Early in 2020, soon after coronavirus and COVID-19 started overwhelming health systems and dominating headlines, economists began predicting disruptive, potentially devastating financial impact on consumers.

As it turns out, the suddenness and extent of those side effects are proving historic. Harvard University economist Lawrence Katz told The Atlantic, “No national economic shock or downturn in the U.S. has ever happened as fast as this one.”

  • Economic lockdowns, business layoffs and furloughs caused unemployment claims to spike from 1.7 million in mid-March to nearly 25 million by early May.
  • A July Gallup-West Health study revealed concern among half of U.S. adults that a major health event (such as a COVID-19 diagnosis and hospitalization) could lead them to bankruptcy.
  • Nearly 90% percent of U.S. adults surveyed by the National Endowment for Financial Education said COVID-19 was causing stress on their personal finances.

Solving employee's COVID-19 financial challenges

Self-insured employers looking to extend added support to their health plan members during these unprecedented times are finding significant value in healthcare navigation.

As a provider of navigation for more than 300 employers, Quantum Health has spent much of 2020 engaging thousands of employees and their dependents struggling with financial challenges related to COVID-19. Real-life examples reveal just how varied and difficult those issues can be:

  • An employee living with diabetes faced a significant reduction in income due to his employer’s slowdown caused by COVID-19. His pharmacy benefit for maintenance medications requires a 90-day prescription, costing $250, compared with $100 for a 30-day fill. The member struggled to see how his family could afford the added cost in the near term, given groceries, utilities and other essentials consuming his smaller paychecks. A Quantum Health Care Coordinator worked directly with the pharmacy benefit manager to override the 90-day requirement for the rest of 2020. That highly targeted advocacy is allowing the member stay on his medication, potentially preventing a costly inpatient stay. In another case, our team connected a diabetes patient with a manufacturer’s copay assistance program, helping that employee save $4,300 annually on medication.
  • An employee was discharged from the hospital, on oxygen, after treatment for COVID-19. Soon after, her husband and primary caregiver also was diagnosed with COVID. Left to care for herself, and now concerned for her spouse, the woman lacked transportation to visit her hospitalized husband. Researching community resources, one of our Care Coordinators identified a free transportation service. Although her husband later died, the member got to visit him and was grateful for receiving that level of support from her employer’s benefits.
  • Many employers have been hustling to make plan enhancements to help employees through the pandemic. Such mid-year changes can lead to claims processing and billing errors, which typically cause worry and frustration for employees and their families. In one example, a financially stressed member received a coinsurance charge of several hundred dollars for a COVID-related office visit and lab test which should have been paid at 100%. Our Care Coordinator spotted an error in the original diagnosis coding and worked directly with the payer, which reprocessed the claims to pay at 100%.
  • Because of COVID-19 restrictions, a hospitalized employee nearing end of life was unable to be visited by her family yet couldn’t be discharged until in-home hospice care was arranged. The primary care physician’s (PCP’s) preferred in-home hospice provider was out-of-network, posing significant financial hardship for the family. Quantum Health quickly identified a high-quality in-network provider, then engaged with the PCP to facilitate the referral. Thankfully, the employee was transferred home and spent her final hours there, among family.

Insights from the front line

As a benefits leader or consultant, you might be contemplating plan changes to help employees cope with financial strains triggered by COVID-19. Following are some observations you might find useful, based on Quantum Health’s experience during the pandemic:

  • Financial remedies often reside outside the core benefits plan and claims process.
    The starting point for helping consumers reduce or avoid medical expenses often falls within a plan’s core parameters. Examples include resolving an inaccurate bill or negotiating out-of-network charges that go beyond usual and customary. However, almost as often, the solutions that can save plan members health-related financial and emotional stress lie outside the core plan. There, traditional financial benefits — retirement planning, budgeting, financial literacy — tend not to be of much help when employees and their loves ones have an immediate, health-driven financial concern or even crisis. Independent navigation can help educate and guide members across the broadest possible spectrum of issues. Sometimes that means steering them to use other plan benefits (e.g., mental health services). Often it involves connecting them with community-based resources, including free or reduced-cost food programs, childcare assistance, rent support and transportation services.
  • Not all customer service models offer highly individualized, proactive engagement.
    In the scenarios above, the members’ financial outcome probably wouldn’t have been as positive if the underlying service model were based on one-size-fits-all phone scripts and digital-only touch points. Experience tells us most members don’t expect beyond-the-basics assistance from any customer service entity, much less from insurance or healthcare companies. When they receive above-and-beyond support, their appreciation for the service provider and their employer typically grows. That might explain why Quantum Health’s Net Promoter Score — a highly regarded measure of customer experience — peaked over 80 among members during April and May, in the teeth of the pandemic’s initial wave.
  • Healthcare, health insurance and financial well-being are tightly connected.
    A recent SoFi survey found that, because of COVID-19, 59% of consumers believe it’s more important than ever that employers offer financial wellness benefits (e.g., retirement plans, student loan assistance, financial counseling and others).

The stories above highlight that employees don’t experience financial well-being separate from their health and health benefits. Instead, those aspects of daily life are intertwined. Helping them tackle financial issues in real time is key to removing affordability barriers that might cause them to skip follow-up visits, postpone preventive care or take shortcuts on maintenance medications. In that sense, healthcare navigation is tantamount to providing cost-saving consulting to consumers in ways that dovetail with their desire for more financial wellness benefits.

Relevant, actionable health benefits insights

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