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Consumer / Employer

Self Care

Celebrating Women in Health Care Starts with Reimagining your Workforce

by Bailey Amber
written by Bailey Amber

These are challenging times for health care, and particularly for women in health care. Consider that nearly 78% of the health care workforce is represented by women.

When I look at the pressing challenges affecting health care today from inflation, shrinking margins, staffing shortages, turnover, and supply chain disruptions, I think about how these issues may be disproportionately affecting women. It can happen in a trickle-down effect and spur a vicious cycle where understaffing may lead to poor patient experiences, discouraging future visits and further suppressing health system revenue. This scenario can fuel overwork and burnout for women whose hands touch all aspects of care delivery. This cycle – often exacerbated by the challenges of our times – can take a toll on our female workforce and their own health and well-being.

Inflation adds to the burden in an insidious way as well. Rising costs can mean that more patients may put off screenings, prevention, and early treatment. Thus, they may show up to emergency rooms and doctor’s offices sicker, possibly with more advanced stage diseases.  This situation can be more costly for the patient’s health and wallet but can also be costly to our female workforce resulting in fewer hands to care for more acute patients.

Not surprisingly, stressed, short-staffed environments can jeopardize patient outcomes.

We need to invest

These circumstances explain why a vast majority (85%) of health system leaders recently said in a Deloitte survey that staffing challenges would have a “major impact” on their 2023 strategies. More than nine in 10 surveyed said investing in their workforce was “important or “very important.”

Although these intentions are encouraging, well-meaning executives will likely be forced to balance workforce investment with the need to maintain profitability. This month, as we recognize International Women’s Day and Women’s History Month, let’s commit that every dollar that’s invested in the strained, largely female health care workforce pays off.

Can we do it? 

I believe we can, and there’s no better time than now. The right approach can improve workforce performance and satisfaction for women throughout an organization. I recommend new initiatives from the top that show support for women, starting with an all-important listening initiative to help ensure that women (and others) feel heard and that eventual solutions are on target with their needs.

Here’s how

Specifically, I recommend the 3Rs: retain, reengage, and reimagine. One main principle of the 3Rs is to carefully blend quick wins with longer-term transformation.

  • Retain – Focus on improving working conditions right out of the gate. This could start with identifying problems that are high on priority lists, relatively easy to solve, and address them right away. Brush up on effective leadership behaviors and communicate transparently. Examples of quick wins could be new support for childcare, flexible scheduling, job sharing, mentorship arrangements, and remote work options. Also look for ways to show appreciation through nonmonetary rewards like gratitude days, celebrations, and wellness resources. Other quick retention measures could be more direct, such as retention bonuses or launching a new mental health service to help provide additional support during difficult times. Small wins can help build momentum and demonstrate your commitment to women in your organization.
  • Reengage – Strive to help women feel empowered. Encouraging women to identify root causes of stress and dissatisfaction, and to propose ideas for a better workplace experience is important. Here is where you can clarify and formalize efforts to reflect their specific needs from career paths to professional development to growth opportunities. Another reengagement measure could be reassessing your total rewards program and adjusting the mix of benefits, pay, and other rewards. This can also be where you can transform the culture by fostering greater inclusion, addressing safety (psychological and physical), and encouraging courageous decision-making. Effective reengagement can give women a true sense of ownership in the organization. They should believe their workplace can be a satisfying and rewarding one in which to advance their career and wellbeing.
  • Reimagine – Think big! (And big doesn’t have to mean expensive.) Examine from a 30,000-foot level what work is done, how it’s done, where it’s done, and who does it. Identify the key operations that need re-engineering to help optimize the human experience and transform care delivery.

Examples of reimagination could be events or initiatives that support women to share their stories or foster mentoring.  Reimagination also could be offloading, outsourcing, or automating administrative tasks so that more time can be dedicated to delivering work that is most meaningful and impactful. Or go further and restructure roles – for example, creating interdisciplinary care teams that help everybody operate at the top of their license. Other moves could include intelligent new-hire onboarding, optimization of permanent and travel RNs, intelligent patient placement, and automated discharge planning.

Admittedly, the biggest, most “reimagined” ideas may have to be rolled out in phases as health care seeks to balance financial realities with workforce improvements.

This year, let’s take action to reimagine the health care workforce for women. With so much of health care resting on women’s shoulders, it’s time we retain, reengage and reimagine health care with women leading the change. Our future workforce and our health depends on it.

