By Jeff Roe / For The Herald
Coronavirus is exposing huge gaps in American health care. It is time for all of us in the industry to recognize what it is telling us and ask ourselves how we can respond to make health care work better for those we serve here locally, around the state and across America.
The United States spends roughly double per capita on health care of what other developed nations spend, and our high costs leave millions of Americans unable to afford basic care. Too many parents face an impossible choice between feeding and housing their children or paying for needed care.
But the pandemic is providing a roadmap on how to eliminate such no-win trade-offs, bringing the public and private sectors together in new ways to bridge the gap between consumers and the health care they need and deserve.
For example, with encouragement from the government, the private sector moved quickly in the early days of the pandemic to largely eliminate patient out-of-pocket expenses for covid testing and treatment. Looking ahead, when vaccines become available to help fight the virus, we must work together to apply the right mix of competitive pressure, public awareness and government intervention to make the vaccines similarly affordable for everyone.
More broadly, the coronavirus underscores the importance for providers and health plans to continue to collaborate to improve patient outcomes.
Early in the crisis, Premera was one of the first health plans that offered to prepay provider claims. Since the program was put in place, Premera has prepaid more than $850,000 to Snohomish County doctors and hospitals, providing much-needed funds during a time when shelter-in-place restrictions have precluded many regular procedures that normally help fund these providers.
Prepayments also gave the government time needed to eliminate regulatory barriers and encourage utilization of telehealth services, so patients could get care in a safer and more timely fashion.
Prior to the pandemic, telemedicine occupied a small niche within health care. Weeks in, we expanded our telehealth offerings for our members and virtual visits went from about 5,000 in January to more than 170,000 in March. In Snohomish County alone, our telehealth volume is more than 30 times larger than it was a year ago. This explosive growth demonstrates telemedicine’s potential to cost-effectively improve patient access to quality care by removing geographic barriers, such as requiring patients in Marysville to travel to Seattle for regular check-ins with specialists.
Next, we should intensify our focus on preventative medicine and dealing with the formidable community, societal and environmental factors that impact the health of those we serve. Many organizations throughout our region, including Premera, have begun taking a more holistic approach to address social determinants of health.
Locally, we have made nearly $5 million in grants to 45 Snohomish County nonprofits since 2018 to support programs to reduce homelessness, treat addictions and broaden access to mental health services. These systemic factors impact people’s potential risks related to the virus and their overall quality of life. We must step up coordinated, community-wide efforts to address them.
Finally, health plans like Premera must continue to take a hard look in the mirror and critically assess the administrative burden and costs we impose on the health care system. We must partner differently and share accountability with providers to deliver the best outcomes for patients.
Like many employers responding to the onset of the virus, Premera quickly pivoted to a remote work environment. With that transition, we also streamlined our claims review, approval and payment processes related to coronavirus. Moving forward, we need to apply this creativity in other areas as well.
The coronavirus has dealt a massive blow to our community. But if we strategically apply the lessons it is teaching us, it can help us change health care for the better.
Jeff Roe is president and chief executive of Premera Blue Cross, the state’s largest and only Washington-based provider of health insurance.