COVID-19, the SDoH, and Payers

By now the healthcare industry and every stakeholder knows that the pandemic’s impact will be felt indefinitely. However, with escalating numbers of unemployed, and uninsured, I’ve received countless emails from colleagues and our Monitor Mondays listeners asking about how the payers are stepping up? What’s the status of Medicaid expansion? How are payers assuring patients get their basic human needs addressed? Pre-COVID-19, the financial impact of NOT addressing assessment of, and intervention with the Social Determinants were concerning enough. There was a massive hemorrhage of dollars, which are continuing to drain as you read this article. Patient outcomes were already challenged, and hundreds of hospitals were on the verge of closure, especially those across rural communities.

Here’s a current broad swipe of relevant payer efforts:

As of July 1, 38 states (including District of Columbia) have adopted Medicaid expansion, 13 states have not. The Kaiser Family Foundation has actively tracked state expansion activity, with an interactive map and grid of all state programs and benefits available at www.kff.org. The most recent states include Idaho, Utah, Nebraska (implementation 10/2020), and Oklahoma (implementation targeted for July 1, 2021, if not before. Since the pandemic began, more than 20 million new Medicaid applicants have hit the rosters, 1.5 million over last month alone. Many of these persons are in states without expansion, and with among the highest rates of COVID transmission including Florida, Georgia, Missouri, Mississippi, and Texas. New estimates have global unemployment expected to hit 80 million by the end of 2020, close to 50 million in the US alone.

Medicare Advantage beneficiaries have doubled in the past decade, finalizing requirements last month to increase telehealth access (up to 80% of plans), with:

• 61% paying for over the counter medications
• 39% for meals
• 34% transportation
• 6% for bathroom safety

Managed Medicaid also focused on the expansion of telehealth for all intervention, especially for behavioral health, including substance abuse treatment.

Humana is using medical transportation vehicles to deliver food to vulnerable members in Louisiana, and several other states. Blue Cross Blue Shield is bringing care delivery to at-risk communities, such as sending out vans to do Coronavirus testing throughout Oklahoma. CareSource is using its JobConnect platform to link members with employment, offering education and skill-building programs. Several Centene subsidiaries are partnering with community-based organizations to provide access to food and other essential supplies across the states. Gateway health plans have increased their collaboration with community-based organizations to address food insecurity, job training, and education programs, in Philadelphia, Pittsburgh, and throughout Central Pennsylvania.

As the virus rates continue to rise, we can expect to see more individual managed care providers step up to address the social determinants. Assuring access to these necessary services and programs will maximize health outcomes, especially amid the pandemic.

With the virus rates rapidly rising among a majority of states, our Monitor Monday team wanted to check on how organizations are doing with personal protective equipment supplies. The survey results were surprising and concerning. They are viewable here. 

Programming Note: Ellen Fink-Samnick is a permanent panelist on Monitor Mondays. Listen to her live reporting every Monday at 10 a.m. EST.