COVID-19’s Financial Impact and Expectations for Employer Sponsored Health Plans

Sep 9, 2020 | Staying on Top, UpstateVibe365

by Jim Shew, Vice President—Employee Benefits, Marsh & McLennan Agency

Jim Shew, Vice President—Employee Benefits, Marsh & McLennan Agency

COVID-19 has created unprecedented changes and challenges for employers, employees, and healthcare systems across the country and around the world. For employer health plans, there is a particular challenge to understand the financial impact of COVID-19. Will the virus lead to more sickness and increased costs? Reduced utilization and thus lower costs due to shutdowns? Increasing rates of morbidity due to less routine care? Information is rapidly changing, and it is impossible to know for certain what the future holds; however, experience through the pandemic thus far has revealed some relevant data that informs employer expectations.

First, utilization is increasing in some specific areas:

• Diagnostic laboratory costs are increasing due to federally mandated waiving of the cost of COVID-19 testing as well as all testing ordered by a physician. 2020 diagnostic laboratory utilization is therefore likely to continue to be high as testing continues. While COVID-19 tests are relatively inexpensive ($50-150), more of the population is being tested. On average, roughly 15% of covered members will receive a COVID-19 test.
• Telemedicine: Nationwide, just 10% of healthcare consumers had used telemedicine prior to the pandemic. With the outbreak of COVID-19, more services are covered by insurance (and Medicare) through telemedicine, and healthcare systems have expanded capacity for telemedicine. Many routine visits and non-urgent health concerns have already switched from in-person to phone and video visits, and this will likely continue.
• Mental health services utilization may increase as individuals cope with difficult social, economic, and health situations. In addition, some mental healthcare providers are also converting appointments from in-person to phone or video.
• Inpatient hospital utilization has increased as individuals are hospitalized due to COVID-19. The nationwide average cost per day for a hospital stay is $4,000 – $5,000 and the average cost per COVID-19 inpatient admission is $38,000.

Conversely, employers have observed clear utilization decreases in elective and non-emergent procedures as well as routine medical, dental and vision procedures.

With all of this as a backdrop, we are getting to the time of year for health insurance plan renewals for 2021, and planning for cost and utilization expectations in 2021 cannot be done in the traditional way. The past 5+ months of experience are probably not going to be predictive of what employer plans will experience in 2021. Employers will now need to gauge the following different factors:

• Pent-up demand: This may occur as infection rates decline. Individuals who deferred elective and non-emergent services may seek these services later in 2020 or 2021, in addition to those who are seeking care along usual time horizons.
• Demographic risk: Thus far, epidemiologic studies have consistently shown that older (60+) populations individuals with pre-existing conditions are at a higher risk of developing severe symptoms, complications, and potential death from COVID-19. Employers covering greater concentrations of older individuals and individuals with pre-existing conditions are at higher risk of increased health plan costs.
• Geographic risk: Employers with employees traveling to high risk, COVID-19 areas or to countries with large concentrations of COVID-19 cases face a higher risk of an increase in health plan costs.
• Industry risk: Employees working in certain industries where social distancing is not possible or where exposure to potentially COVID-19 infected individuals is a requisite part of the job also present potential cost implications. These industries include manufacturing, healthcare, retail, hospitality, and public safety sectors.
• Government risk mitigation efforts: The impact of social distancing and other local, regional, and national government risk mitigation strategies will affect the rate of the infection spreading throughout the U.S., and thus health plan costs.

Also in preparation for upcoming health plan renewals, it is essential that employers maintain an updated plan document in 2020 to reflect any plan design changes that were made in response to the COVID-19 pandemic. Some employers waived costs related to COVID-19 treatment or extended benefits to furloughed employees for some period of time. Documenting those changes, particularly for larger employers who self-fund their health plan and purchase stop-loss insurance for large claims, is especially important.

