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As we head into summer after a lengthy stay-at-home order in Minnesota, we all feel a powerful urge to “return to normal.” Who wouldn’t? As individuals, families, a state and a nation, we’ve never gone through anything like this before.

The good news is that we can do many activities today that we couldn’t in the spring – both because of the weather and the easing of restrictions. But as we enjoy more flexibility, we also must remember that we’re living in a new era when it comes to work and personal safety. As we return to the office, attend small family gatherings and maybe visit some lakes, pools, restaurants and malls, we need to be even more sensitive to the risks involved. Most importantly, we need to acknowledge that the decisions we make don’t just affect us; they affect everyone.

June is the perfect time to renew our focus on health and safety because with it comes the official start of summer – June 20 – and it’s also National Safety Month. Started by the National Safety Council in 1996 to build awareness and reduce illness, injuries and death, this tradition has taken on more significance this year than ever before. In addition to shining a spotlight on vital issues like mental health, ergonomics, driving and building an overall culture of safety, it also gives us an opportunity to review the safety challenges brought on by COVID-19.

In a recent blog post, the chief medical officers of Blue Cross Blue Shield Minnesota, Medica, PreferredOne, UCare and HealthPartners remind us that COVID-19 is most frequently spread between family members and at large gatherings. So as our neighborhoods and economies continue to open up during the summer, it can be easy to grow complacent about safety protocols at the exact time when following them is most critical.

For employers, the National Safety Council offers a great resource page with comprehensive COVID-19 safety guidance. For the general public, the Council’s medical directors remind all Minnesotans to:

Additionally, there are plenty of articles and resources available online to help you assess the level of risk with various activities, be it going to the mall, the gym or a hair salon. A good place to start is the CDC website, which has an “Errands and Going Out” page that offers some recommendations on how consumers can protect themselves in certain environments.

As summer heats up, don’t let your guard down. Take care of yourself and your family, as well as friends, coworkers, and the elderly and vulnerable by following social distancing guidelines and other measures to prevent infection, illness and death.

Our new safety normal is going to be with us for the foreseeable future. As you head outside or in public to enjoy everything Minnesota summers have to offer, remember that what you do now directly impacts what life will look like in the fall and winter. Let’s use this time to make our future months as healthy as possible.

Recently, the state legislature passed the ground-breaking Prescription Drug Pricing Transparency Act, mandating that drug companies must now notify Minnesota consumers when they institute significant price hikes for certain prescription medications. This bipartisan legislation didn’t happen overnight. It was the culmination of more than a year of negotiations between legislators and various advocacy groups, and I’m proud so say that Minnesota’s nonprofit health plans played a significant role in making it happen.

How does the new legislation benefit me as a consumer?

The new law creates “news you can use” when it comes to your medications. You’ll have a window into when and why your prescription meds are going up in price, and you’ll be armed with better information to potentially help you save money by finding more affordable alternatives. As the saying goes, “sunlight is the best disinfectant,” so the longer-term hope is that greater transparency in pricing will lead to lower drug prices overall.

Specifically, if you’re taking a medication that already costs $100 or more for a 30-day supply, the new law requires the makers of that drug to publicly disclose any sharp increases in price. For brand-name drugs, the requirement kicks in when the price jumps at least 10% over 12 months, or 16% over 24 months. Changes for generic drugs must be reported when prices go up by 50% or more.

When the requirements kick in next year, drug manufacturers must disclose the following information to regulators, which you will then be able to see online via the Minnesota Department of Public Health’s website:

When will I be able to take advantage of this new system, and what are the consequences if the drug companies don’t comply?

The new requirements take effect on Oct. 1, 2021. At that point, manufacturers will have 60 days after they increase prices or introduce new drugs to submit the information above to the state health commissioner. If they fail to do this, or if they provide inaccurate or incomplete information, they’ll face fines of up to $10,000 a day. Those funds would go into the state’s Health Care Access Fund, which helps pay for MinnesotaCare and other programs that increase access to health care for lower-income Minnesotans.

Why is this issue so important to Minnesota’s nonprofit health plans?

It’s all about affordability and accountability. Health insurance premiums reflect the overall cost of care, and prescription drugs are a major driver of health care costs. In fact, most people don’t realize that prescription meds account for nearly 25% of all health care expenses — which is more than in-patient hospitalization costs. Under our current system, drug companies can raise prices with little exposure or justification. The latest round of price increases happened in January of this year – prices increased on more than 200 prescription drugs. The steep increases in drug prices not only harm patients but taxpayers as well who help to pay for public programs, such as Medicare and Medicaid. The new law empowers consumers by making drug companies more accountable to them, and it empowers policymakers by providing better data to help drive better policy.

 

Bottom line: Creating more transparency of drug prices is an important first step toward raising awareness of the role of drug prices in health care. Minnesota’s nonprofit health plans believe that greater transparency in drug pricing will help drive down the cost of prescription drugs and make health care more affordable for everyone.

