of COVID-19 and the differences from a cold, flu, or seasonal allergies.

How to wipe down an area with disinfectant and how often.

What you should do if you have a COVID-19 diagnosis.

Social distancing (including what it means) and recommendations on what to do if you leave your home.

How to help at-risk individuals prepare and stay safe.

Links to CDC and local provider recommendations.

It is also important to serve as a resource for local media and to collaborate with local and national agencies to provide up-to-date information about guidelines and access to supportive resources.

Health plans should also be working to ease access to care. Here are some the steps that they can take:

Waive cost-sharing for COVID-19 testing and any treatment offered by providers.

Provide access to virtual provider visits with no copay or cost sharing.

Increase access to home or mail order delivery of prescription drugs.

Allow early refill of medications for chronic conditions.

Collaborate with local pharmacies and retailers to provide COVID-19 care kits that include OTC meds, thermometer, sanitary wipes, and instructions on managing the illness.

Adapt your organization to the changing environment

It is likely that many organizations will become largely virtual (at least in the short-term) with the bulk of employees working from home, often with dependent children and other distractions. This will create a challenging environment for assuring high level organizational performance. Expect productivity to drop.

Your team will need help to make working from home productive and successful. Here are some ingredients of successful WFH arrangements:

• Tele- and video-conferencing capabilities
	• Ability to log-in to workspaces or VPN for email and projects
	• Regular management communications
	• Telephone and computer access
	• Guidelines on expectation for work product
	• Information on impacts to payroll, training, travel, and PTO
	• Regular updates on schedule and “return to normal”

We’re in unknown territory here, and events seem to be moving at the speed of light.

Health plans are at the front lines and need to be positioned to deal with the information vacuum and provide access to critical testing and affordable care.

Don Hall, MPH and Sherry Rohlfing are principals of DeltaSigma, a consulting firm that specializes in strategic problem solving for managed care organizations. 

Author | Don Hall

Articles

Opinion: 5 Ways MCOs Can Address COVID-19 Transmission

How Health Plans Should Be Responding to COVID-19