Blue Cross Takes Action to Help Members During the Coronavirus Outbreak

Blue Cross Blue Shield of Michigan and Blue Care Network, in line with

Blues-affiliated plans across the country, will be taking action to ensure the health and

safety of our members during the worldwide outbreak of a new coronavirus.

The disease caused by the new coronavirus is called COVID-19, and causes symptoms including fever, cough and shortness of breath. The number of cases of COVID-19 in the U.S. continues to increase daily as the new coronavirus spreads from state to state.

All diagnostic laboratory tests for COVID-19 when used in accordance with CDC testing recommendations will be fully covered by Blue Cross at no cost to the member. This measure will ensure patient testing and subsequent care is completed in an efficient, coordinated way with authorities at every level.

To ensure patients receive the right care at the right locations, Blue Cross will be waiving prior authorization processes for covered services related to COVID-19 — unless prior authorization is required to assure the availability of the treatment for persons in need consistent with CDC recommendations.

Prior authorization means a doctor, in certain cases, would file a request with a patient’s insurance company for certain prescription drugs, as well as for some medical and surgical procedures, before they are pursued as treatment.

Blue Cross will also be dedicating clinical staff to address medical service questions related to COVID-19.

As cases of COVID-19 continue to be reported across the U.S., Blue Cross is taking proactive measures to make sure all members have the medications and the care they need for illnesses and conditions beyond the coronavirus outbreak.

Access to prescription medications will be expanded to ensure patients do not experience shortages or difficulties filling their prescriptions. Early medication refill limits on 30-day prescription maintenance medications will be waived (consistent with a member’s benefit plan). Any additional charges that may stem from obtaining a non-preferred medication for COVID-19 treatment will not be billed to the patient.

In anticipation of high demand at health care provider offices, Blue Cross will be expanding access to telemedicine and nurse/ provider hotlines.

Blue Cross offers the following options to access care remotely:

Blue Cross Online Visits Using your smartphone, laptop or tablet, sign-up or log on to Blue Cross Online Visits account to quickly connect to a licensed health care provider over a secure, webbased video chat. You don’t need to make an appointment and you can talk to a doctor in 10 minutes or less. You can even get a prescription if you need it.

24-Hour Nurse Line At no cost to Blue Cross members, a registered nurse is waiting for your call anytime day or night. Able to help over the phone, they can answer your questions regarding symptoms and help point you in the right direction for any next steps in care.

More Information This is a rapidly developing situation and information is constantly changing and being updated as officials learn more about the virus. Blue Cross Blue Shield of Michigan staff are diligently tracking all updates regarding the disease’s activity, symptoms, travel restrictions and risk assessments from official sources.

For current Blue Cross information on the new coronavirus, please visit our blog. The blog is updated three times per day with information verified by Blue Cross clinical leadership. It includes information intended to help customers and members stay current on developments, guide in managing good health and addressing topics of concern.

ARE PAYER’S AIDING AND ABETTING OUTSIDERS?

By Ewa Matuszewski, CEO, MedNetOne

The venture capitalist will see you now. Unfortunately, it’s not the lead-in to a joke. It’s the next inevitable step in usurping the role of primary care. A s those of us long invested in the health-centered goals of the primary care community mark wins with the patient-centered medical home (PCMH), team-based care and care management strategies; as we dive deeper into the role that social determinants of health play in limiting access to care and optimal health and wellness – and offer practical solutions; as we find success with datadriven, population health strategies…the business people see dollar signs, instead.

Humana entered into an arrangement with a private equity firm to create primary care clinics focused on the Medicare Advantage and dual-eligible population. Doing so will add to Humana’s existing senior primary care clinics, which have a multi-state footprint and were designed to lower healthcare costs while grabbing market share among the mighty senior population. It’s not just Humana, though, it’s a trend among large insurers and health systems. (I must add here that it irks me that the venture capitalists, private equity firms and other outliers are swooping in and tapping large insurers and employers, rather than seeking out partnerships with smaller practices who built the networks of primary care in this state – i.e., locally source healthcare.) From urgent care clinics to variations of the pharmacy Minute Clinics and the extension of authority of advanced care practitioners (highly valued, respected and necessary members of the health care continuum, but not physicians), there’s a mission creep in primary care that seems to be excluding primary care physicians, or at least moving them down the patient care ladder. But what can we do about this dismantling of PCMH practices and the primary care community that built them? How can the primary care physician, even and perhaps especially, the private practice primary care physician, regain their authority and the sacred role they play in the physician patient relationship?

As the saying goes, “No one gives you power. You take it.” But can you take it back? I’m not sure there’s a saying for that, but here are some steps that can be taken:

PCPs need to band together in solidarity (their POs can help) against venture capitalists and other non-clinical opportunistic business dealmakers who aim to lure the coveted senor Medicare Advantage population through shiny new clinics. When patients believe their coordinated needs are being met, there is no incentive to leave a practice, regardless of age. A solidarity among primary care physicians can help stop a rush of seniors from seeking care elsewhere.

