Over 20 million Americans Could Face Healthcare Insecurity Due to COVID-19
Patients ultimately pay for their medications in one or a combination of two ways: through their health insurance plan or out-of-pocket. The COVID-19 pandemic has jeopardized both.
As of June 5, 2020, 44 million people — over a quarter of the U.S. workforce — had filed for first-time unemployment benefits since March, when much of the U.S. economy began to shut down in response to the pandemic.
Compounding the financial strife of job loss is the additional loss of employer-sponsored health insurance. The Economic Policy Institute estimates that, of workers filing unemployment claims, 45.7 percent had health insurance provided by their employer. This means, when they lost their employment, more than 20 million workers lost their health coverage, too. This does not include the estimated 13 percent of the population aged 18-64, who were uninsured before the pandemic.
Millions of Americans now find themselves facing healthcare insecurity due to lost coverage or an inability to pay for health services on their current income. While some may qualify for continued employer-sponsored coverage under COBRA, the costs are staggering. Those electing to use COBRA to extend their coverage during unemployment become responsible for the full share of employee and employer coverage.
In 2019, the average cost for an individual’s annual coverage under an employer plan was over $7,000, and over 20,000 for family coverage — unattainable for many who are suddenly without income. Losing the security of a paycheck and health coverage is unsettling under normal circumstances — it’s especially daunting during a global pandemic.
The 53 million Americans who fall into the category of low-wage workers face a particularly harsh reality in the event of a job loss: 45 percent have employer-based health insurance, and 21 percent are uninsured. Those who remain employed are likely working in environments where they are at high risk of contracting COVID-19, including the 3.5 million Americans who work in the healthcare and social services industries.
While Medicaid and Affordable Care Act programs have expanded in many states, 5.7 million Americans won’t qualify. Others are holding out on completing a sea of paperwork in hopes of getting their jobs back or simply accepting the full cost of their medications and healthcare.
One in ten adults has experienced trouble affording prescription medications, health insurance or medical bills since the COVID-19 outbreak began. And, it’s likely many of these people are on therapy that requires daily prescription medications — like nearly half the U.S. population.
In a survey of nearly 3,000 providers, when asked what medication barriers their patients are experiencing due to COVID-19, 30 percent said their patients are unable to pay for prescriptions. When it comes to medication, many patients are now looking at changed, reduced or even eliminated access channels. Since the beginning of COVID-19, more than one in five patients surveyed said they’ve used a cash price program to help afford medications.
The Healthcare Industry Shifted with Patients in Mind
In response to medical offices closing, social distancing measures and stay-at-home orders, many plans — including government-sponsored plans — relaxed or waived policies for many prescription medication refills, allowing patients to more easily access their currently prescribed medications.,
However, many saw a drop in new prescriptions as patients stopped visiting providers for acute care: From January to May, pharmacies saw a three percent drop in chronic care prescriptions compared to a 25 percent drop in acute care prescriptions. In a recent survey of more than 500 patients who have or are caring for someone with a chronic condition, 64 percent listed longer prescription fills as one positive healthcare adaptation they’d like to see continue, even post-pandemic.
Many retail pharmacies launched prescription home delivery, or waived fees for existing services to better serve sheltering-in-place and vulnerable populations. Of patients surveyed, 84 percent currently receive their medications at a retail pharmacy, and 43 percent indicated interest in switching to a pharmacy home-delivery option for their prescription medications.
Telehealth Visits in 2020 Could Exceed 1 Billion
In response to the closure of many offices, telehealth use skyrocketed by at least 50 percent in March alone, and Forrester researchers predict virtual visits will top 1 billion in 2020. This increase was partially enabled by accelerated regulatory access approval.
As barriers fell, adoption surged. Of providers surveyed, 85 percent said they’ve started telemedicine since the COVID-19 pandemic. In a matter of weeks, providers and patients left their safety zone of traditional in-person care and propelled healthcare into the future — where many predict it will stay.
Most patients surveyed experienced a shift in how they work with their healthcare team due to COVID-19, with 42 percent canceling or delaying in-person appointments and 44 percent moving to telehealth visits. Previous to COVID-19, only 17.6 percent said they’d used telehealth when provided the option. Two out of three respondents said they would now be more likely to use telehealth services moving forward, with their primary care provider or any of their doctors.