Photo: FotografiaBasica, Getty Images

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Let’s Focus on Behavioral and Mental Health in Rural Communities

by Bailey Amber
written by Bailey Amber

If there’s a silver lining to the past two years, the pandemic brought mental health to the forefront.

Studies show that one in five adults will experience a behavioral health disorder yearly. The number is almost certainly higher in rural areas.

Anxiety and depression rates among adults reached 42% during the pandemic, according to data secured by the National Center for Health Statistics in partnership with the U.S. Census Bureau.

About a fifth of the population lives in rural areas. While mental health issues aren’t necessarily higher in rural areas, rural residents receive less frequent mental health treatments and often have more limited access to doctors and counselors who specialize in mental health.

In rural communities, patients often go directly to the emergency room with mental health issues. Unfortunately, these hospitals’ emergency rooms often do not have a safe waiting area for psychiatric patients or patients in crisis.

Sometimes patients can wait hours before a hospital can find the right place. Unfortunately, this scenario diverts one or more nurses away from their primary emergency room or acute care responsibilities because they must stay with that patient one-on-one until the hospital can find somewhere for them.

This scenario often plays out in hospitals and compounds an existing problem.

Rural areas already struggle with an acute shortage of medical personnel and particularly nurses. With patients coming in with urgent, life-threatening medical issues, hospitals need their nurses to focus on those patients.

In the next 12-18 months, healthcare providers — especially rural providers — have an opportunity to lay the foundation that will stem the volume of patients with mental health issues from going to the emergency room. Instead, organizations can see these patients receive the help they need and deserve.

Telemedicine will be more prevalent

Amid the pandemic, rural mental health providers increasingly deployed telehealth to reach more patients. Organizations can use that technology to treat patients, schedule counseling sessions, and hold outpatient and one-on-one sessions.

Telehealth options took off as a “necessary evil” amid the pandemic. In the post-pandemic world, it will be necessary for survival and a bit easier to roll out from a staffing standpoint.

To deliver counseling — whether via telehealth or in-person — healthcare providers must find these qualified counselors out there that can conduct the actual telehealth sessions.

More than that, rural health clinics can relieve hospitals of the need to be the sole provider of mental health counseling for children or adults. These rural health clinics or their outpatient clinics serve as a route to provide health and care by using telehealth, bringing that telehealth into their outpatient offerings.

Furthermore, tapping into larger health systems — specifically, their psychiatric units — for advice and help will enable smaller providers to expand their offerings without increasing staffing and outlaying capital on new services.

While we’re making progress, building those bridges and making those connections takes time.

Growing the connection is paramount

One challenge with telehealth offerings is that not everybody has a computer or a reliable network connection. The good news is that nearly everybody has a smartphone, which has helped patients and providers stay connected.

The federal government has allocated billions of dollars to expand broadband connectivity. Moving forward, some healthcare providers may take a more active role in advocating for the expansion of reliable broadband in rural areas to ensure telemedicine becomes an even more viable option for underserved communities.

As community leaders, healthcare providers and perfectly positioned to advocate for this expansion.

Increased use of analytics will help predict outcomes

Perhaps the most significant trend we’ll see in the next 12-18 months is the increased use of analytics to predict patient outcomes.

Incorporating analytics into enterprise resource planning (ERP) systems allows organizations to monitor and capture data better. That will help organizations gain more insight into where the shortfalls are and what we need to do to improve.

This insight improves strategic planning because organizations can look at those numbers for a more complete picture of what’s happening.

Smaller rural hospitals benefit from ERP systems to help them survive, but since the implementation of ERP systems, I see these hospitals using data more often to capture what’s happening with trends and growth in their marketplace. This technology helps organizations manage their financials and see the bigger picture of what’s happening and what is needed.

For example, I’ve seen this technology specifically benefit diabetic populations in rural areas. Recent trends show that the diabetic population is climbing in rural areas. Now healthcare providers can use technology to help decide whether they need to bring on board diabetic counseling or teach classes with a nutritionist.

Technology can be applied in the same manner to mental health. It helps inform organizations where their shortfalls are and where they can add or enhance services.

More conversation means more clarity.

Ideally, every small town in America would have a psychiatrist. Many rural hospitals are integrating these services into their practices, recognizing the need for psychiatric services. These expansions include adding geriatric psychiatry units to help older populations.

