As the COVID-19 pandemic continues into the summer, public health concerns are at the forefront of everyone’s mind and Guy Carpenter is actively developing a view of how COVID-19 may impact the healthcare industry and the medical (re)insurance market.
Providers and hospitals, whose contact tracing activities before COVID-19 historically focused quite narrowly on provider regulatory compliance, are now serving their greater communities and complementing other institutions’ health missions along the way. Now operating according to expanded health department guidance during COVID-19, the greater healthcare industry is monitoring the infected for worsening clinical conditions that require hospitalization and treatment, according to Oliver Wyman Health & Life Sciences Partner and Chief Medical Officer, Bruce Hamory, MD. Guy Carpenter is an affiliate of Oliver Wyman.
However, current and future pandemic requirements regarding contracted population management – something once focused on identifying and treating those needing preventative care or those at risk of deteriorating health – too aggressively identify and isolate those individuals actively infected with COVID-19. Actions like locating those who may have the virus before quarantining and testing them, although well-intended to stop the spread, limit an organization’s financial exposure to expensive COVID-19 hospitalizations.
Hospitals must do whatever’s reasonable and necessary to reduce the number of COVID-19 patients requiring hospital care. As states reopen, many are requiring hospitals to maintain a fixed level of open beds to handle expected fluctuations in COVID-19 admissions. These capacity requirements are often 20 to 30 percent of the hospital systems’ intensive care units and adult medical-surgery bed capacity. This requirement may be enough to lower a hospital operating margin below a profitable level.