With COVID-19 continuing to evolve daily and with the continued development of potential vaccines, it is not possible to accurately predict the final impact this pandemic will have on employer health plans. But with that said, there are some actions employers can take to respond to the environment and risks they are in as they plan for their 2021 health plan offerings:

1. Use a third party actuary to estimate the impact of COVID-19 on your health plan for 2021, and review those estimates as new information becomes available.
2. Collaborate with your medical carrier or TPA to understand and evaluate any cost projections and/or premium rates
3. Adjust your medical plan budget as appropriate, and IBNR reserve if needed

For self-funded employers purchasing stop-loss insurance…

4. Review individual and aggregate stop-loss coverage provisions and renewal forecasts
5. Communicate with the stop-loss carrier regarding mid-year changes to the plan document associated with COVID-19 treatment and testing to ensure no mid-year change to employer stop-loss attachment factors and/or premiums
6. Confirm that the stop-loss carrier will not decline a stop loss reimbursement if employees are furloughed or allowed to take an extended leave due to COVID-19.

If you would like more information, you may want to also visit the COVID-19 Resource Page from Marsh & McLennan Agency.

VCOM—Spartanburg’s Medical School with a Distinct Mission

Sep 9, 2020 | Staying on Top, UpstateVibe365

Tim Kowalski, DO, D.FACN, Vice Provost for Professional and Public Affairs and Founding Dean of the VCOM-Carolinas Campus

by Tim Kowalski, Vice Provost for Professional and Public Affairs and Founding Dean of the VCOM-Carolinas Campus, with Sharon Purvis

The Edward Via College of Osteopathic Medicine (VCOM), located in Spartanburg, is “to prepare globally-minded, community-focused physicians to meet the needs of rural and medically underserved populations and promote research to improve human health.” We asked VCOM’s founding dean, Tim Kowalski, to talk about how the school fulfills that mission here in the Upstate and what sets it apart from other medical schools.

Q: VCOM, with its four campuses (at Virginia Tech, Auburn University, University of Louisiana–Monroe, and in Spartanburg), is one of the largest medical schools in the country in terms of enrollment. Can you talk about what sets VCOM apart from other medical schools?

VCOM offers the Doctor of Osteopathic Medicine degree (DO), a degree historically established in 1892 to differentiate its training and philosophic approach to the practice of medicine from that offered within allopathic medical schools offering the Doctor of Medicine (MD) degree at the time. The osteopathic approach offered drugless musculoskeletal manipulative therapy to enhance the body’s inherent capacity to heal from within, in lieu of the then standard-of-care, which employed unresearched “best practice” treatments like poisonous drugs (such as mercury), blistering, and bloodletting. Osteopathic treatment, developed by A.T. Still, MD, was a disruptive approach to the practice of medicine that was met with significant resistance.

At the end of the 19th century, infectious diseases claimed the lives of many patients, but the development of antibiotics, other evidenced-based pharmaceutical treatments, and improvements in surgery has led to increased life expectancy and quality of life. While maintaining its distinctive philosophical approach in educating physicians, osteopathic medicine has embraced all evidence-based treatments available today. Osteopathic physicians are fully licensed in all 50 states and are board certified in all specialties and subspecialties from family medicine to surgical specialties.

VCOM’s successful mission to produce primary care physicians for underserved communities has been recognized by the US News and World Report —it is currently ranked 8th place among U.S. medical schools whose graduates enter primary care residencies. Boasting a 3-year rolling average of 63% of graduates entering family medicine, internal medicine or pediatrics, VCOM has averaged a top ten placement in the USNWR rankings for the last 10 years

Q: The VCOM campus in Spartanburg is strategically placed, anchoring the Northside Initiative. How does that support your mission?

Partnering with the City of Spartanburg, the Spartanburg Regional Health System, and Wofford College, VCOM chose to build what now has become its 25-acre campus in the once blighted northside neighborhood of Spartanburg. As a private not-for-profit medical school, VCOM broke ground in February 2010 on the site of the old Spartan Mills property, whose iconic smokestack stands sentinel to VCOM’s nearly 1000 graduates as of this past May. VCOM is proud to have been the catalyst to and a founding member of what has become the Northside Development Group (NDG).

