2021 has arrived, and along with it has come several sunny winter days and a slightly flatter COVID-19 case curve than our region experienced a month ago. While we all need to remain vigilant about social distancing and other public health measures, there are reasons for optimism. In particular, the long-awaited and heavily debated federal actions outlined below, which position our health system to deliver better health care value to patients and communities. They hold promise for the future.

Most Surprise Medical Bills Soon to be Stopped

After years of failed legislative efforts, Congress acted late December to protect patients from most surprise bills. Beginning January 1, 2022, patients will no longer be able to be charged more than they would have paid for an in-network service in two types of scenarios: (1) when they find themselves in an out-of-network facility or air ambulance in an emergency situation, or (2) when they use the service of an out-of-network provider while seeking care in an in-network facility. Ground ambulances, the most common type of surprise bills, were left out. This was due to congressional leaders’ inability to understand the impact on the diverse types of ambulance companies, particularly those serving small municipalities. In an effort to stop these as well, a commission to study surprise bills for ground ambulances was established. The law now requires the out-of-network provider and insurance company to arbitrate and set guidance for the factors to be considered by the independent arbitrator in establishing a fair price.

Hospital Transparency is Expanded
Widely contested price transparency measures went into effect January 1, 2021, after the courts fail to be swayed by the American Hospital Associations’ claims of unfair burden and upheld the Trump administration’s rules for price transparency. Facilities must post the following information on their website for each service and product: (1) charges, (2) negotiated rates with insurance company, noting the lowest and highest negotiated price, without disclosing which insurer received which rate, (3) self-pay price offered to patients without coverage or paying their own claim, and (4) the bundled price for 300 common “shoppable” procedures or services, 70 of which have been defined in the rule by HHS. These are to be posted online, in a machine-reasonable and consumer-friendly format. A quick look at several local hospital websites did not find them to be fully compliant. Yet, there are signs that they are moving to become more transparent. Similar regulations, effective January 2022, have been imposed on insurers.

Payment Alignment Lays Foundation for Stronger Primary Care 

CMS has prevailed in making changes to the CPT coding system and payment rules designed to streamline provider documentation and realign payments to better reward physicians for their time spent in evaluation and management of patients, as compared to the time spent doing procedures. It went into effect January 1. Devised to be budget neutral, the expected $9.9 billion in higher payments has been offset by decreases in the conversion factors for some services. The AMA estimates the impact to provider practices will range between a decrease of 10 percent and an increase of 16 percent. This is a long-awaited and important step in advancing primary care in the U.S. health system. More details can be found here .

Moving into the New Year, the BHC will continue to monitor legislative activities on a local, state, and federal level that have an impact on health care quality, affordability, and safety, as well as employer-sponsored benefit plans. We welcome the opportunity to connect with your organization’s policy leaders to discuss priorities and shared action that can be taken in 2021.

Warm Regards,

Louise Y. Probst,
BHC Executive Director

As COVID-19 ravages, the news that a vaccine is just around the corner offers a bright light on a potentially dark winter. Pfizer, BioNtech, and Moderna’s vaccines have reported high efficacy rates in clinical trials. The FDA is scheduled to vote on Emergency Use Authorization for Pfizer’s vaccine on December 10, with the first doses already traveling by plane to centralized positions. Limited quantities of vaccine are expected by the end of 2020, with supplies increasing substantially in 2021.

Aside from the administrative logistics, hurdles remain in the form of awareness and misinformation. All of us have a role to play in dispelling myths and getting out the facts. Here are five things everyone should know about the COVID-19 vaccine:

(1) Is it normal to feel sick after getting vaccinated? When people feel bad after a vaccine, they often claim they got sick from the vaccine or had a bad reaction. Vaccines work by giving the body a preview of the virus so that the immune system can recognize it and develop antibodies to fight it. Chills, fever, and muscle aches are common following a vaccine and a sign that it is working.

(2) Does the shortened approval process for a COVID-19 vaccine compromise safety? The FDA is expediting vaccine availability through Emergency Use Authorization (EUA). EUA is used in a public health emergency when the benefits of a product that hasn’t received full FDA approval outweigh any risks. It is important to emphasize that all COVID-19 vaccines are rigorously tested on tens of thousands of people in multi-phase clinical trials that are overseen by established safety control boards and protocols. Additionally, the CDC follows long-established protocols to ensure the safety of COVID-19 vaccines.

(3) When can I get a vaccine? Following CDC guidance, the state of Missouri has created a COVID-19 Vaccination Plan laying out a phased rollout to priority populations. Early doses will target frontline health care workers and long-term care facility staff. The focus then moves to critical infrastructure workers, those ages 65 and up, and communities at higher risk of severe COVID-19 outcomes. Supplies are expected to expand substantially in 2021. It is anticipated that 90 to 180 days after initiation the vaccine will become broadly available to any adult who wants one.

(4) Who will pay for the vaccine? The federal government is using taxpayer dollars to distribute the vaccine and ancillary personal protective equipment (PPE) to providers at no cost. Anyone who wants and needs a vaccine can get one free of charge. Providers may charge a fee to cover the cost of administering the vaccine and seek reimbursement from private and public health insurers.

(5) How many doses are needed? The first vaccines likely will require TWO doses. This is standard for many FDA-approved vaccines. The second shot boosts a vaccine’s effectiveness, especially for older people. Unfortunately, this brings a potential drop-off rate after the first dose. Educating employees and the public about this upfront will reduce this occurrence.

COVID-19 vaccine administration plans are being updated regularly. The BHC is tracking the CDC and Missouri plans – stay tuned for more information as it become available.

