Some positive things have come from the response to the pandemic — the rise of telemedicine and a blunted cold and flu season both come to mind. But more than anything, the pandemic has brought uncertainty that is going to take months, if not years, to completely work through.
Telehealth
Before COVID-19, telehealth made up a sleepy corner of the healthcare delivery system.
Held back by uneven reimbursement schedules, telehealth served as a niche solution for just a few healthcare problems. But as social distancing and government-imposed lockdowns swept the country, many people gave telehealth a fresh look. Perhaps more importantly, federal regulators changed how Medicare and Medicaid reimbursed telehealth appointments within their programs.
A recent assessment by McKinsey showed a 38-fold increase of telehealth appointments during the core of the pandemic. And it makes sense. Patients were looking for ways to stay away from other people, but they still needed healthcare. Seeing a doctor from the comfort of their own couch was a great solution.
Many patients also embraced the new healthcare delivery for other reasons. For one, people with transportation challenges flocked to telemedicine as a way to avoid the commute to the doctor. For another, parents used telemedicine to help solve child care dilemmas. Plus, telemedicine was a convenient way for professionals to see a doctor from their cubicle during their lunch break.
So, what started as a pandemic workaround looks like it may be here to stay.
On the other hand, there is a question mark when it comes to telemedicine, and that is whether the more generous reimbursements offered to providers during the pandemic will continue. It is reasonable to assume that, if insurers or federal regulators change back reimbursement schedules, many providers will pull back on virtual appointments, even if their patients are still asking for them.
Mental Health
One of the areas of healthcare that has thrived during the pandemic, on telemedicine, for that matter, is mental health. Therapy appointments don’t rely on physical evaluations, so they seem to be a natural use of telemedicine.
Even still, that doesn’t mean that every patient who was looking for mental health services could find it, even though they are covered by all Affordable Care Act-compliant plans.
An October report published on insurancequotes.com cited data from the National Alliance on Mental Health, which found that as many as 55% of psychiatrists are not accepting new patients, and that a third of people who want to find a mental health provider say they cannot find someone who would accept their insurance.
Considering the pandemic’s effect on the nation’s mental health, the lack of provider availability is bad news. According to the Kaiser Family Foundation, four in 10 adults reported anxiety or depression during the pandemic, up from one in 10 before. 36% reported having difficulty sleeping, 32% reported changes in eating patterns and 12% reported an increase in alcohol or substance use.
Some industry analysts hope that innovations in telemedicine may continue to help ease the bottleneck, but a shortage of mental health providers is likely to continue into the foreseeable future, posing a long-term challenge for the health insurance industry.
Pricing
COVID-19 has thrown a major wrench into the normally well-oiled policy pricing system.
That is because, with premiums priced according to past years’ experience, the past two years pose a problem. For one, COVID-19 disrupted normal care patterns. Early in the pandemic, people avoided routine care, and for people who did contract the virus it drove astronomical ICU costs. Pandemic surges forced some overburdened hospitals to delay elective procedures.
All of this is posing major distortions to the future pricing model. Add the fact that most insurers have now ended the practice of waiving patient shares of COVID treatment and there is very little in the way of reliable pricing from the recent past to use to set future premiums.
Other major challenges include the uncertainty about whether there will be future COVID waves, and if a relaxation of masking and social distancing will cause cold and flu cases to again surge, with the accompanying claims. There is also the potential impact that two years’ worth of deferred or avoided care could potentially have on patients’ morbidity when it comes to chronic conditions.
With all of that, insurers run the twin risk of either over- or undercharging premiums for 2022.
Political influences
Discussions of health policy and COVID cannot be had in a political vacuum. Whether the conversation is about vaccine hesitancy or employer vaccine mandates, tempers flare. The biggest question for health insurance providers is how the courts are going to handle so-called COVID surcharges.
While the Affordable Care Act mandates that different premiums cannot be charged to similar people based on their health history, many employers are charging unvaccinated employees surcharges on their health costs. Employers are taking different routes, ranging from wellness programs to EEOC-endorsed incentive programs, but, no matter the legal justification, issues are almost certain to land in federal court.
Conclusion
COVID-19 will have an impact on the healthcare industry for years. Navigating pricing, the future of telehealth and the political uncertainty is going to take a careful hand.
But, for companies that respond deftly, 2022 also has the potential to offer a cautious return to normalcy, even amid massive uncertainty.