By Mark Steffen, M.D., Chief Medical Officer at Blue Cross and Blue Shield of Minnesota; John Mach, M.D., Chief Medical Officer at Medica; Abigail Miller, M.D., Chief Medical Officer at PreferredOne; Julia Joseph-Di Caprio, M.D., Chief Medical Officer at UCare; and Patrick Courneya, M.D., Chief Medical Officer at HealthPartners

 

Don’t drink and drive, wear your seatbelt and put on your sunscreen are being joined by wash your hands, wear your mask and stay 6 feet away from others as universal messages this summer from healthcare professionals.

 

As the Chief Medical Officers of Minnesota’s nonprofit health plans, we are adding our voices to this very important advice. 

As the weather gets warmer, don’t let your guard down. Join us in taking care of our family, friends, coworkers, and especially our elders, by following social distancing guidelines and other measures to prevent infection.

As we learn more about COVID-19, we know this virus is most frequently spread between family members and at large gatherings. And the summer months are prime times for get-togethers. 

That’s why if you or someone in your household is having COVID-19 symptoms, like cough, fever, shortness of breath, body aches, sore throat, or the sudden loss of the sense of taste or smell, it is important that everyone in your household isolate away from others. This means staying home and calling a health care provider for advice on testing and treatment.

Wash your hands, wear your mask and remain 6 feet from others. Remember these messages and please join us in doing your part to stop the spread of COVID-19.  The health of all Minnesotans depends on it. 

For more information and resources on COVID-19, please visit the Centers for Disease Control and Prevention and Minnesota Department of Health websites.

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Lucas Nesse, president and CEO of the Minnesota Council of Health Plans, issues statement on House passing Prior Authorization Legislation

Statement:

“Prior authorization is a critical tool for ensuring safe, effective and efficient treatment for patients. Individuals and employers greatly benefit from the associated cost savings and lower premiums. Minnesota’s nonprofit health plans are proud to have played a key role in refining this legislation to ensure that important elements supporting patient safety and lower costs were maintained.”

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Pandemics impact us all, but certainly not equally. Among the many tragedies of COVID-19 is that it is hurting people who were already in need — including Minnesotans who were struggling with their health, financial stability and other basic necessities long before any of this started.

One silver lining of this unprecedented crisis is that it is also bringing people together in ways big and small. If we needed any more evidence that our Council members support the overall well-being of their enrollees, then this situation is proving it. The social determinants of health (SDOH) — like food, housing or another need — are becoming increasingly important for our enrollees during this pandemic, and I’m so proud of the ongoing work that Minnesota’s nonprofit health plans are doing to support people and communities during this tough time.

Our members — including Blue Cross Blue Shield of Minnesota, HealthPartners, Hennepin Health, Medica, PreferredOne, Sanford Health Plan and UCare — are directly aiding those who are most vulnerable. This includes health care workers, seniors, people with chronic medical conditions, people with emotional and behavioral problems, those facing abuse and those who lack income to meet their basic needs.

Since this pandemic began, Council members have stepped up in numerous ways to help enrollees. For instance, The Medica Foundation announced in late March that it was donating $1 million across 18 Minnesota nonprofits to meet emergency needs brought on by COVID-19, including $50,000 to Anna Marie’s Alliance to help provide safe shelter and support for battered women and their children. Meanwhile, The Blue Cross and Blue Shield of Minnesota Foundation announced in late April that it was contributing over $1 million to support communities during the pandemic, including $100,000 to the Coalition of Asian-American Leaders as part of its anti-racism campaign.

Also, the UCare Foundation announced in late April that it was providing $500,000 in assistance for Minnesotans impacted by the pandemic, including infrastructure grants up to $25,000 to small provider groups and community clinics for enhancements to provide care in a COVID-19 environment.

And these are just a few initiatives that have kicked off since the pandemic started. Collectively, health plans and their foundations have:

The COVID-19 crisis may be with us longer than we’d like, but it will end at some point. When that happens, we can be grateful that Minnesota’s nonprofit health plans stepped up in a big way to ease the pain of those affected by the pandemic’s health and economic impacts. And as a world-renowned health care community, we can also be proud that the various players in our system came together to keep Minnesotans as healthy and safe as possible when they needed it most.

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Ghita Worcester, SVP of Public Affairs & CMO, shared her take on the ACA turning 10 during a pandemic – and UCare’s experience as an ACA leader: www.linkedin.com/pulse/aca-turns-10-pandemic-ghita-worcester/

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Lucas Nesse, president and CEO of the Minnesota Council of Health Plans, issues statement on Minnesota House Passing Drug Price Transparency Legislation

 Statement:

 “Minnesota’s nonprofit health plans are proud to have played a key role in advancing this bipartisan legislation. Prescription drugs are a major driver of premiums and now account for nearly a quarter of health care expenses – even exceeding in-patient hospitalization costs. Greater transparency of these expenses will help advance affordable drug pricing for all Minnesotans and lead to useful data to better inform policymakers.”

