Adjustments to value-based healthcare, physician pay during COVID-19

Posted at 4:27 PM, May 12, 2020
and last updated 2020-05-12 19:33:59-04

BOISE — Insurance companies have been transitioning to something called value-based health care over the past few years. It's a payment model that prioritizes preventive, essential care instead of reimbursing for volume. It seems like it would be a good thing, considering appointment volumes have been down due to COVID-19. However, companies still have to make adjustments.

"There's a reduction in overall care because people just aren't going out into public to attend physicians and other things," said VP of network development for Regence Regence BlueShield of Idaho John Heintz.

During a pandemic, you don't want to lose needed doctors in the state, so Regence BlueShield of Idaho is reimbursing for telehealth appointments at an equal rate for office visits.

"Traditionally, telehealth visits are paid at a lesser rate than an office visit, but recognizing at this time office visits are not an option for most of our consumers," said Heintz.

That decision was made specifically for the pandemic time, but it's something Heintz thinks the industry will discuss in the post-COVID-19 world.

"I think the genie is out of the bottle on telehealth, I think it's going to be hard to put it back in," said Heintz.

Regence is also expediting physician pay, which maintains cash flow for providers.

"Our claims payments we bumped up to around 15 days to get claims out the door, the typical is 30," said Heintz, "for Idaho, it's averaging around 7-8 days."

A big goal of this balancing act is helping keep smaller practices open, especially those in the rural parts of the state.

"When we get outside of Boise into these more rural markets, we have to support these rural markets to ensure that they're going to operate during this time, and more importantly, they're going to be operating post-COVID," said Heintz.

John says things are starting to pick back up, but he predicts this pandemic will have economic effects for 2 to 3 years.

"What we're seeing now could occur again as we move into fall or winter," said Heintz.

Those with chronic conditions will likely be picking up the costs because conditions will worsen if they don't go to those necessary appointments.

"When the community does start to bounce back from this, and people start to make their way back out, and those who put off care they need, I think we'll see a rise in cost," said Heintz.