As published in Toledo Business Journal - September 1, 2020
As the COVID-19 pandemic continues to impact all aspects of our lives, employer health plans are far from immune.
Aside from the complex compliance issues that have arisen in recent months, the claims experience is going to look different this year. Here are four key steps plan sponsors should take:
Assessing the demographics and illness burden of your population can help you understand where the risks lie.
Emergency room use, office visits, and telehealth visits will continue to assume a different pattern as patients and doctors consider alternative care delivery options. Perhaps this will lead to greater adoption of telehealth options in the long term. There may also be an extended increase in mental health needs as people deal with isolation and anxiety, and we may even see an uptick in pregnancies.
Vice President,
Senior Client Executive
Market Leader
567.803.0103
mcasey@oswaldcompanies.com
Depending on the risk exposure and the current enviroment your workforce is subjected to, the prevalence of positive COVID-19 tests and the severity of required treatment will vary. Are employees hunkered down at home or are they on the front lines stocking grocery shelves? These risk components should be factored into the cost modeling. Some employers may have opted to cover out-of-pocket costs for treatment which adds an incremental cost to the plan.
In some cases, people seem to be avoiding ERs and doctors’ offices, even for necessary care, out of fear of contracting the virus. This will likely cause a decrease in claims over the short term.
However, we anticipate a portion of those claims will come back later in the year and into 2021 once members are more comfortable entering health care facilities again. A consequence may be that conditions worsen over time without intervention and cost more when treatment commences.
Similarly, but in the opposite direction, Pharmacy Benefits Managers (PBMs) have allowed earlier and longer fills of medications, so there may be an accelaration of pharmacy claims in the short term.
Self-insured employers will directly experience the impact of claims fluctuation. Fully-insured employers will also feel the impact as carriers experience the same fluctuations and have new information to consider when providing the next renewal.
In addition to helping our clients navigate compliance issues and communication strategies around COVID-19, Oswald is committed to monitoring the continued impact on our clients’ demographics, utilization, trends, and claims.
Note: This communication is for informational purposes only. Although every reasonable effort is made to present current and accurate information, Oswald makes no guarantees of any kind and cannot be held liable for any outdated or incorrect information.
OC_1950
