The usually bustling corner of Sixth and Gaines streets in downtown Little Rock is quiet these days, but the business of health insurance in Arkansas is anything but.
For Arkansas Blue Cross and Blue Shield, which has called Gaines Street its corporate home for more than 60 years, the pandemic has meant business as usual even if virtually all of the company’s employees are working from home these days.
Blue Cross, of course, is synonymous with health insurance in Arkansas, having dominated the state market for decades. Through its USAble Mutual Insurance Co., Arkansas Blue Cross owned 25 percent of the life- and health-insurance market in the state in 2018, the most recent year for which data is available, according to the Arkansas Insurance Department. Its 2018 premiums totaled $2.4 billion.
Like just about every other industry, health insurance awaits the post-pandemic “new normal.” And health insurance carriers have a unique perspective on how COVID-19 is impacting all facets of the health care industry.
Arkansas Money & Politics spoke with Arkansas Blue Cross CEO Curtis Barnett about challenges posed by the pandemic and what changes could be in store once that new normal arrives.
AMP: What are some specific challenges faced by health insurance carriers, and how has Arkansas Blue Cross handled them?
Barnett: As a health plan, Arkansas Blue Cross and Blue Shield is uniquely positioned to see and support all parts of the health care system. When the pandemic hit, our immediate thoughts went to how do we avoid a disruption in our business operations that would negatively affect our customers, and how do we keep our employees safe? Like many companies, we viewed social distancing achieved by having our employees work from home as a key to meeting both needs.
We had just over 35 percent of our 3,000 employees working from home before the COVID-19 outbreak. We were able to scale up to 90 percent within about a week, and that’s where we’ve been since mid-March. We’re very proud that we’ve been able to continue serving our customers throughout the pandemic with no interruption. They expect us to be there for them when they need us. That expectation has been even greater during the pandemic when uncertainty has been so high.
Next, we turned our attention to our communities, many of which have been devastated by the economic crisis caused by the pandemic. Through our Blue & You Foundation for a Healthier Arkansas, we quickly made a $500,000 donation to address food insecurity by funding three major statewide food hubs and 17 local United Way agencies. We then set up a COVID-19 Rapid Response Fund where we funded over $1.7 million in grants to non-profit organizations working on the frontlines fighting the pandemic. We were able to review requests and fund those that were approved within about a week of receipt. These funds have been used for such items as purchasing personal protective equipment; mobile testing and screening in underserved rural areas; purchasing infection control systems that hospitals installed to help care for COVID-19 patients; and telemedicine equipment in rural areas.
More recently, we funded a grant with the Northwest Arkansas Council for $286,000 to initiate a program to help the Hispanic and Marshallese populations that have been hit so hard by COVID-19. These funds are being used to hire bilingual “community health navigators” who will go into these communities to help overcome the language barriers and other social issues that are making them most susceptible to COVID-19. All and all, the Blue & You Foundation will provide about $4 million in grants this year to help non-profit organizations and communities battle COVID-19. All of those funds are dedicated to helping Arkansans.
Finally, when we learned that providers were facing financial hardships because they had increased expenses preparing for COVID-19 while experiencing reduced revenue due to the deferral of elective and non-urgent care, we took several actions. We expanded access to telehealth services for medical care, dentistry, behavioral health services and select therapeutic services so that our network providers could maintain patient relationships and a level of cash flow during the pandemic. We then implemented a program to provide advanced and accelerated payments to not-for-profit hospitals and primary care clinics to increase needed cash flow when so much care was being deferred. We suspended prior approval and similar requirements to help ease their administrative burden. And we helped lead and support two media campaigns highlighting the safety and preparedness of our state’s hospitals and clinics and encouraging the public not to delay needed care.
AMP: How might an emphasis on telemedicine impact health insurance providers?
Barnett: The true measure of success for Arkansas Blue Cross, and really for the entire health care system, rests in our ability to get and keep people healthy. We recognize that an important part of getting and keeping people healthy is for them to have access to the medical care they need, when they need it.
We promoted telemedicine long before the pandemic as a way to improve access to needed medical care by using digital technology to either extend care to underserved areas or improve patient engagement by making care more convenient. That’s why Arkansas Blue Cross made a significant investment in the [University of Arkansas for Medical Sciences] Institute for Digital Health and Innovation in 2019.
