Ask an independent TPA what sets their business apart and you’ll likely hear something about customer service and a promise to always put their client’s health plan and its members first. Seldom have these qualities been more meaningful than during the uncertainty of the past few months.
Fortunately, self-funding provides the flexibility employers have needed throughout this crisis. By collaborating with broker partners and other colleagues, TPAs have worked to make plan design changes that lower costs while exploring ways to keep coverage in force for as many employees as possible. Unfortunately, most have been involved in the difficult decisions employers have had to make in order to sustain quarantines, stay-at-home orders and extended closures. Their team members have worked tirelessly to help members access non-emergency medical care while avoiding the risks related to the coronavirus.
In addition to addressing health benefit concerns, TPAs have demonstrated great empathy in encounters with employers, members and providers. While the majority of self-funded health plans offer a telehealth benefit, some groups have been slow to engage with this service. With many organizations working remotely during the pandemic, however, the number of virtual visits has increased significantly.
TPAs have helped many patients avoid visits to the ER by directing them to alternative care settings. Some in need of treatment for chronic illnesses have been directed to high-quality, lower-cost providers rather than traditional facilities and, in some cases, treatment has been administered in the home. Searching for solutions takes a tremendous amount of time and coordination but being an advocate for members is nothing new for TPAs.
Health benefits are complicated for everyone. In times of disruption, plan sponsors and members need every possible tool at their disposal. Self-funding offers manyvaluable tools. When backed by expert administration and open communication, these tools can help health plans build trust and take great care of employees.
While working remotely has put some wellness programs on hold, creative companies are adding exercise to the workday and enabling people to connect with co-workers. For some, the social interaction is proving to be just as helpful as the physical activity.
Web conferencing applications such as Webex, Zoom and Microsoft Teams are making it easy to participate in everything from stretch breaks to cardio sessions, meditation and yoga classes. In some cases, fitness trainers or coaches stream classes from their studio or home. When sessions involve more conversation than fitness, such as a virtual coffee break in the middle of the day, staff members often take the lead.
Point is that with today’s technology and a little imagination, many employers are finding greater engagement in virtual wellness sessions than they ever achieved with fitness classes in the workplace. If some of your people are still working remotely, why not give it a try?
If you’ve had COVID-19 in the past, or suspect that you have, you may want to get an antibody test, which tests your blood serum to check for your body’s response to an infection. If you decide to proceed with an antibody test, make sure the test is authorized for FDA emergency use and speak with your doctor about the results. If your antibody test is negative, you probably were not infected with the SARS-CoV-2 virus in the past. If you test positive and have no symptoms of COVID-19, you likely were infected with SARS-CoV-2, especially if you had common COVID-19 symptoms in the past.
Rules governing which tests can be given and who can take them vary from state to state. It is wise to check with the department of public health in your state and also ask your doctor to determine if a test is appropriate for you. With reports of false positives growing, many physicians are recommending that patients wait until experts can better identify which tests are performing best.
A new report released by financial services firm Alera Group shows that few, if any, sectors of our economy have avoided damage by COVID-19. One area that has suffered terribly includes food growers, packers and suppliers that typically serve restaurants, schools and other commercial facilities. Other sectors hit hardest include construction, higher education, healthcare, hospitality and gaming, manufacturing and restaurants.
A recent IRS proposal would enable workers to use ordinary health reimbursement arrangements (HRAs) to pay for direct primary care program memberships. In addition to giving workers the peace of mind in knowing they can fix the costs of primary care, the proposal would help primary care doctors reduce the time and money they spend on administrative work and make them far more efficient.
The IRS says this would be accomplished by declaring that payments for direct primary care arrangements and healthcare cost sharing ministry memberships are expenses for medical care under Internal Revenue Code Section 213. While this step will have a significant impact on healthcare providers and payers, there are sure to be many questions asked within the health benefits industry. The period for comments on this proposal will run through August 10, 2020.
With the help of mobile chatbot technology, a Phoenix-based network of urgent care clinics is helping patients check in remotely for telehealth and in-person visits with primary care physicians and specialists. By using their computer or mobile device to send and receive conversational messages, patients can complete forms and be directed to an exam room. The company says that by using regular language instead of apps or passwords, they are experiencing excellent patient engagement.
