The COVID-19 pandemic has brought unprecedented stress and challenges to the healthcare industry. Based on the nature of the Medicare Advantage program and the predominantly elderly population it serves, Medicare Advantage organizations (MAOs) in particular face unique challenges. Beginning in early 2020, parts of the country implemented social distancing, with periods of closures or reduced capacity for many healthcare professional offices and postponement of nonurgent procedures at hospitals. Due to greater susceptibility, seniors may continue social distancing for more time and may be more hesitant to continue with normal social interactions, including receiving routine healthcare services.
In this article, Milliman’s David Koenig, Rob Pipich, and Michael Polakowski explain why MAOs need to be aware of the possible implications of these realities on their business and why they should address any issues now.
On a nationwide basis, we are being encouraged to limit our
social interactions to slow the spread of the coronavirus, slow the rate of
those who will fall ill to it, and avoid overtaxing our healthcare system over
a short period of time.
What does social distancing mean for those who require
healthcare during this time? Could they be helped by telehealth, which has the
potential to replace some in-person services and better triage care based on
Medicare has specific definitions for telehealth services—it is covered by Part B and is limited to live audio/video services furnished by specific practitioners at a distant site to a beneficiary in an originating site. Restrictions under the Medicare program regarding beneficiary location, provider type, and geography have limited the adoption of telehealth services provided to Medicare beneficiaries. The Telehealth Services During Certain Emergency Periods Act of 2020, which is part of the Coronavirus Preparedness and Response Supplemental Appropriations Act of 2020, has removed many of these restrictions.
In this article, Milliman’s Susan Philip and Susan Pantely discuss Medicare’s telehealth expansion during the coronavirus pandemic.