Opinion: How is the US Healthcare & Insurance Industry Responding to the COVID-19 Outbreak?

By Celynda Tadlock

The emergence of a novel coronavirus disease, designated as COVID-19, is the third known coronavirus that causes fatal respiratory diseases in humans in the past two decades. It has placed global public health institutions on high alert as the numbers of confirmed cases and countries impacted from human-to-human transmission have increased dramatically over the past six weeks. While the confirmed COVID-19 cases have been reported to be not as deadly as the Severe Acute Respiratory Syndrome (SARS) in 2002 and the Middle East Respiratory Syndrome (MERS) in 2012, individuals with chronic medical conditions or serious underlying illnesses are at higher risk of fatalities.

As it is currently unknown how the coronavirus is impacting the healthcare and insurance industry, the event raises many important questions for the industry. Some of the questions include:

1) What is our capability to contain the emerging virus?
2) Can large-scale spread be prevented?
3) What portion of people exposed to the virus develop symptoms?
4) Of those that developed symptoms, how many have serious underlying illnesses that place them at higher risk of fatality?
5) Of those that developed symptoms, what portion seeks medical care?

While these questions cannot be answered at this time, the US healthcare and insurance industry is well positioned to educate consumers about the situation and precautions to be taken. The education is being supplied to health plan members by email and upon login to their health plan websites or mobile apps. The most common points of education are in the form of “Frequently Asked Questions” that include:

1) How does COVID-19 spread?
2) What are the symptoms of COVID-19?
3) What if I think I was exposed to the coronavirus?
4) Will this be covered by my health benefit plan?
5) How can I protect myself from the coronavirus?
6) Will wearing a mask prevent me from getting COVID-19?
7) Is there guidance related to international travel?
8) Where can I find more information?

With the current situation in the United States, the healthcare sector is already seeing increases in medical resource utilization. Even if a virus causes mild disease, some people may be more susceptible and decide to seek medical care. The number of visits to health clinics, urgent care, emergency rooms and primary care is expected to increase among those experiencing symptoms such as fever, cough or shortness of breath.

Fortunately, both the Centers for Disease Control and Prevention and the World Health Organization indicated last month that the risk of the US population contracting the virus is relatively low, but more data is still needed overtime to fully understand the contraction potential as the outbreak has been declared a pandemic by the WHO due to the rapid spread. The guidance being given at this juncture is to make efforts to flatten the rate of contraction. The cancellation of many sporting events and other large gatherings is a part of that effort to flatten the rate of spread as reducing potential for exposure helps ensure public health and safety.

While the US medical system is very resilient, hospital populations are at significantly increased risk of experiencing complications from infection. Nosocomial transmission caused the majority of SARS and MERS cases as they were linked in part to the use of aerosol-generating procedures. The substantial involvement of nosocomial transmission with previous coronavirus cases suggests it will also be a serious risk with any newly emerging coronaviruses. Hospital safety protocols have been established to focus upon preventing nosocomial transmission from the use of aerosol-generating procedures in patients with respiratory diseases.

Several players in the US pharmacy sector have also started removing the “refill too soon” system edit at the point of service to allow patients to refill their medications for chronic illnesses sooner than required in order to help ensure no gaps in therapy for people who might not have access to home delivery and are not able to go to the pharmacy to pick up their routine medications. This is a common approach used in the US to protect patient safety during times of potential natural disasters or during disaster recovery efforts.

Also, this is the peak season for healthcare and insurance-related conferences in the US. The Academy of Managed Care Pharmacy (AMCP) and National Council Prescription Drug Programs (NCPDP) both sent out membership notices that they are monitoring the situation very closely while still planning on moving forward with the conferences, while Pharmaceutical Care Management Association (PCMA) made the decision last week to cancel their annual meeting.

One organization even had conference etiquette guidelines on doing head nods instead of handshakes. There are also healthcare delivery organizations that updated me on the newly instituted corporate travel restrictions and encourage the use of webcast technologies. There are also organizations issuing statements to tell employees that they are not required to travel if they do not feel comfortable to do so.

Another development to note is emerging reports about certain active ingredients that are essential to producing medications no longer being exported from their countries of origin to the US, which market players are following closely and in the process of searching for alternative supplies.

About the author:
Celynda Tadlock is a veteran senior executive with over 26 years of experience in the US healthcare and insurance industry. Tadlock has served in the leadership of some of the biggest healthcare and insurance providers in the US such as Aetna, Express Scripts and Anthem.