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Updates For Brokers & Employers

November 24, 2020

To Our Valued Clients and Partners,

Since our newsletter last month, global cases have increased from nearly 45 million cases to over 59 million cases with the US at over 12.5 million cases. The US broke its daily case number record multiple times over the last few weeks. Across our region, cumulative cases and deaths per 100,000 residents by state illustrate concerning trends in advance of the approaching holidays.

The two graphs below use daily data reported by each state to the CDC as of yesterday and normalized by incidence per 100,000 residents using the 2020 state populations reported through 

cases-nov.png  deaths-nov.png

Testing Trends Across Our Membership

We continue to evolve and refine our COVID-19 reporting as new procedure codes are published and as providers resubmit claims with new codes. Currently, about 89% of our clients have at least one member with a confirmed COVID-19 diagnosis. Because not all testing is submitted as a claim, there are likely more positive cases across a larger span of our clients than we see in our claims data.

Across our membership, approximately 18.6% of our members have had at least one COVID-19 testing claim and approximately 40% of those tested have more than one testing claim.  

Treatment Claims Trends Across Our Membership

Approximately 6.4% of members tested have a positive COVID-19 diagnosis and just over 9% of members with a positive COVID-19 diagnosis and a plan payment have required hospitalization. Less than 3% of members’ COVID-19 treatment plan payments (per member) have been over $10K and 88% of members’ COVID-19 treatment plan payments are under $1K.  

Please make sure to review your Q3 COVID-19 Client Impact reports. Please contact your Account Manager if you would like to have your report sent to you or if you have any questions about the information in your report. We hope you find these reports helpful and we welcome your feedback.

Member Difficulty Finding Testing Locations

We are receiving many calls from members inquiring about testing coverage and where they can get tested. With the recent surge in cases, testing facilities are overwhelmed. Some are turning away non-symptomatic test requests. Members should reach out to their doctor or go to an Urgent Care facility if are symptomatic. Doctors can assess the need for testing. Additionally, each State’s Public Health Department lists the locations of COVID-19 testing facilities that are available for testing. 

Preparing for COVID-19 Vaccinations

The news and every social media site are flush with great anticipation and speculation over recent announcements of at least two vaccines nearing Emergency Use Authorization (EUA) in the United States. Thus, we are getting more questions from our clients about preparing for vaccinations and their impact on the workplace and from members eager to receive a vaccine. 

Though we don’t have any specific timelines for when a vaccine will be available, we know that the vaccines will be rolled out in phases, distribution may require strict temperature control, and that the vaccines will likely require two doses spread out over several weeks for optimal efficacy. The first supply of vaccines will likely be limited to the most vulnerable. The vaccines currently in development are likely to provide immunity duration similar to that of flu vaccines that need to be administered annually. Additionally, Governors from WA, OR, NV, and CA announced a pact on Oct 27th to ensure independent experts review any COVID-19 vaccine released by the FDA for efficacy and safety. States and the CDC are currently evaluating vaccine equity and prioritization frameworks. 

Employer-Mandated Vaccines?

Employers want to avoid virus transmission in the workplace and COVID-related shutdowns. Some employers are wondering if they can require employees to get a COVID-19 vaccination once vaccines are available. 

Many school districts require students to have vaccines before setting foot in a school. Can employers also mandate vaccines? Will the current pandemic’s public health threat outweigh legal precedents on the topic of mandatory vaccinations? 

Because the Federal Government has yet to provide specific guidance about how employers can or cannot require COVID-19 vaccines for employees, we must look to historical and legal precedents for now. Such precedents indicate that employer-mandated vaccines may not be an option. During the H1N1 pandemic, the Equal Employment Opportunity Commission ("EEOC") said that both the Americans with Disabilities Act (ADA) and Title VII of the Civil Rights Act of 1964 (Title VII) prohibited employers from compelling employees to be vaccinated for the 2009 H1N1 pandemic regardless of their medical condition or religious beliefs even during a pandemic. For comparison, according to the CDC, the H1N1 swine flu killed approximately 12,500 people in the US over a 12-month period, whereas COVID-19 is predicted to kill over 30 times as many people before vaccines could be available. While the EEOC did update its pandemic guidance in March 2020 to elaborate on the standard of ‘direct threat’ to public health and expand upon employers’ rights to require COVID-19 screening or testing as a condition of employment, they have not yet modified their position on employer-mandated vaccines.

Other issues to take into consideration include employer liability for potential injuries to employees who have adverse reactions to the vaccine and/or potential complications with collective bargaining agreements that may not allow enforcement of such policies without union consent. 

Some employees might be eager to get a COVID-19 vaccination, where others may have reservations for a variety of reasons, including safety and religious objections. It's understandable that a new vaccine, seemingly rushed to market compared to previous vaccine timelines, may trigger anxiety or fear for many individuals. Education is a great path to mitigating fear. Employers may want to provide objective information to employees regarding vaccinations. Encourage employees to obtain vaccines on their own or assist with easy access to vaccines rather than requiring employees to get vaccinated. 

