A Look Ahead: The Pandemic's Impact on Payers

The COVID-19 pandemic has highlighted many existing cracks in our healthcare system and taken a tremendous toll on the entire economy. So far, unemployment has been one of the biggest economic consequences: the unemployment rate in the U.S. is twice as high now as it was during the 2008 recession.

As healthcare coverage is frequently tied to jobs, a majority of the newly unemployed are also newly uninsured. How that will be addressed is going to vary from state to state. The confluence of unemployment, decreased revenue to employers and governments, and sudden challenges to our healthcare system caused by this pandemic have created a perfect storm of problems we need to address.

The COVID-19 pandemic has put pressure on payers, providers, and patients alike, which is why tools like our Eviti® Connect platform are even more important to maintain efficient workflows and aid smooth operations.

The Pandemic’s Impact on Payers

As a result of the increasing number of uninsured citizens, a shift from private to public-based health plan payment is anticipated. However, potential state and federal budget restrictions may lead to less funding for public-based plans, such as traditional Medicaid, or expanded access plans.

The Pandemic’s Impact on Cancer Care

The pandemic also has had major repercussions on cancer care. Interruptions in cancer screenings may lead to more advanced disease at diagnosis, compromising future clinical outcomes.  But as patients who are undergoing cancer treatment or have a cancer history tend to have poorer outcomes from COVID-19 infection, limiting contact with the healthcare system also decreases their risk of infection and subsequent complications. Striking the appropriate balance between ongoing care and limiting opportunity is required; knowledge of the opportunities for quality care with less contact is critical.

Many of these opportunities to alter usual patterns of care while preserving effectiveness were illustrated by the results of a recent survey of 55 major cancer centers in the U.S. For example, telehealth has emerged as an important tool: 98% of the responding cancer centers have implemented telehealth services to reduce on-site visits. At the same time, 64% of the surveyed cancer centers are concerned about how they will manage care for established patients who have delayed their care, or for those who have not yet been diagnosed – furthering the complexity of providers’ decisions in balancing patient contact with the healthcare system and limiting disease progression when mapping out a treatment plan. Use of evidence-based solutions helps navigate these challenging waters.

Payers also benefit from these solutions. Assuring evidence-based care for members during this time of economic stress (through prior authorization) has multiple downstream benefits. Limiting unjustified variances in care leads to decreased direct costs for members, decreases unneeded expenses to payers, leading in turn to less financial burden on employers during this challenging time. By implementing tools and technology to streamline communication between payers and providers as well as streamline workflows, the medical community will move past this pandemic and be one step closer to achieving true value-based care.

NantHealth | Technology that Simplifies Healthcare.