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​With the COVID-19 pandemic unfolding worldwide, telehealth is quickly being revolutionized. Everyone – individuals, families and organizations alike – must adapt to this increasingly popular way clinicians are practicing medicine, and that’s especially true across every facet of Minnesota’s health care system.

For a sense of scale on the rapid rise of telehealth, consider this: A 2019 J.D. Power survey found that only 1 in 10 patients nationwide engaged in telehealth. By contrast, the Washington Post recently reported that one of America’s largest digital health care providers has seen a 900% increase in patients using telehealth services across its 800 partner hospitals. Closer to home, a recent Stratis Health study found that since the COVID-19 outbreak, telehealth use in Minnesota has increased more than 1,000 fold—from 1,149 visits per day to 15,480. The federal government, which has been reticent to pay for telemedicine except under very specific circumstances (like for those who live in rural areas), has also been quick to expand telehealth benefits and pay providers the same rates as in-person visits.

As with any massive shift, people are wondering just how this system is changing. Since I’ve had a (virtual) front row seat to witness the nimble pandemic response of Minnesota’s nonprofit health plans, I want to share some details on how our member health plans are helping to advance telemedicine. Given that telemedicine can be an incredibly convenient form of care delivery for both patients and health care professionals, we shouldn’t be surprised if its popularity outlives the pandemic. This presents an opportunity for health plans to innovate and create an even more robust telehealth experience

How are telehealth appointments being covered by insurance in Minnesota?

A survey of insurance coverage plans offered by our Council members shows that all of them cover telehealth services for members, and that they will reimburse these virtual visits as if they were done face to face. Hospitals and clinics are being asked to use specific reimbursement codes for remote services, and Council members have set up provider portals to deliver the most up-to-date information on reimbursement codes and procedures. The Council is also working with clinicians to further streamline this process to make it easier for providers, so that enrollees need not worry about whether their appointments will be covered.

 Who decides if telehealth is covered?

 For people who use Medicare or have their insurance coverage through one of Minnesota’s Health Care Programs, the federal and state governments dictate what services and treatments are covered. Telehealth is no exception. Prior to the COVID-19 health emergency, both the federal Centers for Medicare & Medicaid Services (CMS) and Minnesota’s Department of Human Services had strict rules about how Council members could cover and pay for various telehealth services. Council members have been working closely with people in government to figure out what rules need to be relaxed so people can continue to meet with their doctors, therapists, and other health care providers and get the care they need. Some of the changes made include allowing people to use a variety of audio and visual systems; allowing different types of health care providers – like psychologists, social workers, dieticians, and midwives – to provide care to their patients; and making sure that these providers are paid for this work just like they would be if they saw a patient in their office.

 What about self-insured plans?

Self-insured plans – those in which employers use their own funds to cover employees’ claims – can vary, but they generally have the option to cover services the same way as fully insured plans. The Federal CARES Act requires that all testing for COVID-19 and the related provider visit be covered by private insurance plans without cost-sharing (this includes a related provider visit done via telehealth). However, it does not mandate coverage of all telehealth services that are or are not related to COVID-19.

How are health plans letting hospitals, clinics and patients know that telehealth services for mental and behavioral health, as well as other services, are covered?

Council members are providing FAQ documents for health care providers and their members through their respective websites. If hospitals and clinics have additional questions, they are being encouraged to use a plan’s provider portal, or to reach out to the plan’s member services team to answer specific questions, as guidelines for telehealth are quickly changing.

Is there any concern that as telemedicine becomes more readily available and heavily utilized during the pandemic, the cost of mental and behavioral health services will go up?

Minnesota’s nonprofit health insurers care first and foremost about the health and safety of their members and provider partners. Therefore, they should not be concerned that costs for these vital services will rise. A recent MPR article reported that mental health providers are worried that rapid changes governing the way telehealth is delivered (for instance, phone calls versus video visits) could result in providers not being paid for their services. However, this is not the case.

Minnesota’s nonprofit health plans want people to get the care they need no matter which form of delivery is used. As they do with all forms of care, health plans will always monitor the cost of care to limit fraud, waste and abuse. But they fully support the appropriate use of telehealth, especially during emergencies and times of health crisis. So far, we don’t foresee any significant issues on this front.

We recognize that the current situation has people concerned and fearful on many fronts. But those who worry that a telehealth appointment may not be covered by insurance (e.g., a virtual visit with a psychotherapist) can rest easy knowing that Minnesota’s nonprofit health plans are working to address any issues that might arise. We’ll continue to do everything we can to ease the stress and help Minnesotans stay as healthy as possible during this crisis, while also keeping all parties up to date on the latest changes and information.

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