While the expansions are helpful and much-needed, they won’t change the situation overnight. It’s a process that takes a while to develop and hire and train the staff, and organizations still need a medical director and a psychiatrist to oversee it.

Everything won’t be solved with staff, but it certainly will make a good step.

Mental health often isn’t talked about in rural areas. Unfortunately, it still carries a stigma and all the technology in the world won’t change that.

Solving the mental health crisis in rural areas still comes down to people acting — no action is too small.

If there’s one change in the next 12-18 months, let’s hope there’s an increased awareness and openness to talking about mental health, especially in our rural communities.

We’ve already done the hardest part: bringing it to the forefront. Now, we just need to see it over the finish line.

Photo: marekuliasz, Getty Images

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Health Net Tries To Keep Medi-Cal Members Informed As Medicaid Redeterminations Loom

by Bailey Amber
written by Bailey Amber

Medicaid, coverage,

As many as 15 million people could lose Medicaid coverage when the continuous enrollment provision ends March 31, according to the U.S. Department of Health & Human Services. That’s why Health Net, an insurance provider in California, launched its “Review to Renew” campaign Wednesday to ensure Medi-Cal members are aware of this transition.

The continuous enrollment requirement was part of the Families First Coronavirus Response Act, which was enacted in 2020 and bars states from disenrolling people from Medicaid during the public health emergency. In return, the states receive enhanced federal funding. The continuous enrollment provision resulted in Medicaid enrollment rising considerably compared to before the pandemic. But the Consolidated Appropriations Act, signed into law in December, will now end the continuous enrollment requirement March 31. 

This means that Medi-Cal, California’s Medicaid program, will return to asking members to renew and review their eligibility information, a process called redetermination. Medi-Cal provides coverage for about 13 million people in the state.

Health Net is a subsidiary of Centene Corporation and provides health plans to individuals, families and businesses who qualify for Medi-Cal or Medicare. It serves about 3 million people. Its “Review to Renew” campaign will leverage print and digital media — such as mail, interactive voice response calls, text messages, social media, digital advertisements and posters — to make Medi-Cal members aware of the deadline and provide them with resources to retain coverage.

“Through our Review to Renew campaign, Health Net wants to ensure millions of Medi-Cal members are aware of the upcoming deadline and resources to maintain their health coverage, while encouraging all Medi-Cal members to review and update their household information,” said Dr. Ramiro Zúñiga, vice president and medical director of Health Net.

In addition, Health Net will provide educational materials at several cultural and community events to help Californians understand the process for renewal.

Doing this outreach and education work is necessary to make Americans aware of the end of the continuous enrollment requirement after so many years of not having to go through redetermination, Zúñiga added.

“Given that California has not gone through the redetermination process in almost three years, informing members of this change is crucial. If not informed, many members may end up without continuation of coverage,” Zúñiga said. “Maintaining health coverage helps Californians stay healthy and live their lives to the fullest.” 

A recent Kaiser Family Foundation report showed what could happen to those who don’t renew their Medicaid coverage. Prior to the pandemic, 65% of people disenrolled from Medicaid and the Children’s Health Insurance Program experienced a period of being uninsured, according to the report. This includes 17% of people who were uninsured for the full year after disenrollment. 

Photo: designer491, Getty Images

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Paytient Secures $40.5M for Its Benefit Helping Patients Pay for Care

by Bailey Amber
written by Bailey Amber

Financial technology company Paytient announced Tuesday that it raised $40.5 million in Series B funding, which will help the company grow its benefit that helps patients pay for out-of-pocket healthcare costs.

Columbia, Missouri-based Paytient is the creator of Health Payment Accounts (HPAs), which are available for employers, health systems and insurers to offer to employees and members. Users receive a Paytient Visa card, without undergoing a credit check, and can download the Paytient app. When members use the card for a healthcare service, Paytient pays the provider and then the member chooses a payment plan with no interest or fees through the app. They can select the timeline to pay the cost back, as well as a source for payment, such as through a payroll deduction or bank account.

“We preload that card with credit and then that money just sits available to them that they can use to turn any unexpected out-of-pocket medical, dental, vision or veterinary expense,” said Brian Whorley, co-founder and CEO. “Functionally, Paytient is like a healthcare wallet that’s always full.”

