The COVID-19 outbreak is disrupting the healthcare payer market via both government regulation and market-demanded adjustments to support optimal provider operations and member outcomes.
Baker Tilly can help your organization navigate this quickly changing landscape by mobilizing an experienced team to respond to government mandates, such as eliminating co-pays on COVID-19 related claims; upgrade claims systems to approve and pay new billing codes associated with the virus; and help to define a telehealth strategy to meet CMS’ newly relaxed regulations.
At the same time, the market requires new member engagement strategies to deliver effective communications and engage high-risk members, and as new provider costs and treatment protocols are emerging analysis and modeling of network provider contracts is required.
All of Baker Tilly’s services include a comprehensive approach to managing the impact of the change on all stakeholders (staff, customers, members, providers) to ensure efficient communication and maximum adoption of new best practices that facilitate timely and effective results.
Support your organization with transforming and optimizing member engagement plans and strategies to achieve effective, clear, and timely emergency response communications.
Vendor or internal team coordination and support to help deploy newly developed COVID-19 triage solutions for network providers.
Support health plan expansion of telehealth services and define reimbursement for those services in network contracts.
Enhancements and configuration updates to various health plan systems required to support new COVID-19 diagnostic tests, treatments, and eventual vaccines, and any related voluntary or state/federal mandated policies.
Payment programs modeled off of Medicare's Periodic Interim Payments (PIP) program may be able to provide a financial lifeline to the provider community as COVID-19 creates an increasing disruption on the provider utilization patterns and cash flows. This lifeline could also help secure the strength of health plans' provider networks, and establish a set of partnerships that could be built-upon as the crisis recedes.
Network provider contract analysis and financial modeling to help quantify the financial impact of COVID-19.
As your organization addresses new government mandated and market driven changes, Baker Tilly can support you to successfully manage through these challenges.