In addition, if you haven’t yet published a COVID-19 employee and workplace safety policy or guide, this is a great time to do so. Best practice policies are customized to your specific employee population and workplace considerations. Most have provisions such as face mask requirements, remote work, or socially distant work either for all employees, or specifically for those who are unvaccinated. Please reach out to your Account Manager if you’d like to see a sample return to work guide. We are happy to share our own guide with you as a sample. 

For those that have already published a workplace and employee safety guide or policy during this pandemic, set a regular cadence to review and update it to stay current with potential regulatory changes. Whether a new policy is put in place or not, employers should continue to follow general COVID-19 sanitization procedures and protocols as recommended by the CDC.

Finally, we are also receiving questions about the potential costs for COVID-19 member vaccinations. Based on current regulations, the cost for COVID-19 member vaccinations is likely to fall upon health plans. The federal CARES Act already requires health plan coverage of the vaccines, once available, without cost-sharing. We will continue to closely monitor progress on vaccine developments and swiftly notify clients when a viable vaccine is available.

Perhaps you have broader questions about how COVID vaccinations will affect your health plan. No matter what your questions are, it’s likely that 2021 will include challenging decisions for employers. We will keep you updated through our newsletters as these emerging topics develop. 

We provide COVID-19 content for both members and employers/brokers. Just click on the COVID-19 banner at the top of our home page and then choose member, employer, or broker to view our latest updates and content. Our COVID-19 member updates page contains useful information and links to resources to address the most common member questions our Customer Care Advocates receive. Our COVID-19 employer/broker page includes this current update plus links to previous COVID-19 updates for your easy access, just scroll down. 

We’re Here for You 

Our focus, dedication, and support remain steadfast as we navigate these unique times with you. Know that our Care Management nurses are reaching out to those members diagnosed with COVID-19  to help them access the care and resources they need to recover safely. Thank you for your continued trust in our organization. We are in this with you and hope that you and yours stay safe and healthy. Please reach out to your Account Manager if you have any questions or if there’s anything we can do to help. 

Best Regards,

Lindsay Harris, MPP President

Healthcare Management Administrators, Inc.

Proving What’s Possible in Healthcare®

Links to prior COVID-19 updates from HMA:

October 30, 2020 

  • US & Global update
  • Testing trends regionally
  • Outcome trends by state & age Group across regional Covid-19 positive cases
  • Treatment claims trends across our membership
  • Preparing for Covid-19 vaccinations
  • Employer-mandated vaccines?

September 25, 2020 

  • US & Global update
  • Testing trends regionally
  • Treatment claims trends across our membership
  • Testing claims trends across our membership

August 26, 2020 

  • US & Global update
  • Testing trends regionally
  • Treatment claims trends across our membership
  • Testing claims trends across our membership

July 24, 2020

  • US & Global update
  • Testing trends regionally
  • Treatment claims trends across our membership
  • Testing claims trends across our membership

June 26, 2020

  • Return to work webinar series
  • RGA Open Arms Program launches July 1st
  • COVID-19 updates to our website
  • The CDC expands and updates the list of people at risk of severe COVID-19 illness
  • The joint agencies clarify FFCRA and CARES Act implementation guidance
  • Trends we are seeing 

June 11, 2020

  • Return to work webinar series launched this week
  • COVID-19 updates to our website
  • Case counts increasing following phased re-openings
  • Trends we are seeing 

May 29, 2020

  • Return to work webinar series
  • How to participate in the IRS relief for FSAs and other cafeteria plans
  • Provider personal protective equipment (PPE) surcharges
  • Unemployment fraud update
  • Trends we are seeing

May 15, 2020 

  • Taking Care: An emerging mental and behavioral health pandemic
  • Unemployment fraud rampant and how to report it
  • Return to work testing resources
  • Trends we are seeing

May 8, 2020 

  • Interim Compliance Alert: COVID-19

May 1, 2020

  • COVID-19 Client Impact Reports now available
  • Benefit change request form reminder
  • Trends we are seeing 

April 24, 2020

  • $484 billion and more to come?
  • Proclamations & regulatory orders vs health plans – Options for stability in unstable times
  • The heated debate over when and how to return to work

April 17, 2020

  • Expansion of coverage for COVID-19 and pricing for COVID-19 related claims 
  • Access to non-urgent care during the stay at home orders 
  • Trends, testing, and antibody studies  

April 10, 2020

  • A preview of COVID-19 reporting
  • More Telehealth and Telemedicine updates
  • Trends we are seeing and how they may affect your health plan

April 3, 2020

  • How does the CARES Act affect my health plan?
  • An overview of the recent changes to Telemedicine and Telehealth
  • Trends we are seeing and how they may affect your health plan

March 27, 2020

March 20, 2020

March 12, 2020

March 5, 2020

March 2, 2020