The funding round was led by Mercato Partners Traverse Fund and included participation from Bertelsmann Investments. In total, the company has raised $63 million. Existing investors include Lightbank, Felicis Ventures, Inspired Capital, Box Group and Left Lane Capital.

Mercato Partners Traverse Fund chose to invest in Paytient to ease Americans’ financial troubles, said Joe Kaiser, managing director of the investor.

“Working Americans are under more financial stress than ever, and they need a solution that empowers them to access care while taking the stress out of healthcare spending,” he said in a news release.

With the money, the company plans to advance and grow its product, as well as meet demand from potential employer and insurer partners. It has about 700 partners, including Centene, Cigna, Coupe Health, Beta Health and R.R. Donnelly. Paytient serves about 700,000 people.

There’s a need for medical payment assistance, Whorley argued. About 91% of consumers have experienced a payment-related issue in the past, a recent survey from health benefits company Gravie and Wakefield Research found. Paytient aims to fix this issue, Whorley said.

“Our whole goal is to improve the ability of people to better access and afford care,” he said. “That’s our mission.

Other companies that provide financial assistance for healthcare expenses include fintech company Stilt through its product called Onbo and Rectangle Health through its product called Care Now, Pay later.

Photo: claudenakagawa, Getty Images

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Survey: Americans Are Split on the Covid-19 Public Health Emergency

by Bailey Amber
written by Bailey Amber

About 51% of U.S. adults say the Covid-19 public health emergency should still be in effect, while 39% said it is no longer needed, a recent survey found.

The report came from Morning Consult, which conducted the poll between December 14 and December 19. It received responses from 2,210 American adults.

Currently, the public health emergency is set to end January 11. The Biden Administration has said that it will provide 60 days notice on when the emergency will expire, and because it did not do so in November, the public health emergency is expected to be extended to April.

Americans’ opinions varied based on political party, generation, race/ethnicity and location. For example, 72% of Democrats said they think the public health emergency should still be in effect, compared to 34% of Republicans. About 56% of “Baby Boomers” said it should still be in effect, compared to 45% of “Gen Zers.” Additionally, 66% of Black Americans believe the public health emergency should be in place, while 49% of White Americans said this. More adults in urban communities (58%) think it should be in effect, than rural adults (43%).

Almost half of the respondents said the public health emergency should be extended past January, but two in five said it shouldn’t. 

Under the public health emergency, Americans receive coverage for Covid-19 services, such as tests, treatments and vaccines. However, the survey found that once the period ends, 46% of U.S. adults are not interested in paying for Covid-19 products out of pocket. Meanwhile, 45% said they are interested and 9% said they don’t know.

On December 19,  25 governors sent a letter to President Joe Biden urging him to end the public health emergency in April. In 2020, the Families First Coronavirus Response Act was passed due to the pandemic. The Act bans states from disenrolling people from Medicaid during the public health emergency and gives them a temporary increase in the federal Medicaid match rates. The governors contend that this is hurting states and costing them substantial money.

“The [public health emergency] is negatively affecting states, primarily by artificially growing our population covered under Medicaid (both traditional and expanded populations), regardless of whether individuals continue to be eligible under the program,” the governors said. “While the enhanced federal match provides some assistance to blunt the increasing costs due to higher enrollment numbers in our Medicaid programs, states are required to increase our non-federal match to adequately cover all enrollees and cannot disenroll members from the program unless they do so voluntarily.”

About 18 million people could lose Medicaid coverage once the public health emergency expires, according to a recent Urban Institute report. This includes 3.8 million people who would become completely uninsured.

Photo: santima.studio, Getty Images

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CMS: ACA Marketplace Enrollment Reaches 11.5M

by Bailey Amber
written by Bailey Amber

Affordable Care Act Marketplace enrollment has reached a “key milestone,” with 11.5 million people choosing a health plan through the Marketplace as of December 15, the Centers for Medicare & Medicaid Services (CMS) reported Tuesday.

This is 1.8 million people more than the same period last year, representing an 18% increase, CMS said. It’s also a sharp increase from numbers reported last month: Nearly 3.4 million people had chosen an ACA Marketplace health plan, which represented a 17% increase from the same period last year, CMS announced November 22.

“This year, we’re so pleased to see so many new enrollees on HealthCare.gov, taking advantage of expanded financial assistance and new eligibility to purchase affordable, comprehensive health care coverage that they can use to help keep them and their families healthy,” said CMS Administrator Chiquita Brooks-LaSure in a news release.

