Page 56

of Medicine cited, “a substantial fraction of care that has been ‘deferred’ may never happen in the future, depressing revenue for many months to come.” Therefore in 2020, a large percentage of visits will not occur and health plans keep all of those dollars. •

Health plans are accelerating payments to help shore up hospitals.

Accelerating payments is necessary but insufficient because it is merely an advance on revenue, not new revenue. This is like telling an unpaid intern you’ll double their pay. It has essentially little long-term impact on total revenues for providers or the windfall insurers will be receiving. This is very different than the CARES Act revenue that Medicare is providing directly to hospitals. Instead of distributing windfall profits as dividends to shareholders from the safety of their own home while watching providers who selflessly treat COVID-19 patients at great personal risk also suffer financially, health plans can volunteer to do more to help. A few things health plans can elect to do are: 1.

Provide monthly payments to network providers based on payments from the prior year until revenue.


Subsidize COBRA for the newly unemployed for three months. This will reduce Medicaid expenses, improve customer loyalty and improve physician finances because commercial plans pay better than Medicaid.


Provide a premium refund to fully insured employers based on quarterly earnings in excess of prior year, something mentioned by United CEO during an investor call.

What does this mean going forward? Hospitals are suffering financially; revenue is half of what it normally is for many hospitals and health plans are retaining much of that gap. Health plans will not just give money to providers unless they fear regulatory action. Health plans will not fear regulatory action unless the public knows these plans are quietly profiteering off of the pandemic while America’s lauded health care institutions, reduced the pay of physicians, lay-off nurses, furlough medical assistants, and slash benefits of the medical sanitation staff. As appeared in Healthcare Business Today on May 27, 2020.