AHIP Makes Recommendations On Reopening Health Care System

Early in the Coronavirus crisis, health insurance providers expressed our commitment to help the health care system meet the challenges from COVID-19. That commitment included working with America’s front-line health care heroes to build capacity, address supply challenges, simplify processes, and strongly support expansive federal funding.  Health insurance providers also took decisive actions to waive patient costs for COVID-19 testing and treatment and to eliminate administrative requirements related to COVID-19. Now, as the country begins to move toward reopening the health care system and economy, health insurance providers are committed to making the transition as easy as possible for patients and clinicians alike.

Many different types of care – from elective surgeries and non-urgent procedures, to primary and preventive care – were delayed to protect patients, health care workers and first responders from COVID-19 exposure and to conserve limited supplies of personal protective equipment (PPE) for those treating patients with the virus. As many states allow health care services to resume, health systems, doctors and health insurance providers will work together to ensure that preventive care, less-urgent care, and elective surgeries are provided as quickly and safely as possible, particularly with an eye towards following Centers for Disease Control and Prevention (CDC) guidelines to reduce the likelihood of virus transmission.

To that end, the AHIP Board of Directors is committed to the following core principles. Together, we encourage their adoption by all health insurance providers:

• Resuming Approved Surgeries and Procedures Prior to the National Emergency Declaration (March 13, 2020): For surgeries and procedures that were pre-authorized and approved but subsequently postponed due to COVID-19, health insurance providers will implement grace periods to extend the approvals. These grace periods will enable surgeries and procedures to be scheduled and performed without having to be re-authorized.  Because circumstances will vary significantly by geography based on the incidence of COVID-19 and the availability of clinical resources, we encourage approvals to be valid for at least 90 days or until local backlogs are cleared.

• Encouraging Resumption of Routine and Preventive Care: As the health care system re-opens, health insurance providers will promote and encourage members to catch up on preventive and routine care deferred due to COVID-19. Insurance providers cover a wide range of preventive health care services at no cost to the individual patient, including well visits, screenings, and vaccinations. The resumption of routine dental care will also be important given the connection between oral health and overall health.

• Promoting Continued Widespread Adoption and Use of Telemedicine and Additional Efforts to Build System Capacity with Adequate Supplies: COVID-19 demanded that our health care system rapidly evolve and innovate to meet the needs of patients. Health insurance providers are committed to partnering with hospitals, physicians, nurses, and other health care workers to continue the accelerated adoption and use of innovative technologies, such as telemedicine, where appropriate to enhance access and capacity and meet the needs of patients.  Our industry will also continue to work to enhance the capacity of our health care system to address future challenges from COVID-19 or other threats to public health while protecting our nation’s front-line health care heroes with adequate medical supplies, especially PPE.  This may include testing innovative payment models that align incentives to promote patient access to care while ensuring the safety of health care providers and patients.

• Advancing Evidence-Based Care and Patient Safety for Newly Diagnosed Conditions and Newly Prescribed Care and Treatments: As patients and consumers return to more regular use of the health care system, they will require new treatments and services.  Health insurance providers will continue to support access to safe, timely, and affordable evidence-based care through use of important tools, such as precertification and prior authorization. For patient transitions from inpatient to post-acute care settings, this includes resuming prior authorization where feasible while committing to continue to accommodate providers who may have continued capacity challenges. Used in a targeted manner, these tools have been effective in improving quality; protecting patient safety; promoting case management for high-risk members; and preserving valuable resources by detecting fraud, waste, and abuse. Achieving these goals will become even more critical as the nation continues to work to mitigate risks from COVID-19, and these tools and reviews will optimize patient care management and allow for coverage verification.

• Enhancing Efficiency and Streamlining Administrative Processes: Prior to the COVID-19 crisis, health insurance providers were actively working with provider partners to enhance efficiency and streamline administrative processes, including prior authorization, while still promoting safe, timely, and affordable evidence-based care. We are committed to continuing this important work. As non-COVID-related care resumes, insurance providers will continue to streamline the use of prior authorization in an appropriate manner, such as through automation, electronic information exchange, programs that identify high-performing clinicians, and value-based provider contracts that incent reductions in unnecessary medical tests, treatments and procedures.

This unprecedented health care crisis has united the many stakeholders in our health care system. Working together, we can actively promote safe and effective care while enhancing efficiency and streamlining administrative processes.

About AHIP

AHIP is the national association whose members provide coverage for health care and related services to hundreds of millions of Americans every day. Through these offerings, we improve and protect the health and financial security of consumers, families, businesses, communities and the nation. We are committed to market-based solutions and public-private partnerships that improve affordability, value, access, and well-being for consumers. Visit www.ahip.org  for more information.