The 2023 Marketplace Open Enrollment Period began on November 1 and ends on January 15 for HealthCare.gov. Deadlines vary for state-based Marketplaces, however.

Due to the Inflation Reduction Act — which passed in August — four out of five HealthCare.gov enrollees can find a plan for $10 or less after tax credits, according to CMS. Additionally, 92% of HealthCare.gov enrollees have plan options from three or more insurance companies. Standardized plans also made it easier for consumers to compare and choose plans, according to the news release.

The Biden-Harris Administration made a historic $98.9 million investment to 59 navigator organizations in August to help consumers during the 2023 open enrollment period. The year prior, the Administration invested $80 million. These organizations educate consumers on health insurance coverage and assist them in finding the best health plan for their needs. In contrast, the Trump administration gave $10 million to 39 navigator organizations for the 2019 period.

“Unprecedented investments lead to unprecedented results. Under President Biden’s leadership, we have strengthened the Affordable Care Act Marketplace with continued record affordability, robust competition, and historic outreach efforts – and today’s enrollment numbers reflect that,” said Xavier Becerra, secretary of the Department of Health and Human Services (HHS).

The national uninsured rate was at a record low of 8% in early 2022, according to an August report released by HHS.

The next snapshot of plan selections will be released January 11, CMS said.

Photo: YinYang, Getty Images

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What Healthcare Can Learn From Retail About Improving the Patient Experience

by Bailey Amber
written by Bailey Amber

In July of 2020, an Experian survey found that 60 percent of people had higher expectations of their digital experience than before the pandemic. That means it took less than four months for online behavior and expectations to shift — irrevocably.

As the pandemic accelerated the rate of digital adoption across all aspects of life, consumers began to develop similar expectations for their healthcare. These days, people want to search for and evaluate providers, doctors, and treatments in the same way they do electronics and clothing. (After all, that’s the experience they’ve come to expect from Amazon, Google, and Walmart.) They want immediate access to a wide variety of information—from hospital location to a specific doctor’s specialty to treatment reviews from other patients—so they can make their own informed decisions about their health.

In short, patients want more control of their own healthcare journey.

But providers, hampered by outdated data systems and insulated from marketplace competition, have not made the same adjustments as retailers. That will change quickly as new technology makes data more accessible and consumer goods giants like Amazon and CVS continue to encroach on primary care.

Here are three lessons providers can borrow from retailers to improve the patient experience.

  1. Make your “inventory” visible.

Finding the perfect shoes on a site like Amazon is simple and intuitive. A quick search for “green men’s running shoes” shows you what’s in stock and how soon each option can be delivered, while individual results pages provide detailed product information and customer reviews.

Finding the right doctor should be just as easy. If provider data and availability is your health system’s “inventory,” a patient should be able to search for it on your website just as they would for shoes on Amazon.

Modern search technology can take a natural language query like “doctors near me who accept Aetna insurance” and filter out relevant results. It can access information like a doctor’s specialty and whether they’re accepting new patients and available on a specific date — all of which can be used to deliver specific, accurate info to the patient.

This is particularly valuable for providers facing staff shortages. Just because a doctor is available on a certain day doesn’t mean her support staff is. Advanced search technology can determine if support staff is unavailable and remove that option, saving the patient the frustrating experience of having to rebook an appointment.

  1. Break down information silos.

So why isn’t searching for a doctor online as easy as finding a pair of running shoes? That has a lot to do with how healthcare organizations have historically stored and organized information.

Too often, the information a patient needs is scattered across siloed technology systems within a provider organization. Medical records may be stored on one database, facility records in another, and staff schedules in a third. These legacy data systems, often constructed piecemeal over the years, can’t communicate with one another, trapping the information.

This is where modern search technology can make the difference. The right system can leverage APIs to extract information from disparate sources and combine them into workable data sets. This can be used, for example, to match physicians to specialties and conditions treated.

That information can power a specialized search experience like “find a doctor” or a universal search experience that relies on natural language processing. What’s more, it can be made accessible to a third-party search engine — so a patient searching Google for doctors with a specific speciality in your area will see your results.

This allows patients to do more than just find a doctor. They can also answer other critical questions: Where is the provider located? How do I pay my bill? How do I log into my medical records? How do I change or schedule an appointment? All of this information already exists within an organization; the key is connecting it and making it accessible to the patients who need it.