Working strategically with northside residents, the NDG has developed mixed housing, the Monarch Café and Farmers Market, the Franklin School for early child development, and the TK Gregg Community Center with indoor pool. Moreover, construction of additional mixed-use retail/housing and clinic are nearing completion across the street from VCOM.

Spartanburg serves as the mission hub for VCOM to produce globally minded, community focused physicians and to conduct research to improve human health. Improving population health by mitigating social inequities through a positive annual economic impact of nearly $60 million dollars in the state, providing care through our soon-to-open Northside Clinic, and pursuing funding to develop clinical research are examples of a few of the ways VCOM is striving to meet its mission objectives.

Q: What unique challenges does a medical school such as VCOM face during a pandemic like the one we’re in now? How have you addressed those challenges?

In preparing to accept students back to campus, VCOM offered the first two weeks of curriculum online while our students remained physically isolated in their Upstate residences and were monitored for evidence of COVID-19 symptoms. We continue to monitor all students, faculty, and staff daily through our My-Health-Tracer webpage prior to being cleared to enter our building wearing a face covering.

Six-foot social distancing is achieved by splitting the day in half with live streaming of in-person lectures between both classrooms (with half of the chairs removed). All students have the option of viewing each lecture online instead. Labs are broken down into small groups that include the same individuals and faculty with appropriate PPE. A critical part of physician training involves hands-on skills, and VCOM has found creative, safe ways to provide this preclinical training to our students to include simulation and physical examination.

Patient actors offer real-time, video-captured simulated telemedicine sessions that are reviewed with monitoring faculty that allow us to assess students skills in the biomedical and humanistic domains of the doctor-patient encounter. Students study off-campus following lectures, labs, and appropriately social distanced exams are proctored on-campus. Our upper level students complete their clinical rotations in the clinical learning environments of hospitals and office-based care facilities with appropriate PPE and following all required standards to prevent spread of infection.

A New Resource for Women in Business: A Conversation with Ana Parra of CommunityWorks

Sep 2, 2020 | Staying on Top, UpstateVibe365

with Sharon Purvis

Ana Parra, Women’s Business Center Program Director, CommunityWorks

Earlier this year, CommunityWorks applied for and received funding from the Small Business Administration (SBA) to be one of two organizations in South Carolina to launch a Women’s Business Center. The CommunityWorks Women’s Business Center (WBC) is a part of a national network designed to help women start and grow small businesses.

 Q: Can you tell us a bit about the how CommunityWorks came to house the new Women’s Business Center—was it something CommunityWorks pursued, or was it more of an initiative in search of a home? Or a little of both?

While CommunityWorks had to apply for the grant to fund the center, the organization’s commitment to building opportunities for all through financial education lending and investing made us a natural fit for the WBC. CommunityWorks has seen firsthand the growing number of women business owners in our Upstate community and the need for women to have supportive entrepreneurial ecosystem. With the WBC, we will be able to empower women entrepreneurs, through advocacy, outreach, networking, coaching, and education.

Q: What kinds of programs will be offered to women with the center that are distinct from the other programs offered by CommunityWorks?

The WBC continues the work of CommunityWorks to provide relevant training and resources to women and communities of color. Our focus has always been on reaching and work with those who have been traditionally underserved by traditional banking institutions. The WBC will be offering clients one-on-one support through our CommunityWorks team. The guidance and training offered is designed to build confidence, skills, networks, and access to capital to women, with an intentional outreach to women of color.

Some of those programs include self-paced trainings, business planning using an online platform with the guidance and feedback from the WBC, and business coaching for businesses that have been disrupted by COVID-19.

Q: I know that the Credit Union at CommunityWorks is for people who live or work in Greenville County. Does the Women’s Business Center likewise cater only to Greenville County residents, or is it open to women across the Upstate?

We’re looking forward to working with women all over the Upstate and will be working in 15 counties: Abbeville, Anderson, Cherokee, Chester, Edgefield, Greenville, Greenwood, Lancaster, Laurens, McCormick, Oconee, Pickens, Spartanburg, Union and York.

Q: When will the center be up and running, and what will the first offerings be?

