Minnesota Blues CEO Craig Samitt on COVID-19, 2021 Rates Increases, Telehealth, Medicare for all, and WFH | Managed Healthcare Executive

On COVID-19 cases
We represent about 40% of all of the insurance in Minnesota. And so while we don’t necessarily tally our membership against the Minnesota experience, you know, you can estimate that, that of the 2,500 or so cases that we’ve experienced that, in all likelihood, you know, in the ballpark of a 30% to 40% range would represent the impact that that our membership has had. I think the impact for us has been, frankly, what it’s been for everyone. It’s this is a scary and a surreal and unprecedented time.

On BCBSMN expenditures this year
Right now, our current projections are that it [lack of expenditures for elective procedures and other routine care] won’t be an offset, that actually we would experience or at least we’re projecting to experience a financial loss.

We think that we’re going to see some significant financial fluctuations over the course of the rest of the year, and then, frankly, that that’s the role that an insurance company plays that, that we are there to support the peaks and the valleys of, of healthcare coverage and care delivery that that comes in goes through the course of a community’s lifetime. So in the near term, you’re right, we’re seeing a deferral of elective procedures, we estimate that we’ve seen it at least a 50% reduction in services. And so in the immediate near term, we’re certainly seeing a decline in services and obviously a decline in cost.

The next wave, we expect is going to be a significant surge in expense. Minnesota is not quite at its peak. And we don’t envision that we may be at our peak for up to another 15 to 30 days. So we’re expecting, as we’ve seen in other states, a significant rise in costs associated with [COVID-19] testing with treatment.

I think the third phase is also going to be likely a savings phase that immediately after the peak. I think we would expect to go back to a period where folks may be concerned about going back to the hospital or going back to physicians, even for elective procedures, just because we’re fearful about recurrence, so I think we’re going to see a low utilization.

And then the last phase will essentially be recovery, which is all of the pent-up demand, as we feel more comfortable.

So when we look at it longitudinally, there’s going to be there’s going to be valleys and there’s going to be peaks, and at least our projection right now, it’s going to be negative not positive in terms of utilization cost.

On 2021 rate hikes
I think it’s likely too soon to tell. I know that many organizations are beginning to analyze pricing for next year, but there are so many variables and there’s so many moving parts.

I don’t know if we would expect, if we envision, that there’s going to be a new surge of cases. Perhaps so. But if there isn’t a recurrence of the pandemic next year, then the question is, is would we expect utilization to be on par with what it was before the pandemic or potentially even less?

We’ve been calling it the day after tomorrow, the day after tomorrow we envision that they’re going to be many more services provided in the home or in the community or online. I think there’s still going to be some hesitancy about going to go to the emergency room or to the hospital or . going go to the doctor with minor complaints. And so we could estimate that we may potentially see a lower utilization in 2021.

The final thing that I would say [if there an economic depression], I don’t think employers will be able to, and individuals will not be able to, afford significant premium increases. And so I think we will all want to do what we can to suppress inflationary returns on pricing, because we just won’t be able to sustain it and afford it as individuals or as a society going into the next year.

On telehealth 
I’ve mostly spent my career in in organizations that have wanted to fix healthcare and really transform the way we deliver care. And so I’ve been a fan of telehealth for decades now and I’ve been waiting for telehealth to have its day and that day is finally here. One of the very first things that we did was to open up telehealth immediately to our members through a through a partner [Doctor on Demand] who provides national telehealth. And we wanted to eliminate all barriers both technologically as well as financially.

So whether it was COVID-related symptoms or non-COVID-related symptoms, folks should stay at home. So we opened up that immediately. However, we also wanted to make sure that we helped our provider partners develop technology to see their own patients.

We’ve wanted to make sure that we can offer some resources and support for providers to connect but we also realized that you know, we should be paying for telehealth services, at least in the near term comparably as we pay face-to-face services if, if it’s the same type of visit that a patient would have with their doctor face-to-face, and it’s approximately the same amount of time for the physician, why would reimbursements not be more comparable?

So I think we’re going to reevaluate everything, including payment policy. Obviously, there have been historical restrictions that have predominantly been CMS-based, but I think we all have had them and that we have to review these policies and change them so that we can offer a much more convenient and, in some cases, equally high quality service to patients through virtual means.

We wouldn’t have thought that it would be this type of shock to the system to really launch us into a reinvented future. But I think that reinvented future is now here, and I don’t think there’s going to be a going back. I think that this is here to stay.

This content was originally published here.

In A ‘Close Call,’ $424M Medicare Fraud Suspect Gets Bail – Law360

In A ‘Close Call,’ $424M Medicare Fraud Suspect Gets Bail – Law360

Law360 (April 23, 2020, 4:30 PM EDT) — A New Jersey federal judge reluctantly agreed to release the lead suspect in a $424 million international telehealth fraud case on $2.5 million bond Wednesday in a determination she deemed a “close call on bail,” while setting a slew of stringent conditions to deter the jetsetter from fleeing the county.