  1. Focus on consumer experience. 

Providers used to focus on digital search primarily as a patient acquisition tool. The web was seen as a way to attract more patients and feed them into the top of the conversion funnel.

Priorities have shifted amid the healthcare workforce shortages caused by the pandemic and Great Resignation. With more than eight in 10 facilities facing shortages of allied healthcare professionals and America’s already thin nursing workforce retiring en masse, many hospitals aren’t in position to take on additional patient volume.

So, what are short-staffed providers to do? Shift the focus from filling the funnel to improving the patient experience for those already in it. As retailers have shown, digital channels can be just as adept at improving retention as they are driving acquisition.

An immediate way to address the digital experience is by ensuring consumers have easy access to the information they need. Patients already in the process of receiving care within your health system have just as many questions about their care as prospective patients… maybe more. They want access to their medical records, contact information for their physician, details about their treatment, reminders about scheduled appointments, and more.

People accustomed to easily accessing information online don’t have the patience to navigate complicated website drop-downs or pick up the phone every time they want an answer. Putting this information at their fingertips with advanced search shows that you prioritize their time and wellbeing.

Of course, building a strong patient experience will help with acquisition as well. As the primary driver for making healthcare choices has shifted from things like proximity and price to valuing the experience, patients are relying more on word of mouth. Improving the experience brings in better reviews, which improves both your online and offline reputation and brings more patients to your facility. What improves the bottom of the funnel improves the top of the funnel, creating a flywheel.

Hospitals go to great lengths to deliver exceptional care to their patients. That commitment should extend to the digital space. By making your inventory visible, breaking down data silos, and building a better patient experience, providers will have happier patients and healthier margins.

Photo: LumineImages, Getty Images

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Financial Management: The Next Area for Innovation in Serving Seniors

by Bailey Amber
written by Bailey Amber

With 10,000 people turning 65 every day in the U.S., Americans aged 65 and older now hold more than 27% of all U.S. wealth. It’s no wonder seniors are prime targets for scammers and swindlers. An expert at the University of Michigan estimates that “about 20% to 25% have mild cognitive impairment while about 10% have dementia.” For these seniors — nearly 20 million — the chore of accurately and promptly paying bills may be stressful and difficult to execute properly. Medicare Advantage (MA) plans, accountable care organizations, long-term care insurers, Medicaid home and community-based providers, and others with a financial interest in preserving the independence of seniors can benefit from assisting seniors in their financial tasks.

Effective personal financial management is necessary for preserving assets and maintaining independence. This is increasingly important as the cost of health care continues to increase. Even with Medicare, 20% of seniors pay more than $2,000 a year in out-of-pocket health care costs. As the nation’s senior population continues to grow, those who care for seniors can address fraud and cognitive impairment by investing in financial management services that extend independence for seniors by reliably paying their bills.

Studies show that financial management services can also lower health-related costs. In just one example, the Brookdale Center for Healthy Aging & Longevity analyzed the value and costs of daily money management programs (DMM). The research found DMM programs to be cost-effective in extending independent living and staving off expensive custodial care alternatives, such as nursing home placement. DMM/case management programs save an estimated $60,000 per individual compared with nursing home placement throughout the Medicare beneficiary’s lifetime. This is because individuals with DMM services remain in their homes and communities longer and maintain a higher quality of life.

Approximately 80% of people with Alzheimer’s disease and related dementias receive care in their homes from family or friend-of-family caregivers. In 2020, the financial management service, SilverBills, was selected to partner with AARP to conduct research studies that explored the mindset of caregivers for older adults with regard to financial management. Caregivers often experience extreme stress associated with managing the lives of their loved ones — 40-70% suffer from caregiver stress syndrome, according to one source. Caregiver stress syndrome is a condition characterized by physical, mental and emotional exhaustion, and it has a significant impact on the lives of those who take care of their loved ones. It can impact not only the long-term health and wellness of the caregiver but also the health and wellness of the patient. Financial management services can help address caregivers’ frustration with the overwhelming needs of their loved ones by providing an overlooked yet necessary benefit for the patients.

Helping seniors with their personal finances by paying their bills according to their wishes is a relatively new service. Evidence shows that these financial management services directly improve the health and well-being of seniors and their caregivers. Some financial management service companies have earned the patronage of local governments and prestigious funders, including the National Institutes of Health and AARP. It is time for health plans, particularly MA plans, to pay attention as well.