With summer comes outdoor activities and plenty of fresh air. But really, how fresh is the air we breathe if we’re wearing a mask? When asked this question in a recent Facebook Live event, a specialist in charge of infectious disease at a Midwest-based healthcare system said wearing a mask outside is fine and there’s no reason to be concerned about breathing too much of your own carbon dioxide.
While this is one of several myths circulating on social media networks, Dr. Robert Citronberg said there is no scientific evidence showing that wearing a mask can be harmful, even for long periods of time. He went on to confirm that wearing a mask is still one of the best ways to stop the spread of COVID-19.
According to the U.S. Surgeon General, one in six high school students admitted to using e-cigarettes in 2015, with use among teens rising. While the media and elected officials have warned Americans of the risks inherent to electronic cigarettes, it is important to be aware of the dangers.
E-cigarettes, consisting of a battery, an atomizing device and an e-liquid, are devices used to heat the liquid cartridge and release a vapor that is inhaled. Most e-cigarettes contain nicotine and other dangerous substances including metals such as nickel, tin, lead and diacetyl, a flavoring chemical linked to lung disease. And just as second-hand smoke from regular cigarettes harms those nearby, vaping exposes those close by to toxic chemicals.
In addition to being addictive like nicotine in regular cigarettes, liquid nicotine is poisonous – especially to young children. Teenagers are at greater risk of addiction because their brains are still developing. The more nicotine a young person consumes, the more likely it is that they will become addicted for life.
As some state and local governments move to re-open, we’re hearing more about contact tracing. Since many Americans may be unsure of its meaning, we thought it might help to explain how this process may impact us.
Massachusetts seems to be out front, already working to hire and train nearly 1,000 people to do contact tracing. Other health departments have formed teams to begin the process, which consists of identifying and isolating anyone exposed to a confirmed COVID-19 patient. Here’s how it typically works:
- Health officials call a person who recently tested positive for the virus.
- The patient describes where they have gone and who they interacted with during the 48 hours prior to their symptoms appearing.
- Health officials then reach out to these businesses and individuals to inform them that they may have been exposed to the virus.
- People who were in close contact with this individual for several minutes are advised to self-isolate for 14 days.
Technology developed by Apple and Google is expected to identify people who have come in contact with a person infected by the virus. While this makes far more sense than expecting someone to remember exactly where they’ve been, concerns about privacy are still keeping these apps from being rolled out in the U.S.
There are many concerns that cause top executives to lose sleep, but the events of the past couple months have tested business owners and decision makers in ways that can only be described as unprecedented.
The uncertainty surrounding the Coronavirus coupled with a burning desire to get back to business have created an increasingly dynamic and stressful time. From manufacturers scrambling to provide healthcare workers with PPP to non-essential businesses that have had to furlough workers, most CEOs are faced with the biggest challenges of their careers. And while employees are able to share their concerns, leaders must have the courage to hide theirs. Real leaders are able to endure intense pressure while making sure the people around them don’t sense it.
Ensuring Safety & Access to Care
The reality is that in the face of this pandemic, true leaders are preparing rather than panicking. After taking steps to keep people safe, they’re thinking and planning for a future that will likely be very different. Leaders know that staying calm is critical to sound decision making. Clear thinking helps them communicate with confidence and listen in a way that calms other’s fears. In a crisis, taking the time to listen can make all the difference to a worker finding it really difficult to cope.
While some insurance carriers are waiving member copays, co-insurance and deductibles for COVID-19 diagnostic testing and treatment, some states are mandating it. While state mandates don’t apply to self-funded plans, some plan sponsors have chosen to provide COVID-19 patients with first dollar coverage. These actions require the approval of your stop loss carrier since related claims may exceed your stop loss deductible. A written and executed plan amendment is also required. As always, we stand ready to help with these requirements as well as the expansion of HDHP, HSA and FMLA benefits included in the Families First Coronavirus Response Act. We hope you will contact us if your plan is facing any of these issues.