Warm Regards,

Louise Y. Probst,
BHC Executive Director

Congratulations, we made it! Election Day is here, at last. With 100 million of Americans reported to have voted before Tuesday, November 3, and large early morning crowds in socially distanced lines at the polling places, the U.S. is expected to reach record highs for voter turnout, despite pandemic concerns.

Many thanks to the state and local public officials and employees, and the army of volunteers that made casting our votes in this election both safe and convenient, including the newly available drive-by voting for people infected with COVID-19, which I happened to see this morning. The large number of cars lined up and volunteers in protective gear was a pleasant reminder of American’s shared commitment to democracy, and also, a sad reminder of COVID-19’s reach.

Again, health care registers as a top issue among voters. ACA rules that expand access to coverage and remove barriers to those with pre-existing conditions are valued by most people. Estimates find that 135 million Americans had some preexisting condition pre-pandemic; that number is likely to have grown as a result of COVID-19’s lingering symptoms. Fortunately, both presidential candidates have vowed to keep the ACA provisions which enable this. 

Gaining insight into the federal health policy agenda post-election will require additional days, weeks, and months. The outcome of the Supreme Court’s deliberation of California vs. Texas, a case challenging the ACA’s constitutionality, is expected mid-2021.

As an expansive piece of legislation, the ACA has enough provisions for most people to find things that they deeply appreciate and others that they strongly oppose. The list is long. What I find most often underappreciated about the ACA is the enormous amount of effort contributed by American employers toward its successful implementation. Just think about your HR team’s work agenda in the years preceding 2014. While collectively I do not know your opinions on its repeal – I expect few self-insured employers would wish for the ACA to be repealed, in its entirety, now that these health benefits changes have become the norm in your workplace. If you have an opinion to share, please reach out. In the meantime, we will be advocating for thoughtful and transparent policy deliberations, opportunities for public comment, and long lead times for the implementation of any changes.

Warm Regards,

Louise Y. Probst
BHC Executive Director

Flu season is on our doorstep and how we prepare matters. While no one knows what the upcoming flu season will bring, Dr. Jay Butler, the Centers for Disease Control, Deputy Director of Infectious Diseases, has warned that the flu and COVID-19 could be circulating together as we move into the fall and winter months stating, “If anything, we must over prepare for what we might face later this year.” Preparing means that everyone, 6 months and up gets a flu vaccine, particularly those that are pregnant, over the age of 65 or have a chronic illness. 

According to the CDC, the 2019 – 2020 flu season was mild. Still, there were between 39 million to 56 million cases of the flu, up to 740,000 hospitalizations and between 24,000 to 62,000 deaths. Add COVID-19 infections and this potential “twindemic,” or simultaneous outbreak of these two serious infections, could overtax regional health care systems and be catastrophic for patients trying to fight off both conditions at once.

Some fear that with COVID-19 center stage the public may forego the annual flu vaccine. Stay at home orders, fewer workers coming into the office and hesitancy to utilize elective medical services while COVID-19 looms could all deter people from getting their flu vaccine this year. As it is, in a normal year, only about half of the population gets a flu shot.

Employers can help bolster these numbers by helping employees understand that, in the face of the pandemic, the flu shot is an essential part of protecting their and their family’s health and fulfilling their civic duty. Taking definitive action, the University of California system recently in the face of the pandemic announced that because of the pandemic, it is requiring all 230,000 employees and 280,000 students to get the flu vaccine by November 1.

The potential of vaccines is enormous; it is one way we can each make a difference in our community. To find educational resources to share with your employees and to learn about discounted flu shot pricing available from BHC preferred vendors, please click here.

Warm Regards,

Louise Y. Probst
BHC Executive Director

Employers increasingly see a need to address the emotional fallout of the coronavirus crisis, even as they focus on protecting their employees’ physical health. Improving resilience and emotional well-being is critical during these challenging times, which is why workplace mental health will be the spotlight of the 2020 BHC Summer Forum on July 29.

There is mounting evidence that Americans are experiencing COVID-19 as a serious threat to their mental health. A study by Express Scripts found that the use of prescription drugs to treat anxiety, depression, and insomnia spiked between mid-February and mid-March of this year, with prescriptions for anti-anxiety medications alone rising 34%. Of the prescriptions issued during this period, more than three-quarters were new prescriptions. Just months into the pandemic, more than a third of households contacted by the Census Bureau reported symptoms of clinical anxiety or depression.

It’s clear that the pandemic is exacting a tremendous psychological toll, which can severely impact employee focus and retention. Many Americans worry that they or a loved one will get infected. Juggling work and childcare, fear of job loss, and loneliness are other common sources of stress. Experts say people with pre-existing mental health or substance use disorders are at increased risk.

Workplaces have diligently implemented new routines to prevent the spread of infection, with checklists that include social distancing, temperature checks, and a doubling down on disinfectant. Yet there is a gap in guidelines for navigating the pandemic’s psychological effects.

In fact, the COVID-19 crisis has exposed the cracks in our already fragile mental health system. Unfortunately, the workplace is often the last place where mental health is discussed. According to the National Alliance on Mental Illness (NAMI), roughly 85% of employees' mental health conditions were undiagnosed or untreated before the virus struck. This despite estimates that mental health conditions cost employers more than $100 billion and 217 million lost workdays each year.  

Fortunately, there are many resources available for employers who want to step up and effectively support their employees, and the BHC’s 2020 Summer Forum is a great place to start. Join over 300 benefit and wellness leaders to learn about best practices for increasing awareness, decreasing stigma, and creating a culture of health. Featured speakers will include Dr. Charles Zorumski, Head of the Department of Psychiatry at the Washington University School of Medicine, and Mettie Spiess, CEO and Founder of A World Without Suicide. To learn more and to register for the virtual conference, please click here.

Warm regards,

Louise Y. Probst

BHC Executive Director