For some, the quick conversion to telehealth was a lifeboat to buoy patients’ health needs during a time of shutdown. But with widespread adoption, it is now becoming a keystone for more accessible, connected healthcare standards. Telehealth can allow much of the patient journey to take place without the patient ever leaving home, from consultation to prescription and even prescription delivery, in some cases.
At a time when many feel removed from “normal,” telehealth can bridge the distance between provider and patient. Technology solutions that prioritize patient choice can enable providers to further involve patients in the prescription decision process, including method of payment and drug selection. Involving patients allows care plans to continue and keeps medication access channels open so patients can continue living healthy lives — no matter the circumstances.
Virtual visits and technology can bring providers into patients’ lives like never before, potentially improving relationships as they understand each other as people in their own homes, removed from a clinical setting.
The Path Forward for Medication Access and Patient-Centered Care
We’ll undoubtedly look back at 2020 as the year of the COVID-19 pandemic, but we might also remember it as the advent of a new era in healthcare — and medication access.
Workflows have adapted to home lifestyles, prescription decisions are made over apps and, in some cases, delivery drivers are an important part of the medication adherence equation. These are changes that may better suit where we are as a society: connected, mobile, nimble, diverse and personalized.
In recent months, health insurers, systems and practices have helped break down previous adoption barriers such as cost, availability and a standing provider relationship by reducing or eliminating virtual visit costs and making the technology widely available.
Patient consumerism is an underserved need in the process of improving medication access. Empowering patients as consumers of health can help ease the economic pressures burdening many people — potentially improving their access to the medications they need. Digital and virtual tools amplify the role of patients in their own care plans. Removing the waiting room aspect of health visits may keep patients healthier and give them valuable time back in their day.
Virtual interfaces, including telehealth platforms and prescription drug comparison apps, also allow patients to quite literally take scheduling, pharmacy selection and record management into their own hands, without the pressure of on-the-spot decision making. When asked what patients found helpful about telehealth services, the most-listed response was convenience.
Connected price transparency and affordability options can also help patients worried about paying for their mediations choose the financial avenue that makes the most sense for them at the time. With updated, integrated pharmacy and benefit apps, as well as more patients opting for cash-pay programs since COVID-19, patients can compare pricing at different locations and across methods.
While prior to COVID-19, only 11 percent of patients had used telehealth, recent data shows it’s likely to become a standard-of-care mainstay. Frost & Sullivan researchers predict a 64.3 percent increase in the demand for telehealth in 2020 compared to last year.
Perhaps the population that most stands to benefit are those living with chronic health conditions, who depend on consistent care and medication access, pandemic or not. For this group, the next frontier likely includes remote patient monitoring tools and artificial intelligence to enhance the virtual care experience.
When the COVID-19 pandemic hit the U.S., the provider space scattered in several directions: Some went to the frontline to help treat COVID-19 patients, others to work remotely as offices shut down and some to continue their original standards of treatment in a completely new landscape. As the dust settles, healthcare providers will find a rhythm — but one they’re likely unfamiliar with.
It is more important than ever that providers have a single, reliable source of truth for patient and prescribing information. With some seeing patients both in-office and virtually and others managing the post-visit process of verifying insurance benefits and handling processes such as prior authorization (PA) — many still remotely — information wires can easily become crossed and providers overburdened.
Real-time benefit check (RTBC) solutions can be an effective part of this surge in technology use. These solutions can help providers stay abreast of constantly shifting medication regulations and policies. For providers offering telehealth services to remote patients, RTBC can allow them to evaluate pharmacy-specific information for their patients, including home delivery and mail order options, helpful for the 22.5 percent of prescribers who said their patients are unwilling to visit the pharmacy.
Other technology solutions, including electronic prior authorization (ePA) and medication verification processes, are also becoming more important as medical staff help patients clear access barriers from home. Without fax machines and the ability to grab coworkers in-person, teams are becoming more nimble. Some payers have reported at least a 5 percent jump in ePA use from March to April.
When the COVID-19 pandemic reached our nation, payers set the stage with critical changes for healthcare in the U.S. Without these changes — including copay waivers for telehealth, lifted PA requirements and patient support — many patients may have gone without treatment or medications. But what’s next?
