From Excellus BlueCross BlueShield:
Excellus BlueCross BlueShield expects to spend at least $162 million on its comprehensive response to the COVID-19 pandemic.
The health plan is funneling more than $1 million worth of grants for testing supplies and personal protective equipment to upstate hospitals and area health care workers. It is also working with regional business groups to help employers and their employees return to work.
“No one has faced a public health crisis like COVID-19 in the almost 90 years that our health plan has provided coverage in upstate New York,” said Christopher C. Booth, president and CEO of Excellus BlueCross BlueShield. “This crisis requires a strong and comprehensive response to assure our members are able to receive the care they need and to help assure the system will survive. The pandemic significantly impacted the economy, sickened tens of thousands of people and continues to threaten upstate health care.”
With the state’s stay-at-home order and the suspension of elective medical procedures, Excellus BCBS expanded access to telehealth, trained physician offices how to use it, and increased the reimbursement to providers for these services. This allowed many local provider practices to continue to see patients using remote technology and replace lost in-office revenue. That expanded coverage and the increased reimbursement associated will cost at least $80 million in 2020.
The health plan will absorb a $12 million reduction in Medicaid rates from the state this year, rather than pass it on to providers. Restoring some Medicare fees for providers that had been cut at the federal level added an additional $6 million in cost this year.
Excellus BCBS also took several steps to reduce the administrative burden on hospitals which increased costs for the plan.
- Suspension of prior-authorization, reviews, clinical editing programs and claim filing requirements will cost $51 million;
- Implementing the 20 percent increase in reimbursement for COVID-19 admissions required under a new federal law will cost $3 million this year.
For members, Excellus BCBS absorbed the cost of member out-of-pocket expenses for the diagnosis and treatment of COVID-19, medically appropriate testing, as well as absorbing the member cost share for all telehealth visits. These steps are adding about $9 million in cost this year.
The $162 million in unbudgeted spending is being funded through the health plan’s reserves. The comprehensive response is in addition to $192 million in cash advances the health plan had extended to most of the 70 upstate hospitals in its network prior to the pandemic outbreak.
“Our priority in this crisis continues to be taking care of the customer and making sure members have access to the care they need,” Booth said. “We are starting to see an increase in claims from the pent-up demand for elective procedures and routine care that may have been put off during the quarantine. We are also still bracing for a possible second wave in COVID-19 related costs later this year. We hope it doesn’t come. We must be prepared if it does and we are ready.”