COVID-19: How Can Payers Prepare for Mandates and Support Pandemic Relief Efforts

Elizabeth Bierbower, Former President of Humana’s Group & Specialty Division

Healthcare can achieve optimum efficiency when patients are at the center of care. When patients have the necessary information to navigate their care journey, they will choose the path to high-quality care at the lowest costs. Cost-sharing and insurance premiums are rising consistently since the last decade for employer plans, which covers nearly half of the country’s population. Plan members are shouldering a part of the healthcare cost burden, so they want to keep it as low as possible. At the same time, they want maximum value for their money with access to quality care.

CMS identified this as an opportunity and issued the Final Interoperability and Patient Access rule. The rule allows patients to access electronic health data through any third-party application of their choice. The rule intends to allow patients to take control of their data and determine who can see which data. It will also make transferring data from provider to provider easier. So that patients can be ensured that their provider is fully aware of their medical history. 

The Challenge of Providing Members Access to Healthcare Data 

The biggest challenge that health plans will face is to extract data from multiple sources in-house, clean and scrub it, and ensure it is in the appropriate format as required by the Centers for Medicare and Medicaid Services (CMS). Some health plans have been in business for a really long time. Patient data has been accumulating through these years in legacy systems. Providing access to that data through certified third-party applications will require a lot of effort on the part of health plans. The health plans also have to ensure tight authentication standards so that only the people requested by the members have access to their healthcare data. 

In addition, there are multiple problems associated with provider data. Incorrect data in the provider database costs close to $3 billion annually. CMS has also issued warnings for inaccurate provider directories, high claim-reprocessing volumes, and substantial encounter-data rejection rates. Payers have been addressing the data issues with short term solutions. But now they have to resolve the provider data problems for good and make health data readily available to the members.

The COVID Crisis Upended The Payer Compliance Initiatives

Payers are in solidarity with providers and patients in this time of crisis. While providers work tirelessly to help an increased number of patients access the required care, payers are providing support through fast track reimbursements and reduced utilization management.

 Many health plans are focused on ensuring that their members have access to resources to fight COVID, which is why CMS extended the deadline for the Final Interoperability rule. Utilization patterns are witnessing a significant change. Many members are not receiving scheduled care as some elective surgeries are rescheduled and some provider offices are shut down. There has been a drop in certain kinds of utilization. Conversely, there has been a dramatic surge in telehealth office visits and behavioral health services.

The Road Ahead for Health Plans

Healthcare payers have endured significant claims-based, economic, and operational challenges during the pandemic. While they battle those bottlenecks, they also have to ascertain and prepare for the future and devise ways to ensure that their members have access to quality care.

Health plans will have to try to anticipate what utilization patterns will look like in the future, especially in the next year. Telehealth utilization will not be the same as it was pre-COVID. They will also have to ensure that members have access to care. They will have to reach out to members, especially those who are the most vulnerable. They will have to make sure members are not suffering from social isolation, they are taking their medication and they have access to transportation to get to the doctor.

Provider Alliance for CMS Compliance

CMS is handing over the reins of the care journey to the patients to improve care delivery through the Interoperability rule. Providers will play a key role in enabling access to healthcare data to patients by streamlining data and closing coding gaps. Payers must assist providers with their data needs to ensure compliance with the CMS rules.

As the pandemic ends and CMS comes out with more definitive long term rules and coverages, it is going to be important to ensure that providers are on the same page with payers. Health plans can partner with providers to educate them about the acceptable telehealth codes and what type of services are to be performed using those codes. Providers want to take care of their patients and they want to do it well. They want to leverage technology to ensure patient access to care and ensure their safety, especially for patients who suffer from multiple comorbidities.


About Elizabeth Bierbower

Elizabeth Bierbower is a strategic leader with more than thirty years of executive experience in the health insurance industry. She has experience scaling cost-effective and profitable growth strategies through internal innovation, and a reputation as being one of the industry’s most fiscally responsible and progressive leaders. Bierbower currently serves on the Boards of Iora Health, the American Telemedicine Association, and is on Innovaccer’s Strategic Advisory.

Previously Beth was a member of Humana’s Executive Management Team and held various roles including Segment President, Group and Specialty Benefits, and was an Enterprise Vice President leading Humana’s Product Development and Innovation teams.


Fern Health Taps 10M Mass General De-Identified Patient Records for Pain Management

Massachusetts General Hospital to Deploy CarePassport’s Digital Health Platform for Clinical Trials

What You Should Know:

– Fern Health will reveal a
first-of-its-kind collaboration with Mass General Hospital where it will inform
existing and future digitally-delivered pain management programs through the
marriage of AI + predictive analytics with 10 million de-identified Mass
General patient records.

– MGH will validate emerging Fern Health products and pilot new products in clinical environments, setting the stage for Fern expansion into all aspects of non-invasive multimodal pain management.


Fern Health, a digital health company pioneering virtual musculoskeletal pain programs and pain neuroscience education through employers, announced that it has expanded its collaboration with Massachusetts General Hospital (MGH) and the MGH Center for Innovation in Digital HealthCare (CIDH). MGH is the original and largest teaching hospital of Harvard Medical School and home to one of the world’s leading pain management clinics.

Fern Health’s relationship with MGH, formed 18 months ago, will now broaden to entail a multi-year collaboration in which MGH will validate emerging Fern Health product lines, pilot new products in a clinical setting, and investigate new scientific approaches to pain management.

The expansion supports Fern Health’s long-term vision of democratizing access to non-invasive multimodal pain management. Fern Health’s current product suite, which includes an evidence-based, digitally delivered musculoskeletal (MSK) pain management program, was originally developed with experts from within Mass General, in consultation with their clinical collaborators at the world-renowned Spaulding Rehabilitation Network. Fern’s biopsychosocial pain management solution was validated with the clinical rigor of MGH’s renowned hospital-based research enterprise.

