Opinion: Coming Together During a Pandemic

MHE Publication, MHE March 2021, Volume 31, Issue 3

An efficient healthcare system depends on strong relationships between health plans and providers. Much of what makes healthcare seamless for consumers happens behind the scenes as health plans, doctors and hospitals work together to improve access, quality and cost of care. Not since the introduction of the ACA has anything redefined these relationships as much as the COVID-19 pandemic.

Many health plans, including my employer, Independence Blue Cross in Philadelphia, have long prepared for — and then responded to — public health emergencies such as the SARS and Ebola viruses. However, as the cases soared during the first weeks of March, it was clear that the COVID-19 pandemic and the spread and danger of this new virus were unprecedented.

Health plans that already excelled at working side by side with their provider networks were in the best position to recognize and respond to the unforeseen challenges.

Before COVID-19 hospitalizations surged, many health plans anticipated making quick policy changes to give providers some relief. The changes included waiving cost sharing for testing and treatment, easing guidelines for patient transfers to make room for more patients with COVID-19, and lifting prior-authorization requirements for acute inpatient admissions from the emergency department.

At Independence, we developed a dedicated website and “COVID-19 primary care playbook,” which were updated once or twice a week. This information helped our population health specialists better support primary care doctors in a constantly changing environment.

When personal protective equipment was hard to get, some health plans jumped in to help. Independence purchased and dispensed nearly 500,000 masks to healthcare workers who care for patients in underserved areas in the Philadelphia area and 45,000 to Medicare Advantage members. Through its foundation, Independence supported several local nonprofits focused on helping underserved communities get access to COVID-19 testing.

One such organization, the Black Doctors COVID-19 Consortium, has tested more than 20,000 individuals in Philadelphia and is now administering the vaccine. Independence also helped convene a consortium of regional health providers to share best practices and assess the capacity of our health institutions during the pandemic’s peak.

Notably, the pandemic caused an exponential growth in telemedicine. Concerned that individuals might forgo necessary medical and preventive care for fear of contracting the virus, health plans such as Independence promoted the ease and convenience of telemedicine. In Independence’s Beat COVID-19 public awareness campaign, telemedicine was front and center.

Consumers and doctors now rely on these digital tools as never before. In 2019, telemedicine made up a tiny proportion — 0.12% — of professional claims among our commercial members. Last year, it made up 16% of those claims. It’s safe to say that telemedicine is here to stay as a reliable complement to in-person care.

It will be important for health plans to continue working closely with providers. At Independence, we will continue to evolve our value-based and alternative payments models, which focus on quality, experience and cost of care over quantity of care. This emphasis became even more important during the pandemic as many healthcare providers struggled financially under a system still disproportionately focused on care volume.

The paradox of healthcare providers worried about going out of business when they were needed most reinforces the need for value-based payment, which is less vulnerable to volume shifts such as those the pandemic caused. At Independence, we will continue to build upon our value-based programs and primary care capitation payments.

We’ve learned a lot, but this pandemic is far from over. Millions of people need to be vaccinated. This next challenge will require equal determination and collaboration. Fortunately, this past year has taught us that health plans and providers are more than ready and willing to work together to make that happen.

Rodrigo Cerdá, M.D., M.P.H., is vice president of clinical care transformation at Independence Blue Cross in Philadelphia and a member of the Managed Healthcare Executive® editorial advisory board.