Arkansas Blue Cross also recognizes that mental health is as important as physical health to our overall well-being and that the two are deeply connected. Once the pandemic is finally behind us, one of the greatest “silver linings” will be the role telehealth has played in mental health treatment. We see patients and providers much more willing now to use new technologies, like telehealth, to treat mental health conditions. This allows us to overcome social and economic barriers to care. For Arkansas Blue Cross, we’ve seen more than a 10-fold increase in our total telehealth visits since the pandemic started and over 35 percent of these visits have been for mental health services.
AMP: What measures did Arkansas Blue Cross take once the virus hit to help policyholders?
Barnett: From the outset of the pandemic, we knew our policyholders were anxious and concerned, asking questions like: How will I know if I have the COVID-19 virus? Will it be covered by my health insurance? If I socially distance by staying at home or if I get quarantined, how will I get my medications and routine care?
So, very quickly we said we’d cover the diagnostic test for COVID-19 with no copay from the member if the test was ordered by a doctor. Also, if one of our members is diagnosed with COVID-19, we said we’d pay 100 percent of the costs for the treatment. For prescription drugs, it’s often common to limit supplies to 30 days to reduce the possibility of waste or abuse. During the pandemic, we’ve opened this up so our members can get a 90-day supply.
Finally, we began covering telehealth services with no copays from our members. We didn’t restrict this benefit only to services provided by companies that specialize in telehealth, rather, we also made the benefit available when our members used a network doctor or mental health professional in their local communities. This included not just video but telephonic services as well. These actions gave our policyholders tremendous peace of mind.
AMP: Will the pandemic expedite expanded health care access?
Barnett: I believe so. This tragic event should be a powerful force for positive change and an opportunity for all of us in health care to develop creative solutions to chronic problems like access.
In the future, we’re going to see a much greater push to meet patients where they are when it comes to providing health care services. And where they are is on their mobile devices, in their homes and in the communities where they live. We’re seeing a growing willingness by our members to receive services in different settings and through different channels, which is being influenced not only by the pandemic, but also by a generational change as 73 million millennials, who are already comfortable using technology and value convenience, will pass baby boomers as the largest generation in the United States within the next two years, representing more than 50 percent of the workforce.
In addition to the growth in telehealth visits, I think we’ll see several other areas grow to help improve access. Remote monitoring through digital technologies is likely the next area poised for significant growth and should represent a meaningful step toward more scalable health care. People having their condition monitored through a digital device can have access to their health information 24 hours a day, 7 days a week; they can easily receive guidance if they need help interpreting the health information they receive. Then a qualified health care professional monitoring their condition can proactively reach out to the patient if a concern is detected, rather than the other way around. This represents the vast power and potential of telehealth.
As patients continue to push for safe and convenient care, we’re going to see more services provided in the home environment. Many parts of the country already have fairly advanced “hospital at home” programs where hospital-level care provided in a patient’s home is a full substitute for certain types of acute care. These programs recognize there are many benefits to providing care in the home. It’s often where the patient is most comfortable, where they’ll rest and recuperate. It’s also where health care professionals can observe, firsthand, many of the social factors that can influence the patient’s health, such as diet, medication adherence and family support.
Finally, retail health centers, many affiliated with pharmacies, will continue to emerge as neighborhood-based “one-stop shops” to meet many of people’s basic health care needs. They will provide a range of services, including primary care, prescription drug fulfillment, wellness coaching and personal care supplies.
AMP: Will the pandemic result in higher rates?
Barnett: I can’t specifically talk about any rate actions as our 2021 rate filings have been submitted and are currently being reviewed by the Arkansas Insurance Department.
I can say that this has been a particularly challenging year for filing rates due to all the uncertainty caused by the pandemic, especially as it relates to making assumptions around: 1) when will the care that was deferred while the health care delivery system focused on preparing for COVID-19 actually occur?; 2) will the medical needs of those patients be even greater because their care was delayed?; and 3) how many COVID-19 waves will we experience and what will be the intensity and duration of those waves?
Another uncertainty is the long-term health impact on those who experienced significant COVID-19 issues/long-term hospitalizations.
AMP: Will we be better prepared if there’s a “next time”?
Barnett: If we’re disciplined enough as a country to implement the “lessons learned” from this pandemic, then no question, we’ll be better prepared.
Once this pandemic is behind us, we should convene an independent, science-based, nonpartisan commission to conduct a thorough assessment of what went right and what went wrong this time. The United States has a critical global leadership role to play to help ensure there is international cooperation so that future pandemics are identified and communicated as soon as possible. We should start there and extend the review to address the public health infrastructure needs at the state and local levels. There needs to be a focus placed on the rapid deployment of testing and in using technology to build the capacity needed for effective contact tracing.