Photo: Olga Shumitskaya, Getty Images

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How UnitedHealthcare Is Supporting Americans’ Travel

by Bailey Amber
written by Bailey Amber

As travel returns to pre-pandemic levels, UnitedHealthcare has recently introduced a set of three travel protection plans called SafeTrip, which offer healthcare insurance and trip cancellation coverage for Americans.

The first travel plan is International Travel Medical, which provides insurance coverage in the case of an accident or illness while traveling. Through this plan, Americans have access to care coordination services, evacuation support and a network for more than 1.7 million care providers and 176,000 clinics, hospitals or healthcare facilities in 180 countries. They can also use virtual care services or connect with the Emergency Response Center for non-medical problems.

Another plan available to Americans is Travel Protection. This plan offers coverage for unexpected flight changes, such as interruptions, delays or cancellations. It can also cover loss of baggage or added costs for pet care if a person’s flight is delayed.

Lastly, there is International Travel Medical Plus, which is a combination of International Travel Medical and Travel Protection.

“What [these plans] do is if you’re traveling — especially away from home overseas and become ill — they provide you with a degree of security and comfort knowing that you’re going to be taken care of,” said Dr. Amit Arwindekar, medical director for North America, in an interview.

The travel plans are available for all Americans, not just UnitedHealthcare members, Arwindekar said. Average premiums range between $80 to $150 depending on the plan selected, trip length, trip cost, state of residence and age of travelers.

While UnitedHealthcare offered travel plans in the past, the new offerings are improved versions following changes to travel due to Covid-19.

“We wanted to include more benefits that are important to people who are traveling, things like trip cancellation, especially in the era of Covid,” Arwindekar said. “We realized trips were getting canceled because of health concerns. People have become much more diligent about their health … The plans include better benefits for travel, better benefits for trip cancellation, better benefits for better coverage of medical issues when you’re traveling.”

Arwindekar added that he hopes these plans offer Americans a sense of security when they’re traveling to an unfamiliar place.

“What we’ve seen over the last 12 months or so is that people want to get back out there and travel,” he said. “We’ve seen a lot of people go on these trips, but they don’t understand what the healthcare system is like where they’re going … We’ve seen so many cases where people get sick either with something they’ve had before or an unexpected accident happens and these stories become really heartbreaking.”

Photo: izzetugutmen, Getty Images

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Overcome Genomics Benefits Management Vulnerabilities With Vetted Expertise

by Bailey Amber
written by Bailey Amber

dna, genomics

It’s easy for health plans to think about genomics as “just another specialty” to manage, much like radiology or cardiology. However, given the dynamic nature of the field and the ever-changing testing landscape with little regulation, genomics must be approached differently when developing clinical policy and enacting utilization management strategies.

Here’s why:

There are now more than 167,000 genomics tests on the market.  Yet there are only a little over 400 CPT codes to represent them. That makes ensuring accurate coding and comparisons of tests against policy and between laboratories complicated and nuanced.

Furthermore, many genomics tests are released for commercial use before there is clinical evidence demonstrating their clinical benefit or comparing them with currently available diagnostic, treatment, or management options. Consequently, health plans often need to develop coverage criteria for genomic tests utilizing far less robust clinical evidence than they typically have for policy development in other medical specialties.

Due to all these intricacies, health plans’ genomic benefits management (GBM) programs face sizable vulnerabilities. Without the help of genomics specialists, it is hard for health plans to manage genomic benefits efficiently and effectively. Now is the time for health plans to evaluate their GBM programs to find the right expert guidance and utilization management support.

Understand current GBM vulnerabilities

Health plans that try to manage the breakneck pace of change and tsunami of information associated with GBM primarily struggle with three things:

  • Policies that cannot keep pace with increasing test volume and complexity
     Most health plans’ GBM policies tend to be static and focus on individual tests. While somewhat feasible in the past, this approach is not sustainable. Health plans can’t expect to write a new policy — and maintain it — for every test or panel given the hundreds of thousands of tests on the market.  In addition to the growing number of genomics tests available, the scope of the medical specialties impacted by genomics is constantly expanding. Thus, health plans must be prepared to incorporate the latest advances in clinical genomics across their library of medical policies addressing  clinical specialties — such as oncology, reproductive health, endocrinology, cardiology, and ophthalmology — to ensure timely coverage of useful treatments and therapies.
  • Consistency in policy application
    The risk of applying genomics policies inconsistently rises when reviewers lack expert-guided resources and references for clinical decision support. For example, a lack of genomics coding expertise may result in apples-to-oranges comparisons of vastly different genomic tests that lead to inappropriate determinations or inaccurate coding. Without providing reviewers with access to continuously updated, evidence-based clinical guidance resources that address genomics across all medical specialties, health plans risk regulatory and compliance issues; inappropriate approvals; inappropriate denials followed by overturns upon appeal; and provider and member abrasion.
  • Reviewer confidence and job satisfaction. The ongoing tsunami of genomics information makes it hard for clinical reviewers to keep up with the latest science and best practices all on their own. Therefore, a lack of clear, relevant and up-to-date policy guidance for clinical reviewers enabling accurate and consistent decisions may require  reviewers to spend a lot of additional time evaluating each request. This may cause them to feel overwhelmed, as well as drive up review costs and resource utilization. Ultimately, even with extra time and effort, inconsistent and incorrect policy applications and therefore, inappropriate determinations, may still occur.

Pursue the GBM program ideal

Above all, health plans want to be confident that their GBM program gives members access to the most clinically useful genomics tests at the right time to drive effective care and improved health outcomes. Few would argue with the statement that solid GBM starts with strong genomics policies and coverage criteria.

Clear, clinically-relevant genomic testing policies written by clinical genomics experts can help ensure that genomic testing coverage guidelines are evidence-based, up-to-date, and easy to use. When coupled with step-by-step workflows and decision aids, health plans can enable consistent and reliable genomic policy application across multiple clinical reviewers.

Moreover, policies that guide appropriate clinical decision-making when step-by-step testing cascades are involved – such as with reproductive testing or tumor testing – allow health plans to engage providers collegially, utilizing these policies as a roadmap to assist providers looking for the most appropriate testing pathway for a given clinical situation. This not only guides members towards the right test at the right time, but limits inappropriate testing and related downstream procedures that can add costs and risks for members. Such support goes a long way toward making providers and members feel they are being heard and well cared for. Indeed, clinicians appreciate when real-world clinical expertise is  behind real-world guidance.

What to consider when evaluating avenues to access GBM expertise

Health plans seeking expert clinical genomics guidance should evaluate resources across three domains: quality of clinical guidance, clinically appropriate cost management, and clinical reviewer support. Here are a few things to consider within each domain:

  • Quality of clinical guidance
    First, what are the professional genomics credentials of the individuals providing the expert guidance? Then, be sure those credentialed individuals are the ones directly involved in writing the genomic policy criteria. Also, be certain the expert resource you choose ensures that their policy criteria is reviewed through a sound external review process. Look for guidance that allows your health plan to create a dynamic, flexible genomics policy framework capable of accommodating fast-paced change without extensive policy revisions. At a minimum, expect quarterly evidence updates so policy keeps pace with rapid changes in genomic testing.
  • Clinically appropriate cost management
    Check that the scope of the organization’s GBM program encompasses expert guidance in crucial clinical categories that genomics touches, such as cancer, reproductive health, rare disease, and pharmacogenomics. Also, verify that relevant clinical practice considerations are factored into the cost management strategy so that clinical quality and value remain high while appropriately reducing clinically unnecessary costs.
  • Clinical reviewer support. Ask how your health plan’s internal review teams can readily access expert guidance when they need it to support informed decision-making and facilitate effective peer-to-peer conversations. This includes up-to-date genomics policy criteria, ready-to-apply clinical decision aids and decision trees, access to relevant references and clinical evidence library, and coding guidance for accurate test identification.

Finally, check provider and member satisfaction rates for the expert guidance program. Satisfaction rates and real-world examples should be readily available for any expert resource your health plan is considering.

Fortifying policies and relationships with genomics expertise

GBM is increasingly crucial but involves significant nuances and complexities that few health plans have the in-house expertise to manage effectively on their own. Engaging experienced and supportive genomics specialists enables health plans to fortify their GBM programs.

By delivering clinical guidance and expertise aligned with current clinical best practices, genomics specialists can help health plans ensure their members have access to the right genomics tests at the right time to drive improved health outcomes and value. With expertise generating confidence in the health plan’s genomics policies, provider and member relationships will be strengthened.

Photo: iLexx, Getty Images

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