The CommunityWorks Women’s Business Center is open! When clients register with the CommunityWorks Women’s Business Center, they will be able to sign up for business consultation to determine how we can best help them on their business journey—whether that’s support in creating or updating a business plan, personal finance, or business coaching.

We are working on a variety of trainings and webinars to help business owners better respond to COVID-19 depending on what sector they are in, as well as providing technical assistance in areas such as business planning, accounting, marketing, and technology.

Q: What else do you want people to know about the Women’s Business Center?

The CW WBC wants to support business owners at every level. We are here to help with next steps whether you are in the idea phase or growth phase. And if you happen to be a business owner who wants to provide mentorship and network with other small business owners, we want to hear from you too, as we develop a network of women entrepreneurs who represent the Upstate’s diverse communities and a variety of sectors.

We have had such a great response so far and we hope to grow and develop to meet the needs of the amazing women who making the Upstate community a dynamic place to live.

The State of Event Planning from Different Industry Experts

Aug 26, 2020 | Staying on Top, UpstateVibe365

Eliza Hart, Account Executive, Smoak Public Relations

by Eliza Hart, Account Executive, Smoak Public Relations

With the current circumstances surrounding COVID-19, we are without a doubt experiencing a different time and all businesses have had to pivot. The event world is no exception. COVID-19 has forced all events to come to a halt and determining the next steps has been a challenge.

We reached out to some of our friends in the event industry to gather different expert opinions on what they recommend to best help you move forward with your event. Please find the below pointers on how to navigate the event world during such a unique time.

Perspective from the event planner (Smoak Public Relations): As an event planner and account executive at Smoak PR, I suggest using this time to get organized, work ahead and make your event even better! For starters, reach out to your venue and hold several new event dates—request first right of refusal. With the status of COVID-19 ever changing, it is important to have more than one date option and to consider the possibility of a virtual event. The upside of having a virtual event is that you are able to keep your original date and stay connected with your attendees. In addition, you are saving on the majority of event expenses, such as food & beverage, rentals, event signage, and more. However, hosting a virtual event makes it more difficult for networking opportunities to occur and may also result in lower event attendance. You must be very creative if you are hosting a virtual event!

Perspective from the event rental company (Professional Party Rentals): Janice Mancuso at Professional Party rentals gave us some insight on what they are seeing from an event rentals standpoint. She shared, “With events coming to a stop it has resulted in most event rental companies temporarily shutting down. We are getting small orders here and there, but we are no longer running at full capacity. At PPR, sales representatives are only working one day a week; therefore, response time may be delayed. Be sure to stay organized and make a list of everything you need so you can limit the amount you are contacting vendors. It would also be helpful to visit our website, where you most likely will be able to find the answers to the majority of your questions. The website will give you a good idea of what items we have and hopefully provide some inspiration!”

Perspective from the caterer (Southern Way Catering): The general manager of Southern Way Catering, Mark McCalmont shared, “With event dates being rescheduled, we will be busy when things are back up and running; however, in the meantime we are taking a hit. COVID-19 has affected scheduling, food orders and staffing, so share updates with your caterer as soon as you can. Most people who order food to go are picking up from local restaurants rather than ordering meals through a caterer. Most caterers, Southern Way Catering included, have family meal options for any day of the week and especially options for holidays. Use this time to support your caterer and order food to go so you can sample different menu offerings. This is also a great time to check things off your list and finalize your menu and bar package.”

Perspective from the venue (Bon Secours Wellness Arena): According to Joe Dolan, assistant general manager at the Bon Secours Wellness Arena, “the live event, sports, and entertainment industry has been impacted significantly by COVID-19. Our industry was one of the first to cease operation after the spread of the virus, and will likely be one of the last to return as restrictions are lowered. Customer safety and security is at the forefront of every decision we make, so new best practices will be instituted to ensure each guest is comfortable enjoying the unique experiences our events have always provided. Our industry is familiar with adapting to protect our guests, and just as we did post 9/11 and in the age of violence against mass gatherings, we will overcome these new challenges to create a welcoming and safe atmosphere for fans of sports, events, and live music.”