Recent regulations, including updates resulting in flexibility for Medicare Advantage plans and discounts in specialty care telehealth, only indicate forward progress.
Current telehealth offerings are likely to be status quo at least until a COVID-19 vaccine is widely available, which means providers and their offices will need telehealth infrastructure in place for at least the next 12 to 18 months.
Payers have the opportunity to continue setting a rapid pace for healthcare innovation by investing in cost-effective solutions that help get patients on therapy sooner. By offering more availability to connect with providers, payers can open the door to optimize outcomes and keep healthy patients healthy.
Pharmacists are juggling increased expectations lately: Regulations are constantly shifting, major chains are now COVID-19 testing sites and the biggest drug supply chain pressure test in history.,
Amidst these challenges, pharmacists have the potential to be change agents and key healthcare partners as they’ve stepped into a significant patient engagement role during the pandemic.
In a national COVID-19 survey of patient behavior, nearly half of respondents said they feel very comfortable picking up their medications at their local pharmacy. Fourty-seven percent of patients surveyed received a new medication in the last 90 days — and 90 percent picked it up in-person at a local retail pharmacy.
Unfortunately, many pharmacists don’t have the tools they need to reach their full potential in helping patients. In addition to their responsibilities under normal circumstances, they are also keeping up with prescriptions from telehealth visits, some of which come from prescribers outside their state. They must be familiar not only with federal regulations but also with current state laws, on top of changes to PA, which vary from payer to payer.,
There are opportunities in the pharmacy for prescription tools to help patients find suitable alternatives when an original prescription is denied. And if PA can’t be avoided, solutions that make the process more automated will allow pharmacists more time with patients. This can help build patient-pharmacist relationships.
To further improve the patient experience, some retail pharmacies are now shifting to health hubs. These pharmacies often employ nurse practitioners and other medical staff for quick diagnoses and allow pharmacists to practice to the full extent of their license with more patient education involvement. This model enters the market at an ideal time, as pharmacies expand testing sites for COVID-19. In a recent survey of pharmacists, 56 percent said they are expecting an increased scope of practice as a result of COVID-19 changes.
Solutions for the pharmacy, including ePA and drug-switch capabilities, can help pharmacists stay on top of requirements and regulations with real-time updates, so they can spend more meaningful time with patients.
Under bleak circumstances, a new beginning for healthcare is emerging. Through the industriousness, innovation and collaboration of all partners in the patient journey, the healthcare industry has embraced challenges to do the right thing for patients.
Yet, there’s still much work to be done to help patients access the medications they need.
To continue on progress made, the healthcare industry needs more interoperability. More than 30 percent of providers surveyed said lack of integration within EHR and privacy concerns were challenges they’ve faced with telemedicine. Sharing data can be cause for concern, but many healthcare stakeholders have already proven we can efficiently transcend previous barriers to enable patients and providers to connect from afar. The more various health tracking and record systems can connect, the better everyone can meet patients where they are, in their health and in their lifestyles.
The industry also need to address social determinants of health. Telehealth has the potential to change the lives of those in rural areas and medication access deserts, but without broadband connectivity, they may not even have the resources they need to get to virtual visits. This also includes connected devices for low-income patients. Eighty percent of providers surveyed listed patients’ lack of technology skills as a telemedicine challenge.
These social determinants include healthcare disparities due to race and gender bias. Black Americans are 2.3 times more likely to die from COVID-19 than white or Asian Americans. The COVID-19 numbers are a microcosm of a larger problem: In an analysis of health status measures, including infant mortality, mental health and chronic condition mortality rates, black, Hispanic and Native Americans fared far worse than white Americans.
Certainly, efforts to address these disparities need to extend across industries, but discrimination must even be dismantled within healthcare algorithms.
A study of a widely adopted algorithm used to refer over 200 million patients to complex care programs found that the average black patient was measurably sicker than the average white patient and received $1,800 less in care, annually.
And finally, the healthcare industry needs continued innovation — for everyone involved. Telehealth adoption happened quickly, with office staff building the plane as they were flying. But much of the framework has existed for several years: In a 2019 American Well survey of physicians, results showed telehealth adoption increased by 340 percent from 2015 to 2019. With many more now taking the leap into existing technology, it’s time for healthcare information technology to pioneer next steps that best suit provider and patient needs moving forward.