Tag Archives: payers

How has COVID-19 affected home and community-based services in the U.S.?

Millions of Americans with chronic or disabling conditions rely on home and community-based services (HCBS) to meet daily self-care and independent living needs. These services enable participants to remain safely in their homes and communities rather than moving to a nursing home or other institutional setting. State Medicaid programs are the largest payer for HCBS across the United States. The COVID-19 pandemic has presented numerous challenges and had a significant impact on the provision of HCBS.

In this paper, Milliman’s Jill Herbold and Nick Johnson discuss some challenges faced, actions taken, and the impact that the COVID-19 pandemic may have on HCBS for years to come.

How can medical management teams help enhance their health plan’s COVID-19 response?

The COVID-19 pandemic has the potential to significantly disrupt and challenge the healthcare delivery system, including health payers. It also presents opportunities for payers to leverage internal resources and deliver value for their provider partners and customers.

Traditionally, the U.S. healthcare system is bifurcated into two major types of organizations: those that deliver healthcare services and those that finance or fund the delivery of healthcare services. There are a few areas where there has been some convergence of these key functions. In particular, the introduction of risk contracts has moved provider organizations closer to the financing end of things and the growth of medical management has moved some payers closer to care delivery.

In this brief, Milliman’s Penny Edlund and Maureen Tressel Lewis highlight some areas where a health plan’s medical management team may contribute to the COVID-19 response.