As we post this today, the “social isolation” guidelines instituted to curtail COVID-19 have been extended through April 30. For those who are older, have health issues, or were already struggling with social determinants of health (SDoH) needs, this may seem like an eternity.
Health plans are scrambling to make sure that phones are answered timely with the influx of calls from those trying to gain access to standard care, concerned about having enough medication, etc. The focus at the moment is on the immediate need: ensuring that all parts of the organization fulfill their obligations given the increase of calls and inquiries coming through in unprecedented numbers and the up-to-the-minute guidance coming from CMS allowing for flexibility in access to care.
With the emphasis on addressing needs related to COVID-19 prevention and treatment, who is checking within your organization to ensure that previously instituted barriers have been truly lifted and that your members are getting what they need? It is critical that a pro-active approach is taken to determine that the access to care for at a minimum the following have truly been lifted:
1. Waive COVID-19 test cost-sharing*
2. Waive or reduce treatment cost-sharing, including primary care, emergency department, and telehealth services*
3. Eliminate prior authorizations*
4. Eliminate prescription refill restrictions*
5. Decrease limitations around home or mail prescription delivery*
6. Increase patient access to care through telehealth*
Let us assist in determining if the fixes your organization has put in place are truly working. By taking measures such as reviewing call logs and analyzing appeals and grievances and other transactions, we can ensure your members are getting what they need.
Before you know it, we’ll be gearing up for the next Annual Election period (AEP). This seems so far off, however, we are in the depths of the planning season now and current events will forever change the way in which we think of plan design. Rebellis Group can help with this as well. SDOH, telehealth and other access items once viewed as add-ons should now be seen as common place essentials. Let us help you build a plan design that fits the needs of your specific demographics.
You are doing so much to assist your members and to navigate through this time, let us lend the same support to you.
Contact us at firstname.lastname@example.org