Getting Members the Care They Need—Despite COVID Cost Concerns


Before COVID-19, half of families with employer-sponsored insurance delayed care or avoided filling a prescription. Recent data shows consumers face barriers to care.

Even before COVID-19, half of families with employer-sponsored insurance delayed care or avoided filling a prescription due to cost concerns. Now, with record levels of unemployment and the nation facing a recession, recent data shows consumers need help overcoming financial barriers to medically necessary care.

An AccessOne survey conducted in early April shows 58% of consumers would consider delaying a non-emergency but medically necessary surgery this year due to cost, while 56% said they would delay a diagnostic procedure due to the expense.

Perhaps most striking: high-income earners were more likely to say they would delay surgeries and diagnostic procedures than those with lower incomes. That’s because 75% of consumers in the $100K+ income bracket are concerned they will lose their jobs due to the pandemic.

Mark Spinner

Mark Spinner

These are sobering statistics. It is clear that assisting members in overcoming financial barriers to care is vital to ensuring they will pursue recommended treatment. Such an approach improves members’ ability to maintain their health while reducing healthcare complications. It also helps contain costs—for members and health plans—over the long term.

How can health plans help members navigate healthcare cost concerns? Here are four strategies to consider:

Educate members on a new IRS rule that covers lifesaving healthcare products and services. The IRS released a rule that expands the definition of “preventive services” to include products, services, and prescription medications used to treat chronic disease. The rule enables members to pay for these expenses through their health savings accounts (HSAs). Formerly, HSAs could not be used to treat preexisting conditions.

However, because the rule is so new, members will need guidance around what the rule means and how they can apply it to their out-of-pocket costs for chronic conditions. Health plans should provide targeted marketing by age group and across multiple channels to ensure policyholders with chronic conditions are aware of the change and are able to receive the services they need. One generation health plans should be sure to target: Millennials, whose rate of chronic conditions is higher than that of Generation X when they were the same age.

Run claims analyses to spot members who have not filled prescriptions for chronic disease. One in three consumers has skipped refilling a prescription one or more times due to cost, a recent survey found. Meanwhile, 18% have had to choose between filling a prescription or being able to afford food or housing. When members with chronic conditions put off filling their prescriptions because they cannot afford their copay, this results in hospitalizations, readmissions, and increased costs. Use claims data analysis to spot instances where at-risk members demonstrate challenges refilling their prescriptions. Then, assign care managers to contact these members to determine the root cause and find a solution. It’s an approach that helps policyholders with chronic conditions access the medications they need while lowering their costs of care.

Health plans also are testing risk contracts with pharmaceutical companies to ensure members with chronic conditions not only receive their medications, but also demonstrate improved outcomes from taking prescription drugs. These health plans use data to target vulnerable populations and put in place social supports to ensure members get the medications they need. When the medications don’t achieve the desired outcomes, the pharmaceutical companies pay rebates to the health plans.

Assist policyholders in finding lower-cost options for care. One analysis found health plans could save billions by helping members navigate today’s highly complex healthcare system. This strategy significantly reduces calls to customer service and other administrative costs. Options to consider include the following:

  • Implement health literacy initiatives—especially among those with high-deductible plans. Health illiteracy doesn’t just affect those who have limited schooling. The analysis found 48% of consumers with low health literacy are college-educated, reflecting the complexity of the nation’s healthcare system. Consider targeted education for policyholders with high deductibles, whether through the health plan app or a short online webinar—and offer incentives for completing the education, such as a $25 gift card for taking a half-hour session.
  • Use digital tools to help members identify lower-cost options for care. Incorporate simple tools within your health insurance app that help members quickly determine their out-of-pocket costs for specific types of care and point them to high-value providers. Design the approach so that consumers can identify options quickly and make a decision within seconds.

Work with healthcare organizations to ensure members have multiple options for medical bill payment. The AccessOne survey shows 64% of families with children are very or somewhat concerned about their ability to pay for medical care following COVID-19. When providers don’t adopt flexible payment options, consumers feel the burden in multiple ways. According to the survey results, 46% of high-income earners plan to delay non-emergency but medically necessary surgery by up to six months, and 43% would hold off on undergoing a diagnostic procedure. Among other income brackets, about one in three consumers plan to delay care for up to six months.

At a time when cost pressures and income uncertainty have intensified, it’s critical that health plans help members navigate their costs of care. Work with providers to increase price transparency, knowing that the most meaningful price transparency is an estimate of the out-of-pocket costs members will pay after insurance. Encourage providers to offer multiple options for members to settle their accounts, including zero-interest and low-interest payment plans. A 2019 survey found 54% of consumers would use a low-interest or zero-interest financing option for a medical balance of $1,000 or less, and 46% would rely on financing for higher balances.

Taking these steps ensures members who fear they will be unable to pay for medically necessary care following COVID-19 get the care they need when they need it—improving health outcomes while reducing costs of care.

Mark Spinner is CEO and president of AccessOne, a leading provider of flexible, co-branded patient financing solutions that help patients afford medical expenses for health systems nationwide.

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