“There are a multitude of gaps in the U.S. healthcare system that unfortunately fail our patients with chronic pain, from lack of access to high-quality pain care to the proliferation of costly and often ineffective treatments,” said Mihir M. Kamdar, MD, MGH Pain Physician and Digital Health Advisor. “Evidence-based models of care are still rare in digital health solutions even though they have the potential to address these gaps and give clinicians innovative and effective care options for their patients.”

Leverage Data-Driven Insights from De-Identified Patient Data

Fern Health will leverage clinical validation and implementation science, clinical protocol development, access to data-driven insights derived from de-identified patient data, third-party corroboration for peer-review publications, and FDA approval processes. 

“By evaluating digital health tools in a real-world clinical setting, we can provide distinctive insights, understand user preferences, and validate clinical protocols for optimal implementation and outcomes,” added Joseph C. Kvedar, MD, Senior Advisor, Virtual Care, Mass General Brigham; Professor of Dermatology, Harvard Medical School; and Senior Advisor, MGH Center for Innovation in Digital HealthCare. “This collaboration is designed to help advance pain management through digitally-delivered personalized exercise therapy, education, and health coaching—which early results suggest is occurring.” Dr. Kvedar is also President of the American Telemedicine Association (ATA).

Expansion into All Aspects of Non-Invasive Multimodal Pain Management

The collaboration also gives Fern Health substantial clinical and scientific data to expand into the broader ecosystem of digitally-delivered pain management platforms: 

– The Fern user experience will replicate how a patient might experience evidence-based, personalized treatment at a hospital-based pain management clinic. Rather than delivered in-person, treatment is delivered digitally and is accessible from anywhere.

– Informed by predictive analytics and an expansive MGH data set of 10 million de-identified patient records, personalized, evidence-based Fern patient treatment plans will leapfrog the performance of “one-size-fits-all” pain management platforms that are limited to publicly available data or their own user data.

– The collaboration will form the foundation from which Fern will launch new products and services rooted in collaborative care aimed at treating the whole person across physical, emotional, and behavioral considerations.

Why It Matters

One out of every two people suffer from MSK pain and the U.S. spends $380 billion on MSK conditions each year, contributing to MSK pain being the top driver of employer healthcare costs. Fern Health eases the burden on employers who face daunting pain management treatment economics. Provided as a benefits add-on for self-insured employers, Fern Health offers a biopsychosocial approach to pain management, including personalized restorative therapy, pain neuroscience education and virtual 1:1 health coaching. The company is currently engaged in pilot programs with several mid-size and large employers spanning the professional services, manufacturing and transportation sectors.

“At least half of the population suffers from physical pain and its cascade of effects across social, mental and emotional well-being,” said Travis Bond, CEO, Fern Health. “This initiative marries science, clinical rigor, artificial intelligence and incredibly rich historical patient data sets with digital care delivery. It’s a huge first step into a better future for pain management science and for the millions of people living with musculoskeletal pain today.” 

ATA 2020 in Review

Follow along with our new blog series #HealthcareNow and #PublicSectorNow, where we’ll addresses healthcare innovation around the world and how to maintain business continuity in today’s health climate.  

Now is the time for innovation and transformation in virtual health. During these unprecedented times of social distancing, stay at home orders and phased re-openings, one thing remains constant. Patients still need to receive quality care, and clinicians and care teams need a way to safely deliver that care. 

This year the use of telehealth has increased exponentially. We’ve seen clinics, hospitals and healthcare organizations speed their telehealth deployment faster than previously possible, and patients, clinicians, care teams and administrative staff adopt this technology with speed and agility. 

One Bay-area hospital saw a 2000% increase in telehealth sessions in March.  

A Southeastern hospital system went from 0 to 5,000 telehealth visits in a three-week period in April.  

The Centre for Addiction and Mental Health increased their virtual mental health visits by 750% between March and April.  

The University of Maryland Medical System connected more than 28,000 employees across 13 hospitals and 5,000 homes in just 5 days.   

And these are just some of the incredible stories coming from our customers. 

With telehealth more important than ever in today’s health climate, we were thrilled to be a sponsor of the American Telemedicine Association (ATA)’s virtual conference in late June.  

The conference focused mainly on accelerating the adoption of telehealth and working to change the way the world thinks about healthcare. Throughout the week of engaging virtual sessions, Cisco gave two presentations around the current state of telehealth and the new normal in healthcare.   

Check out the sessions below and watch the on-demand recordings:  

How Cisco is Expanding Access to Care

Speakers: Troy Yoder, Global Public Sector Healthcare Leader, Cisco and Jono Luk, Senior Director, Webex Applications & Integrated Collaboration Team, Cisco

Description: Patient expectations continue to rise, and technology is now at the core of how patients access care and interact with their providers. Join Cisco for a discussion on how to meet patient expectations and improve clinical efficiencies with an end-to-end digital healthcare journey.

Watch on demand now

Between Healthcare of the Past and Present, There’s Telehealth

Speaker: Allison Norfleet, Global Helathcare Leader, Cisco

Description: Between healthcare of the past and healthcare of the present, there’s telehealth. The world is changing, and the delivery of virtual care is more critical now than ever before. Join Cisco for a discussion on why now is the time for innovation and transformation in virtual health.

Watch on demand now

Be sure to watch our sessions on demand and check out the other educational content from the American Telemedicine Association’s 2020 virtual conference  

We’d love to hear what you think. Comment below and stay tuned for the next blog in our #HealthcareNow series. 

The post ATA 2020 in Review appeared first on Cisco Blogs.