Managed Care Insights During COVID-19: Gary Owens, MD

^{By Edan Stanley}

Gary Owens, MD, president of Gary Owens Associates, Ocean View, DE, and First Report Managed Care editorial advisory board member, shares his thoughts on COVID-19’s effects on managed care markets and potential long-term effects on the industry as a whole.

As of April 1, 2020, there are 186,101 COVID-19 cases and 3603 deaths in the US, according to the CDC. 

As COVID-19 continues to affect all facets of health care, can you please share your observations of its impact on the managed care industry and offer some perspective on what is still to come?

There are a number of things. Let me think about the managed care one first, as I was thinking about this. First of all, it's caused managed care plans to have to relook at some of their policies for getting medications, for access to medications, for days' supply to medications.

It has also caused them to have to look at and relax policies to access [emergency room] ER care, testing—especially testing for the COVID-19 virus. I think payers are actually going to see a downstream financial hit, because if people become unemployed, some of those unemployed people will no longer be able to pay premiums and be covered.

Depending on how long this lasts, I believe payers will see a reduction, much as they did in the recession of 2008 in topline revenue. There's going to be some financial strains on payers. On one hand, they have to relax some things to cover the cost of treating these patients, and at the same time, are going to fairly quickly see some loss of revenue.

As far as prescriptions, I think we're going to see shortages in certain critical medications, either because international commerce has flowed down and, in some cases, stopped. Many of our drugs, if they're not manufactured overseas, the critical components of them are.

Quite honestly, if you have fewer workers than even US factories to produce what we need, there may be reduction and shortages there. In some ways, I think there are a lot of unknowns. We may be seeing some unprecedented issues that I really don't even know how to predict.

Do you anticipate any new problems presenting themselves, perhaps in relation to how the US seems to be struggling with its response to COVID-19?

We are. We deemed [last week] a distinction that I'd hoped we would never have, which was to have more cases of COVID than any other country in the world. If you think about how this took off like house on fire in China, they got it under control more quickly because they actually took much more draconian public health measures than the US did.

I think there's a portion of the US population that just ignored, at least, the obvious, thinking about partyers at bars early on, and spring breakers in Florida. We just haven't done as good a job from the top down in getting the public health message out.

Sadly, we've actually gotten mixed public health messages. The truth is, we don’t know the timeline for something like this.

Still, we're on the increasing curve. I guess my other big worry is, COVID-19 puts a strain on the health care system, but all of that burden of illness that's out there, and continues to be out there, will continue to need care.

If health care workers are either, A, devoting the vast portion of their time to care for very sick viral patients, and B, some of those health care workers actually have the virus themselves, so they can't take care of non-infected patients, or may even actually be too ill to take care of those patients, I think we're going to see an uptick in a crisis in the lack of being able to care for some of those chronically ill patients.

People with advanced cancers, dialysis patients, transplant patients, end stages disease of all kinds, including heart failure, are going to get, by definition, less care. I think in addition to the burden imposed by COVID-19, we're going to see a burden of all those comorbidities taxing the system.

How are the facilities handling the mental health and the wellness of the providers that have to show up to work every day to expose themselves and to deal with a pandemic? What long-term effects do you think it’s going to have on people on the ground working directly with infected patients?

I think it has a lot of long-term effects. The first one being, some of our health care workers are going to succumb to this disease. They're human beings like everybody else. Every health care worker you take out of the system is going to create a burden on the rest.

I think the intense level of activity these people are under, there's going to be burnout in some of these individuals who simply are going to reach the point of exhaustion, and not be able to perform.

Of course, there's a big burden on their families. I've read several pieces by physicians saying they feel like they're radioactive when they go home. They literally are having to do everything they can. Undress in the garage, take a shower, and even minimize or isolate themselves from family contact. They're away from their families.

I also read a particularly moving piece about an ER doctor, a woman who is near term in pregnancy, and struggled with taking herself out of the system to protect her soon to be delivered unborn.

There's probably thousands, if not tens of thousands, personal stories here. People when they're sick, they don't forget. You have too much on your mind if you have a bad disease to think about the impact of my disease on health care workers, but it's out there.

Is there anything you’d like to add?

I think the big thing is I have been impressed by the overwhelming dedication of the scientists at our laboratories, our pharmaceutical manufacturers at the university, at looking for what can we do, in terms of both treatments and vaccines, and devoting incredible amounts of resources.

I'm not necessarily going to say they're going to be rapid breakthroughs, but I think just like when we realized that the HIV epidemic required a concerted effort and within months we had a treatment, I think this will take a similar if not faster trajectory, just because we're putting even more effort into it.

There's a part of me that's cautiously optimistic there.