San Diego Business Journal

The medical and insurance communities are dealing with circumstances unique to early 2021, on top of issues that have been around for a while.

The timely issue, of course, is the reaction to COVID-19.

More timeless issues include work to bend the cost curve.

Many insurers are absorbing COVID-related costs, for now at least.

Kaiser Permanente, for example, has agreed to waive all member out-of-pocket costs for screening, testing, and treating COVID-19-related services (inpatient and outpatient) through at least March 31, or as long as the public health emergency lasts, said Jane Finley, area manager for Kaiser Permanente San Diego. “This action means that members diagnosed with COVID-19 will not have to pay copays or other cost-sharing related to their care and treatment of COVID-19, even if they must stay in the hospital through the end of the month.”

An executive with Cigna noted customers receive $0 cost sharing for all FDA-approved COVID-19 vaccines, as well as $0 cost sharing for COVID-19 diagnostic and pre-hospital admission testing in the United States. Cigna said it is also helping to shield customers from unexpected costs for COVID-19 care through “surprise” or “balance” bills from out-of-network providers.

More Emphasis on Telemedicine

Telemedicine — consultation with a doctor via voice or video — is one technology that is getting more use during the pandemic.

"COVID-19 represented a watershed moment in the adoption of virtual care," said Tim Rhatigan, vice president for small business sales and account management for UnitedHealthcare in California.

Kaiser’s Finley said her organization has been working with the technology for decades. At the height of the nationwide shelter-in-place orders in April, she said, more than 80% of Kaiser’s walk-in visits were conducted as virtual appointments, up from 15% before the pandemic.

“The use of telehealth has increased dramatically and shown us a clear path to scaling cost-effective ways for the safe delivery of care to those who need it,” said Beth Andersen, president of Anthem Blue Cross of California, in recent public remarks. And it is more than a doctor in the loop. To make it easier for providers to manage resources and capacity, Andersen said, Anthem was able to rapidly develop and deploy a COVID-19 symptom checker on Sydney Care, its app powered by artificial intelligence.

Value and the Big Picture

As for controlling costs, Anthem said it is concentrating on high-quality, value based care. “By working to accelerate growth in value-based payment models, we reward our care providers for efficiency, coordination, health outcomes and experience, rather than on the volume of care provided,” Andersen said.

Cigna is also pursuing value based payments. “Providers who participate in these arrangements are compensated when they meet targets for quality and cost,” said Vicki Clements, vice president of sales and client management, and COO for Cigna’s Southern California/Nevada markets.

Finley said that a coordinated, team-based model lets Kaiser provide the right care at the right time, reducing unnecessary treatments. For example, she said, team-based care means that doctors can focus on medicine instead of running a practice, which streamlines care and reduces medical errors and waste. “Also, Kaiser Permanente caregivers can pull up our members’ entire medical history — including lab test results. As a result, tests do not get repeat ordered unless crucial to care, reducing duplication and overall costs,” she said.

Anthem’s Andersen said the pandemic “has shown us technology holds the promise to a healthcare future of greater access to transparency and data allowing the healthcare consumers, employers and other partners to make better-informed decisions.”

Pulling Together

The COVID-19 pandemic has created a certain esprit de corps, with non-clinical staff volunteering for mass screening and vaccination efforts, Kaiser representatives said. A spokeswoman said it is not unusual to see a high-level executive assistant directing pedestrian traffic at a recent vaccine event.

“These extraordinary times have called for exceptional measures from all,” Finley said, including doctors, nurses, aides, respiratory therapists, pharmacists, housekeepers, labor leaders, managers, and the entire staff.

“Without a doubt, the best work-related moment I’ve experienced in the last six months is witnessing the Kaiser Permanente San Diego team coming together from their respected disciplines to take care of our patients and their families and each other,” she said.