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Chief Medical Officers Release Principles For Clinical Care In Continuing The Fight Against The COVID-19 Crisis

posted by AHIP

on April 29, 2020

Clinical evidence and excellence will continue to guide health insurance providers’ decisive actions to keep Americans healthy and protect health care workers as states plan their re-open strategies

WASHINGTON, D.C. – America’s Health Insurance Plans (AHIP), in partnership with Chief Medical Officer (CMO) leaders of our health insurance provider members, developed and released a set of clinical principles to promote continued safe, effective, and evidence-based care for Americans in the wake of the COVID-19 crisis.

These principles leverage the vast clinical and population health experience and data that health insurance providers have, and they are intended to complement the heroic efforts of clinicians fighting on the front lines of this crisis. They also reflect important clinical priorities as states begin to plan for re-opening businesses across the country, including elective and preventive health care services. Health insurance providers, led by their CMOs, will continue to evaluate and evolve these principles as clinical and scientific evidence grows, and as federal and state leaders further define their roadmaps to reopening.

“Patients and public health safety must come first. These clinical principles underlie our commitment to ensuring patients and health care workers are safe and supported in the delivery of effective, efficient, and evidence-based care,” said AHIP President and CEO Matt Eyles.

Health insurance providers employ doctors, nurses, pharmacists and other medical and care experts to lead our clinical operations, guide our efforts to ensure high-quality and evidence-based care, and to inform all aspects of the work they do. Based on that insight, principles agreed to by CMOs include:

  • Expanding Access to Alternative Sites for Care and Diagnostic Testing. No one should hesitate to seek testing or treatment for COVID-19, especially due to concerns over costs. But the need to reduce the risk of exposure to the virus and promote access to diagnostic tests and care has led to a shift from traditional office-based sites of care to other settings. Health insurance providers will continue to work with local doctors, nurses, and care professionals to increase access to patient care in alternate settings, including telemedicine, drive-through diagnostic testing, and special testing sites for the elderly and at-risk individuals. Care providers are highly encouraged to make use of the latest available diagnosis and billing codes to ensure appropriate tracking of patient care.
  • Promoting Use of Virtual Care and Telemedicine. Telemedicine expands patients’ access to care while protecting the safety of health care workers and patients. Health insurance providers continue to encourage the use of telemedicine and virtual care for primary care; behavioral health; specialty care diagnosis and treatment; management of chronic conditions; allied health services such as physical, occupational, and speech therapy; and in areas where there are access issues or high infection rates.
  • Supporting Providers by Raising Awareness About Clinical Practices and Policy. Information on effective practices for clinical care of patients either confirmed or suspected to have COVID-19 is evolving. Health insurance providers will continue to serve as a dependable source of clinical information to health care workers. Examples include effective practices related to infection control, options and availability of laboratory testing and logistics, protocols for diagnosing and caring for patients, the use of personal protective equipment (PPE), and clinical management of patients.
  • Prioritizing Mental Health. Mental health services are more important than ever – for American families and health care workers alike. Patients and front-line health care workers may experience trauma-related mental health needs long after the pandemic ends. Health insurance providers are working to increase tele-behavioral health care access, and to offer additional options to help all Americans avoid feeling isolated, alone and anxious throughout this crisis.
  • Adapting Medical Management Tools to Support Patients and Health Care Workers. Health insurance providers continue to provide maximum flexibility, consistent with state law, to limit prior authorization for COVID-19 related care and treatment and increase access to medication refills during this crisis to ensure patients have a continuous supply of needed medicines. Health insurance providers also are partnering with hospitals to accelerate patient transfers to safe clinical care locations in the most affected and at-risk regions.
  • Educating Members and Supporting Awareness. Health insurance providers are reliable sources of timely, accurate, and evidence-driven information for patients. In addition to providing information from science-based sources on their websites and nurse hotlines, they are expanding call centers to answer COVID-19 questions and make calls to patients who are most vulnerable to the worst effects of the virus. Health insurance providers will continue to take these actions, and to make people aware of their benefits and how they can access necessary care.
  • Protecting Clinicians and Other Public Health Teams’ Health and Safety. To meet unprecedented demand for critical supplies, health insurance providers will continue to facilitate increased access to PPE like gowns, masks, and gloves so it is available to those who need it. It will be important to ensure that PPE continues to be available to clinicians, health care workers and at-home caregivers as we work toward opening up health care services. Health insurance providers will also ensure that health care workers have the latest information on effective practices related to infection control, options and availability of laboratory testing and logistics, protocols for diagnosing and caring for COVID patients, and on the appropriate use of PPE.
  • Working with Government and Other Stakeholders to Share and Aggregate Data on Disease Progression. Better data is needed on the prevalence of COVID-19 at the county and facility levels to inform how to best prepare and care for patients and consider how to safely resume elective procedures and preventive and routine health care services. Health insurance providers are committed to working with other partners at the national level and in their local communities to gather and analyze this data. Understanding the incidence and trends of COVID-19 will help inform when and how to prioritize surgeries and other procedures, high-complex chronic care, and select preventive services that may be critical for patient care going forward.

Overcoming COVID-19 requires a comprehensive and coordinated response, with the government and the private sector working together. Health insurance providers are committed to working with state, federal, and local officials in every way possible. Because together, we can and will defeat and overcome the COVID-19 crisis.

For more information on what health insurance providers are doing to overcome the coronavirus crisis, visit https://www.ahip.org/health-insurance-providers-respond-to-coronavirus-covid-19/


About AHIP

AHIP is the national association whose members provide coverage for health care and related services to hundreds of millions of Americans every day. Through these offerings, we improve and protect the health and financial security of consumers, families, businesses, communities and the nation. We are committed to market-based solutions and public-private partnerships that improve affordability, value, access, and well-being for consumers. Visit www.ahip.org for more information.

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