Health plans can make a difference in the fight against COVID-19

Payers may not be on the frontlines of fighting COVID-19, but there are ways they can support members and providers in the wake of the pandemic.

By | 3 minute read | May 7, 2020

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COVID-19 is stress-testing all parts of the healthcare system, and payers are no exception. They might not be on the immediate frontlines, but they will contribute substantially to the second wave of support that will help people recover from the physical and financial challenges brought on by COVID-19.

As the experts from Simpler Consulting, an IBM Company, are helping healthcare payer organizations prepare to perform their vital role in the recovery, they have identified six strategies to help payers adapt their business models to the needs their members and providers will have throughout the crisis. These strategies include:

  1. Establish robust support for telemedicine and drive-up services: To prevent disruptions in patient care, providers have made quick pivots to drive-up clinics and telemedicine. Since this is one trend that might outlast the COVID-19 crisis, payers should strongly consider expanding their support for these creative solutions by making it easier for providers to offer them and providing clear steps for reimbursement. Also, provider directories and other tools for members should be updated to help people easily find providers who are seeing patients through these services.
  2. Provide a clear source of information: People will have similar questions about how payer organizations will be handling COVID-19 claims, so payers should consider sending proactive communications to members and providers about where COVID-19 information can be found as well as updates about any major decisions that have been made. Tailoring communications to specific groups of members or providers could also help people focus on the information that’s most relevant to them. New advances in voice assistant technology and online assistants can also help payers direct people to the information they need.
  3. Prepare for increases in public and marketplace plan enrollments: With millions of people out of work and receiving unemployment benefits, many people will be looking for other healthcare coverage options. Payers and agencies that offer either short-term plans or special enrollment periods for their major medical plans due to job loss should prepare to dedicate more resources to processing applications and enrolling new members.
  4. Prioritize emergent care claims: Although there will be some claims for elective procedures and routine appointments, most claims for the foreseeable future will be related to emergent care and hospitalization. By redeploying resources to focus on processing those claims efficiently, payers could help relieve some of the stress and uncertainty their members experience while waiting for a medical bill to arrive. Increased efficiency would also be helpful to providers who are experiencing revenue losses because of seeing fewer patients.
  5. Reduce turnaround times for provider payments: Due to social distancing, many providers are facing a decline in revenues that could leave them struggling to pay their bills. By identifying ways to reduce turnaround times and make processes more efficient, payers could help providers and nurture critical relationships. Providers who feel supported are more likely to share their experience with peers, which could ultimately encourage more providers to participate in a payer’s network in the future.
  6. Make billing as efficient and transparent as possible: Many members will be anxious to know how much their final bill will be, while providers will be just as eager to know how much reimbursement they can expect and when they’ll receive it. By giving everyone an estimated timeline as well as a clear view of the process, payers could potentially reduce the number of follow-up calls they receive and free up team members to focus on other needs. Payers should also consider whether there are any immediate steps they can take to make the billing process more efficient without sacrificing accuracy.

Any payers interested in implementing these strategies to respond to COVID-19 could benefit from the third-party perspective of experienced industry experts. Simpler Consulting, an IBM company, offers executive coaching and other services for payers to help them assess their current processes and identify changes they could make to improve their business practices. Simpler uses a system that encourages whole teams to focus on continuous improvement, which helps healthcare organizations take the lessons they’ve learned from responding to short-term crises and use them to support long-term success.

Help your members and providers get back on their feet. Learn how Simpler can help.

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