OODA Health recently hosted a webinar with Oliver Wyman, At the Front Line of COVID-19: How Leading Health Systems and Payers are Addressing Severe Financial and Operational Risks. We invited panelists from Northwell Health and Empire BlueCross BlueShield, who are delivering care and administrative support in New York in the hot zone of COVID-19. As there has been a lot of coverage on the clinical issues for providers caring for patients, the intent of our panel discussion was to shed light on how providers and payers are dealing with the administrative challenges of the pandemic.
Here are some highlight excerpts for the conversation. You can also see the full panel discussion and see industry forecasts on the impact of COVID-19 from Oliver Wyman research by viewing the webinar on-demand.
What has COVID been like for Northwell? I’m going to guess that you probably didn’t have in your capital plan of building a field hospital. What happened to your plans and what has been your experience here?
It has been a tremendous administrative challenge and also drew me back into my clinical days as an emergency physician and emergency management leader. I was asked to help stand up one of our field hospitals with the Army Corps of Engineers and the Department of Health, so we took over a local state university, using their soccer/football and two baseball fields, their gym, and worked with the Army Corps of Engineers, the National Guard, the Department of Health, and FEMA. In two weeks, we had the standup of a 1,000 bed hospital, which unless you were a member of the soccer, football or baseball teams, was pretty inspiring to see. It’s a tougher environment for patients to get care, family couldn’t be at the bedside, and I think one of my key takeaways is to focus on anything that we can do to preserve the patient experience.
From my perspective, it has been the most challenging period of my career, first and foremost serving the community that’s in need but at the same time trying to keep our staff safe. Just to give a sense to the audience of, when we say that we were in the hot spot, we either tested or treated over 40,000 COVID positive patients across our health system, including over 14,000 inpatients during the period. We peaked around April 12 at over 3,400 in-house COVID positive patients across our hospitals, and in order to accommodate that, we took extraordinary efforts to increase our bed capacity by over 50 percent across our hospitals.
From a financial standpoint it has been extremely challenging and we are actually still under a restriction in our part of New York State to perform any elective or routine services. The COVID population in our hospitals has declined significantly although we’re not yet out of the woods. We’re at about one-third of where we were at the peak in terms of COVID hospitalized patients, but the cost to care for these patients is very significant. They have about three- to four- times the length of stay that we would see in a typical medical-surgical patient and we’re incurring significant costs related to labor, supply costs, and equipment.
You might hear the sirens and ambulances in the background right now directly next to the Brooklyn Hospital Center, which is an independent hospital here in Fort Greene, Brooklyn. I watched literally from my window for about two months as they stood up all the testing tents and temporary sites down there in their parking lot. I realized that these were not all testing sites but actually about half of them were morgues. It was just such a chilling dose of reality and how serious, taking it from just numbers in a spreadsheet working in our offices as a payer, to the depths of what this really looks like on the front lines and what our partners at Northwell and the rest of the provider community are going through out there actually in the day-to-day of all this.
At Anthem, we asked ourselves what is our role in a pandemic crisis like this? We’ve honored waiving premiums for a period of 60 days for many of our clients, and obviously nobody is hoping to leave anybody out without insurance during this strange time when it’s most needed. We just took another step forward and announced last week that we’ll be issuing a series of advanced payments to hundreds of independently owned provider practices throughout the state and across the country, practices who simply can’t afford to keep going the way things are, and hospitals have obviously substantial material financial challenges and turmoil of their own right now which I’m sure we’ll talk about a little bit more throughout this presentation. I was really proud and happy that our company stepped up and is out there partnering with those independently owned entities to try and bring them through this time of change and toughness into obviously what should be a more stable period as new bed days continue to come down.
I think there is a lot of awareness among the general public of the clinical and operational challenges that healthcare providers have been facing. To Jordan’s point, there’s increasing awareness of the financial challenges that this crisis has created, but there’s a lot of administrative challenges that I think don’t get discussed often enough. Can you talk a little bit about what that those challenges look like and what you’ve been doing?
Early on, there was a lot of confusion around the cost sharing issue because some plans were covering certain things and some weren’t, so we made the decision early on to stop point-of-service collections and then further, to hold sending any bills to patients after we received the insurance portion of the payment if it did indicate that there was a patient cost sharing amount. Because all of this was happening so rapidly, it was difficult for the various payers to configure their systems to eliminate the cost sharing on the COVID testing and/or treatment as may have been applicable. In order to protect consumers and to not send out bills in error for cost sharing we’ve held back on collections of point-of-service and on sending out bills until we’re sure in working with the payer that any amounts for cost sharing that we’re invoicing are in fact accurate and appropriate.
To add some other administrative challenges we’ve faced: a lot of our financial counseling work was a lot tougher to do, just to get in to see a patient if they were COVID positive. There were a lot of coding changes to catch up with. This has been important work to get on top of because we were using those codes to help identify the COVID cases to know how to handle those accounts versus a non-COVID visit. It has really involved all front, middle and back parts of the revenue cycle to get up-to-speed quickly and make sure those accounts were handled correctly while still doing normal work.