Medical societies need to lay off the politics and turn their attention, and spending of annual dues money, back to physician members who seek guidance and advocacy for themselves and their patients on a holistic level. The trend is for medical societies to focus on a piece of the puzzle, such as pre-authorizations and administrative issues, often partisan in nature, that can be addressed by nonphysicians. Medical societies instead, can re-focus some of their attention on preserving and strengthening PCMHbased primary care.

Looking back to 2007, I was a presenter at a state conference held at the Dearborn Hyatt introducing the PCMH model. Several physicians walked out, complaining the fledgling movement would never gain traction and wasn’t worth their time. Well, they were obviously wrong; the PCMH model did take hold, thanks to its reinforcement of the value of the patient/physician relationship, solid foundational principles and the support of major insurers like Blue Cross Blue Shield of Michigan and PriorityHealth. But is it strong enough to hold up against all the outside money eager to invest in healthcare for profits, rather than patients?

If the greater primary care community doesn’t see what’s happening with the senior community (just for starters), they could be waiting in line behind their patients to see what the investors can offer them from what once was their very own primary care practice. Don’t kid yourself, a threat to primary care is a threat to the medical profession as a whole.

UPCOMING EVENTS

The MOA is monitoring the situation regarding Coronavirus disease 2019 (COVID-19) as a community health emergency, and in regards to managing our own events. At the time of this publication, the 121st Annual Spring Scientific Convention will be held May 14-17, in Southfield, MI. The health and safety of attendees, speakers and exhibitors is the utmost concern to the MOA, as well as adhering to any recommendations made by the Michigan Department of Health and Human Services (MDHHS). At this time, all options are being examined.

In the meantime, meetings have been postponed or changed to teleconference meetings. Visit www.domoa.org for updated information. The MOA will continue to monitor the situation and relay updates as they are announced.

MICHIGAN OSTEOPATHIC ASSOCIATION 16th Annual Autumn SCIENTIFIC CONVENTION

Join us in GR!

November 8 - 10, 2019 Amway Grand Plaza Grand Rapids, MI

20 AOA Category 1-A CME credits anticipated. The #DOfamily meets for the latest in osteopathic health & research updates at the Autumn Scientific Convention.

www.domoa.org/autumn

June 18-21, 2020 Mission Point Mackinac Island, MI

Join the NMOA for an opportunity to network with your colleagues, experience outstanding lectures, and engage with exhibitors on beautiful Mackinac Island.

www.domoa.org/nmoa

TRIAD STAFF Kris T. Nicholoff, CEO and Executive DirectorMHA Lisa M. Neufer, Director of Administration Todd Ross, Manager of Communications Virginia Bernero, Executive Assistant & Marketing Coordinator Melissa Budd, CME Program Manager

2019 - 2020 BOARD OF TRUSTEES Department of Business Affairs - Directors Craig Glines, DO, President Jeffrey Postlewaite, DO, President-Elect Lawrence Prokop, DO, Immediate Past President John Sealey, DO, Past President David Best, DO, Secretary/Treasurer

Department of Socio Economics - Directors Stephen Bell, DO Emily Hurst, DO Department of Education - Directors Kevin Beyer, DO Adam Hunt, DO Department of Membership - Directors Jasper Yung, DO Nathan Holmes, Student Trustee

Department of Healthcare Technology & Informatics - Directors Andrew Adair, DO Miles Medina, DO

The osteopathic profession in Michigan is made up of osteopathic physicians, osteopathic hospitals and an osteopathic medical school. This TRIAD stands together to serve our patients and one another. TRIAD, the official journal of the Michigan Osteopathic Association, serves Michigan’s osteopathic community, including its osteopathic physicians, hospitals, medical school and patients. The Michigan Osteopathic Association will not accept responsibility for statements made or opinions expressed by any contributor or any article or feature published in TRIAD. The views expressed are those of the writer, and not necessarily official positions of MOA. TRIAD reserves the right to accept or reject advertising. The acceptance of an advertisement from another health institution or practitioner does not indicate an endorsement by MOA.

COMMUNICATIONS DEPARTMENT Michigan Osteopathic Association Communications Department 2445 Woodlake Circle, Okemos, MI 48864

Phone: 517.347.1555 Fax: 517.347.1566 Website: www.domoa.org Email: moa@domoa.org

AOA Annual Business Meeting........................................... 16

Blue Cross Blue Shield of Michigan .................................... 22

Coverys................................................................................ 2

Healthcare Partners of Michigan......................................... 24

Kerr Russell........................................................................ 14

Maner Costerisan................................................................ 16

McLaren Health Care............................................................ 8

Metro Health...................................................................... 18

MHA .................................................................................... 6

MOA Spring Convention...................................................... 4

MOPAC.............................................................................. 14

NMOA Summer Conference............................................... 26

Origami.............................................................................. 12

For advertising inquiries, please email Todd Ross at tross@domoa.org or call 800.657.1556.

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