To Our Valued Clients and Partners

This is our seventh weekly COVID-19 update. In those seven weeks over 22 million Americans have filed for unemployment, the US healthcare system and its healthcare workers have gone to war with a shortage of weapons and armor, and our COVID-19 death rate accelerates. Yet, as Americans, we hold onto the dream, to our resiliency, and our need for connection and community. We recognize our healthcare and essential workers as our heroes. All of us are finding new ways to support struggling businesses in our local communities and we are invested in helping each other get through this together. 
 
We want to share a few updates to help your business and your employees adjust to changes in your daily lives and your business. Today's topics include: 
 
  • Expansion of coverage for COVID-19 and pricing for COVID-19 related claims 
  • Access to non-urgent care during the stay at home orders 
  • Trends, testing, and antibody studies  
Expansion of coverage for COVID-19 and pricing for COVID-19 related claims
Today marks 30 days since the Families First Coronavirus Response Act (FFCRA) became law. It mandated full coverage and no cost-sharing for COVID-19 diagnostic testing and testing-related services. On Saturday, April 11 th , the US Department of Labor (DOL) published Part 42 to the ACA Implementation FAQ addressing FFCRA and CARES Act Implementation. In this FAQ, the DOL expanded the definition of diagnostic tests to include serological tests for COVID-19 used to detect antibodies against the SARS-CoV-2 virus. The CDC updated ICD-10-CM coding for COVID-19 effective April 1, 2020. No plan amendments are required to accommodate the code updates. We are seeing wide variability in provider adoption and use of the new codes, though it is early and we expect to see increased adherence in the weeks and months to come.   
 
As the regulatory definitions and scope of services requiring coverage expands, and as new COVID-19 CPT and diagnosis codes are issued, know that we are adjudicating COVID-19 claims carefully and with our best-faith-effort.  
 
Pricing and availability of COVID-19 tests and test administration are still in flux. We do have estimates and claims data now on inpatient treatment and will be incorporating all of our data and analytics into the COVID-19 reporting that we previewed for you in last week’s update. Many fully-insured plans have announced that they will go beyond federal and state regulatory requirements and cover 100% of costs related to COVID-19 treatment, at this time we still recommend that you hold on making a similar decision. We know that acute COVID-19 treatment may require extended hospitalization including an ICU stay and that many of our clients may struggle to cover 100% of such costs. If you are eager to explore expanding your coverage benefits for COVID-19 we can help you make an informed decision.  
Access to non-urgent care during the stay-at-home order
Telemedicine and access to care during the stay at home orders  
Due to the stay at home order, many providers have moved away from scheduling in-person office visits for non-urgent care and are offering only virtual visits. For members to access these virtual benefits, the client’s health plan needs to include a telemedicine benefit. Over the last month, most of our clients have chosen to add a telemedicine benefit or enhance their existing Telemedicine benefits. This week, Account Managers will be sending member-facing flyers to all clients that cover telemedicine or telehealth. The flyers help educate members on telemedicine and how to find an in-network telemedicine provider. As a reminder, at HMA we differentiate between the definitions of telemedicine and telehealth. 
 
Telemedicine  covers medically necessary healthcare services between you and your physician to consult, treat, and prescribe for medical conditions. This benefit includes audio and video communication services, such as video conferencing and scheduled telephone visits. Telemedicine visits must be initiated at the request of you or your authorized provider, and replace the need for an in-person office visit. Scheduling and record-keeping standards that apply to in-person visits also apply to telemedicine visits. If a doctor is in-network for in-person services, they are also in-network for telemedicine. 
 
Telehealth  refers specifically to our buy-up MDLIVE partner product that many of our clients offer as a benefit for their members. Clients that choose MDLIVE as an added benefit decide the types of services (medical only, medical plus behavioral health, medical plus dermatology, or medical plus behavioral health, and dermatology).    
 
Mental health access  
Even before the pandemic, the Pacific Northwest had a shortage of mental health providers. The average wait to schedule a first-time appointment with a provider was nearly three months. COVID-19-triggered depression and anxiety have greatly increased demand for counseling and mental health services over the six weeks. Mental health providers in our community have extremely limited capacity to take on new patients. There are other options to access mental health services that expand access to providers beyond traditional driving-distance boundaries. Our Telehealth partner, MDLIVE, offers members access to behavioral health therapists and psychiatrists through its behavioral health product. Please contact your Account Manager if you are interested in expanding your MDLIVE coverage to include behavioral health. Additionally, some employers offer Employee Assistance Programs that include counseling sessions.  
 
Telehealth (MDLIVE) wait time improvements  
For clients with MDLIVE, we saw dramatic improvements in wait times dropping down to less than 45  minutes over the last week. MDLIVE has added new providers to meet increasing demand and they have updated their mobile app, phone IVR system, and website to provide you with estimated wait times.  
Trends, testing, and antibody studies
The talk and trends right now are all about getting over the peak, easing stay-at-home orders, returning to work, and what role antibody tests will play in that return to work strategy. Many predictive models expected that COVID-19 daily new cases in the US would peak by now. The US did see a peak on April 10 th  with a dip mid-week, yet daily new cases in the US have increased steadily over the last four days according to the John Hopkins COVID-19 tracking website. The Trump Administration is using the latest University of Washington predictive model for active COVID-19 cases. This model has the US reaching a peak for active COVID-19 cases next Monday, April 20 th
 
We believe strongly that increased testing, both for COVID-19 infections and antibodies, will be a key factor in the timeline and safety of our nation returning to work.  
 
Because we recognize the public health urgency of advancing antibody studies both for our community and our nation, we are standing behind our company vision, Proving What’s Possible in Healthcare®, by donating $10,000 this week to Bloodworks NW in support of their landmark COVID-19 antibody study with UW Medicine. Additionally, we have committed to a 100% corporate match for employee donations to the study.  
 
The study is seeking fully-recovered adult COVID-19 survivors to donate their plasma for the study. The study aims to understand how antibodies from people who have recovered from COVID-19 can help those who are currently ill with the virus. The donated plasma may provide a potential new treatment option for patients who cannot generate antibodies on their own. Please encourage survivors you know to visit the  Bloodworks Northwest COVID-19 Donor Project   to learn more about participating in this study.  
 
We’re Here for You  
Our focus, dedication, and support remain steadfast as we navigate these unique times with you. Thank you for your continued trust in our organization. We hope you and your loved ones remain safe and healthy. Please reach out to your Account Manager if you have any questions or if there’s anything we can do to help. 
 
 
Best Regards, 
 
Lindsay Harris  
Chief Growth Officer 
HMA - Proving What’s Possible in Healthcare ®