Building on that a bit, I think about this situation from the point of view of a consumer who might have symptoms they don’t understand and they’re terrified of, and are suddenly scared to go in and get care. They’re getting conflicting guidance from their health plan, the media or their employer about what might be and what might not be covered, and then suddenly they’ve had their income cut or lost their job and feel more economically vulnerable than ever before. That’s a terrible place to be in. A surprise bill might actually be more devastating to you as a patient than it would have been a couple of months ago.
Seth, how does OODA help with that, and what have you all been doing?
I’m grateful to support these partners at the front line and others that we’re working with; for example, in California, Blue Shield of California announced a $200 million relief package not unlike what Jordan mentioned, but where they’re asking us to step forward as part of that relief package. Sam, the consumer has always been in-between a health plan and a provider when it comes to a financial relationship; we deposit that consumer right between these two organizations, and we’re doing our best to stay coordinated and communicate. But the reality is we’re not coordinated, and I don’t think I’m offending anyone on the line when I say that Anthem, like any payer, will send out communications about what you owe and this is what you should expect, and then Northwell will, like any provider, send out information separately about what you actually need to pay. That has always been a disjointed and confusing process, but for reasons you just mentioned, Sam, it has become even more distressing and complicated.
What OODA Health believes, and grateful that the partners on the call share this belief, is that we really need to streamline and remove some of that confusion by focusing the financial relationship through one entity. We think this is now the time more than ever to relieve the providers of the burdens that Jerry and Rich are talking about, and to have a consumer really focus it’s financial relationship with the payer, to be able to say, “I know that the payer is going to be the single source of truth, they’re going to send me all the information I need to know about what I owe, and they’ll set up financing options for me, and I’m not going to be ping-ponged in-between with me, the payer, and the provider on what’s going on.”
I think we’re finally getting to the point where things are now beginning to pay and process correctly, although clearly still awaiting a fair amount of guidance on COVID reimbursement and claims in that sense. Separate and aside from this pandemic, the reason that we’re partnering with OODA in that component of the patient journey is because our company from our president down firmly believes that we can all do better and that putting the patient in the middle of that collections process should not remain a problem for as long as it has. There’s certainly a better way for us to all work together so that the patient isn’t the sacrificial component of that transaction.
Amen to that. Dr. Brogan, I’d like to go back to you and broaden our conversation a bit. As we talk about the shift to telehealth and a shift in consumer habits, what permanent changes broadly might we see at Northwell coming out of this and going forward?
We are now doing 4,000 telehealth visits per day across the health system. We started a journey of telehealth for very different reasons. It really started with tele-psychiatry because of a lack of availability of psychiatry resources, clearing patients from the emergency departments, and then having to wait sometimes for two or three days until we could do the appropriate evaluation and get them to a psychiatric facility. We’re now in the process of broadening that, we have a tele-ICU program now, a tele-stroke program, and we were in the early phases of testing in internal medicine offices, and this has just put that program on steroids.
I think that telemedicine is here to stay for a number of reasons; one is for safety from the COVID and whatever comes next climate, the other is convenience for patients’ compliance. There is a lot of patient navigation which I think is critical to reducing the cost of healthcare and assisting patients in how they care for themselves.
I think telehealth is going to be an important tool for all of those reasons, and I’m hoping that the net impact is that we can actually provide better care to more patients in a more convenient and safe fashion, but COVID has clearly been an accelerant like nothing I’ve seen. I’ve been in practice post-residency for 30 years and I’ve never seen anything in medicine move as quickly as telemedicine.
Yeah. It’s been amazing, we’re hearing these stories all across the country. Rich, the flip side of what Dr. Brogan just shared with us is that we’ve got patients who are not necessarily coming in for the care that they need. How are you thinking about bringing people back in that environment where you’re probably more in their home than ever before and you’re also competing with more players than ever before?
One of the things that we are doing right now even though we’re not allowed to reopen yet for elective and routine services, is we’re outfitting all of our practice locations and ambulatory locations to be safer environments once we do reopen - examples are putting up plexiglass where needed, spacing out chairs in waiting areas, and stocking up with all the necessary PPE. We’re getting ready for when we do get the go-ahead to reopen that the office locations are safer environments and that our patients are more comfortable coming back in when necessary.
Not everything can be done via telehealth, so there will be a need to continue to have onsite availability for patient care. The other thing that we’re doing on the administrative side, we have thousands of corporate employees who are working remotely currently. We’re evaluating whether or not we can do that on a longer-term basis for portions of that corporate staff and have them be able to work predominantly from a remote location. I know we’re not unique in that regard when looking across the country at other industries.
To see the full discussion, please view the webinar on-demand.
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