Care Management Program needs to be Restarted by Health Insurance Companies

According to the board of America’s Health Insurance Plans, the health insurance carriers need to reactivate care management programs. Some or all of the active care management programs were suspended by the health care providers to mobilize the fight for the COVID-19 pandemic. Some of the health insurers suspended the care management, to plan their emergency planning in compliance with state mandates, or suspended it as a response to state emergency planners’ requests. Health insurers’ efforts toward managed care were not encouraged by doctors and hospitals, but now they should start to reactivate cate management programs, as per AHIP.

Now with the coming back of those care management programs online, a part of the U.S. healthcare system will be safely reopened, according to the AHIP board statement. As per the health insurance carriers, precertification and preauthorization programs improve the quality of care. Precertification and preauthorization are the procedures used by the health insurers to manage the health coverage of enrollees. These procedures are also used to decide whether the proposed medical procedures are appropriate for the patients and whether these procedures will be covered under their plan or not. To ease the burden of healthcare providers, health insurance companies waived preapproval requirements along with other administrative requirements in March.

According to the AHIP board, some of the healthcare providers are still facing problems due to the increase in the COVID-19 patients, and to help those healthcare providers, health insurance companies wish to continue to help them in terms of coping with capacity challenges. Health insurance companies are planning to bring back preauthorization and precertification programs for health insurance companies that are less hard-hit by COVID-19, and are expected to get back to normal.

As per the AHIP board, these programs if effectively used in a targeted manner will improve healthcare quality, protect patient safety, promote healthcare management for high-risk members, and preserve valuable resources by detecting fraud, waste, and abuse. Accomplishing and meeting these goals will become critical, especially with the country working to reduce COVID-19 risks. Health insurance companies wish to ensure that people not only get care, but they also want to ensure that they receive efficient care and are well supported by medical evidence.

Health insurance companies need to perfectly streamline the preapproval process to ease burdens on healthcare providers and to reduce patient’s risk of getting infected with COVID-19 while receiving routine and elective care. The companies can streamline preapproval processes by automation, electronic information exchange, programs to identify high-performing clinicians, and value-based provider contracts, which do not encourage unnecessary medical tests, procedures, and treatments.

The AHIP board share their ideas on how health insurance carriers should manage preapprovals given before March 13, the time when patient’s access to routine and elective medical procedures were blocked due to COVID-19 emergency. Insurance companies must try to refresh the preapprovals to eliminate the patients and providers need to re-apply for the preapprovals. AHIP is advising health insurance companies to extend the preapproval grace period of minimum 90 days or till the local backlogs for routine and elective medical care are clear.

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