Creaghan Harry’s bond will be secured by $1.4 million in equity, and he will be subject to home arrest in Florida, travel restrictions and internet usage monitoring, according to the opinion by U.S. District Judge Madeline Cox Arleo. Harry, 51, must also turn in his and his children’s passports and hand…

This content was originally published here.

Coalition for Medicare Choices

Coalition for Medicare Choices

April 7 marks World Health Day. In 2020, World Health Day focuses on the important work of nurses and midwives, who stand at the front lines protecting us as we battle COVID-19 all across the country.

These health care professionals play an vital role when it comes to helping Americans 65+ and people with disabilities receive the stable health care services they deserve. Whether it is through in-person care or by telephone, nurses are there to help.

Over the years, nurses have expanded their role beyond traditional medical facilities. For example, some nurses work with health insurance providers to deliver home health benefits. This connects skilled nurses with patients to address their health care needs from the comfort of their own homes.

Additionally, nurses are ready to assist patients by phone. Many health insurance providers offer services where enrollees can speak with a nurse to discuss medical concerns and questions over the phone or even your smartphone. This includes helplines that can offer services 24 hours a day, 7 days a week, allowing Americans to conveniently connect with dedicated health care professionals and address their health concerns. It also includes technology called “telehealth” or “telemedicine,” which enables you to video chat with health providers like nurses.

Services like home visitations and phone calls that connect nurses to patients help make health care services more stable and accessible. Americans 65+ who have used the health system for years know that nurses are go-to resources and problem solvers.  In fact, nursing has been recognized in annual Gallup polls as the most trusted profession. In the most current survey, 85% of Americans surveyed rated nurses’ honesty and ethical standards as either “high” or “very high.”

Over the past month, as COVID-19 began spreading in the United States, nurses have played a huge role in keeping health care facilities open and prepared to meet their patients’ health care needs. Like other front-line health care workers, nurses are among the groups who are most at risk of contracting the virus because they work to treat people before their health condition is identified. Nurses are health care heroes, fighting every minute of every day to fight this pandemic.

Today, millions of Americans receive care thanks to nurses. With their help, millions of Americans are receiving better services, better access to care, and better value.

This content was originally published here.

Biden pledges to lower Medicare age and reduce some student debt in olive branch to Sanders supporters

Biden pledges to lower Medicare age and reduce some student debt in olive branch to Sanders supporters

Chief of Staff Mark Meadows, Treasury Secretary Steven Mnuchin, and national economic adviser Larry Kudlow are reportedly among those expected to make up this second economy-focused task force, which will have some overlap in membership with the first one and which the Post says will be a “mix of private-sector and top administration officials.” CNN reports, in fact, “there has been outreach to figures” like Gary Cohn, former director of the National Economic Council, and “even major sports teams and well-known athletes.”

Mnuchin during a Thursday appearance on CNBC said the administration is doing “everything necessary [so] that American companies and American workers can be open for business” possibly as soon as May. A White House spokesperson told the Post, though, that “scientific data will drive the timeline on those decisions.”

The notion of coronavirus immunity is still in question after an announcement from South Korea’s CDC.

In a Monday briefing, South Korea’s Centers for Disease Control and Prevention announced 51 people “cured” after contracting COVID-19 had tested positive for the disease after being released from quarantine. CDC Director Jeong Eun-kyeong leaned toward deeming these cases a “reactivation” of the virus, but will study it further.

While it was never certain, the idea that people who test positive for and then recover from the new coronavirus gain immunity from the disease had even informed government policy in some countries. The U.K. originally resisted closing down businesses and enforcing social distancing guidelines in an effort to spread “herd immunity” among its citizens, for one.

But this latest announcement calls the herd immunity strategy into further question. Patients are deemed recovered when they test negative for the disease twice in 24 hours. Yet in at least 51 cases, people who had apparently recovered had tested positive again shortly after they left quarantine. “While we are putting more weight on reactivation as the possible cause, we are conducting a comprehensive study on this,” Jeong said. Those patients may not have even been cured at all, seeing as “there have been many cases when a patient during treatment will test negative one day and positive another,” he said.

This content was originally published here.

In Nation Without Medicare for All, 3.5 Million Workers May Have Lost Employer-Provided Insurance Over Last Two Weeks

In Nation Without Medicare for All, 3.5 Million Workers May Have Lost Employer-Provided Insurance Over Last Two Weeks

More clusterfuck from a government eager to use its power to put kids in cages but now nowhere in sight: States in bidding wars for equipment, a cancelled warning system for pandemics, just-ordered golf carts. Blessedly, many have stepped into the vacuum, from kitchen-table mask-sewers to thousands of people lending their RVs to bone-weary doctors and nurses in need of refuge that won’t infect their families – a tender, spontaneous exercise in “everything that is right and good in this world.”

This content was originally published here.

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