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COVID-19 and the New Normal for Health Plans

Just a few months ago, our lives were turned upside down by a virus few had contemplated. As I’m sure many have, I’ve spent a lot of time thinking about what the new normal will be for me, my family, and my industry.  

Professionally, those questions center around the health plan space as I’ve now spent most of my career working for or with health plans. Some changes were obvious; transition toward telemedicine, temporary reduction in total cost of care, population shift from commercial to safety net plans, etc. These will have lasting impacts on the industry for sure but I suspect will soon become business as usual.  

Health plans are recognizing their place in real-time engagement with members, hot-spotting and contact tracing. Our colleagues at Cigna realized that early on, and have been tracking real-time suspected and confirmed COVID cases on the Collective platform. This strategy can be scaled to monitor new viral outbreaks (flu, etc.) and seasonal conditions (i.e. asthma).  

Becker’s Hospital Review asked whether this pandemic will be healthcare’s “Amazon moment”. While I agree with their five predictions, I believe our “Amazon moment” will only come when we connect mobile devices and biometrics to longitudinal health and social records to predict adverse outcomes on an individual and population basis. Imagine if an iPhone’s facial recognition technology also took a person’s temperature and shared that with the health plan or public health agencies. We would’ve known much earlier of a spike in fevers and, as more became known about the virus, alert individuals with fevers prevent the spread by socially distancing. But we’re not there yet.  

Where I believe we’ll see the greatest transformation as a result of COVID is in a meaningful shift toward value-based payment structures. By all accounts, hospitals are hemorrhaging cash as elective and non-emergent care fell off a cliff and is only now beginning to recover. This is a direct outcome of the current fee-for-service payment models. For the first time ever, hospital systems and payers may be aligned on the need to look at alternative payment models.  

Value in healthcare can be defined many ways but the Triple Aim sums it up pretty well—improved patient experience and population health outcomes at a lower per capita cost. Hospitals and providers that succeed in this endeavor should be rewarded in a way that compensates for lost fee-for-service revenue.  

Last year, I joined Collective Medical because I believe the industry needs to rapidly move towards value and because Collective provides solutions critical to the success of both providers and health plans engaged in alternative payment models. By providing real-time alerts into a provider’s EMR, we identify risks that save the provider time, reduce redundant care, and improve patient outcomes.

Primary care physicians are critical to the success of value-based models, but they require a real-time understanding of where and how their assigned population is accessing care. This enables them to take timely actions that change patient behavior, improve outcomes, and reduce total cost of care. Similarly, when incentives are aligned, health plans participate in managing the most complex patients, predicting risk, and identifying trends.  Collective brings all parties together in a way that enables collaboration on common goals.  

I predict we’ll see a shift toward value-based payment models as the dust settles. But those won’t be successful unless all parties are working in concert.

Michael Keyes, MBA, PT
VP, Health Plan Business Development