Vol. XIX, Issue 17
In response to the Department of Health and Human Services recently extending the COVID-19 public health emergency period, coverage will be extended until at least October 13, 2022, for the following:
At this time, only COVID-19 in-office testing is required to be covered at 100%. However, Wespath has decided to continue to cover in-network COVID-19 treatment at 100% until at least October 13, 2022.
Some retailers, such as Walgreens and CVS, have recently updated their practices for onsite COVID-19 tests and may not bill insurance if a pre-test questionnaire suggests that the test is not medically necessary (e.g. for employment or travel).
Members can still obtain at-home tests fully covered by HealthFlex (up to eight tests per covered individual per month) at participating pharmacies or through the Optum Store (in Benefits Access, select "Health Details" then click "Go to OptumRx"). This coverage is also extended until at least October 13, 2022.
They can also request reimbursement for tests not purchased at a participating provider, subject to certain limits. For more information about coverage of at-home COVID-19 tests, we encourage you to visit https://www.optumrx.com/testinfo or read the January 24 edition of the HealthFlex Express.
Last week, the key contacts within each HealthFlex plan sponsor group should have received your 2021 Benefit Plans Summary Reports. As you look through these, we wanted to draw your attention to some changes and HealthFlex-specific highlights.
We changed our health data warehouse and moved some well-being programs to Virgin Pulse in 2021, which resulted in a few differences in 2020 metrics in the 2021 reports versus those reported in the previous year's reports.
Please note the following differences:
The cancer screening rates for different types of cancers have changed:
Breast and cervical cancer screening: The preventive screening algorithm in the new data warehouse shows higher compliance.
Colon cancer screening: The rate is lower due to the change in recommended screening age from 50 to 45. We continue to lack a full 10-year history on colonoscopies, which likely underreports compliance.
The new data warehouse classifies Most Costly Drug Categories and Conditions differently.
How we measure Population Health Risks, including what is considered low or high risk, changed:
2020: Population health risks were based on the WebMD HealthQuotient.
2021: Population health risks are now based on the Virgin Pulse Health Check. Health Check measures and categorizes risk areas somewhat differently so we did not include a 2021 comparison.
The statistic measuring behavioral health claimants changed:
2020: The report included mental health diagnoses.
2021: The report usage of behavioral health services. We feel this is a more accurate way to assess utilization going forward.
The statistic measuring generic prescription drugs changed:
2020: The report included the "generic substitution rate," the percentage of prescriptions where the generic drug was substituted for a brand-name drug by the pharmacy if a generic was available.
2021: The report included the generic utilization rate, which represents the percentage of prescriptions which are generic.
Since we require generic substitution, we feel the current utilization metric is more helpful in determining the percent of drugs that are actually generic.
In the next edition of the HealthFlex Express we'll discuss some significant changes in engagement in a few areas.
Anything you can do to remind participants to complete the Health Check and BFW ahead of the August 31 deadline would be greatly appreciated.
We have written promotional text about the Health Check and Blueprint for Wellness (BFW) that you can copy and paste into the body of an e-mail. There also are resources for the Health Check and BFW on the Extranet (which can be accessed through the Wespath Portal) that are designed for you to share with your participants. In the Extranet, click on the "HealthFlex and Virgin Pulse Tools & Resources" link at the top. There you will find PDFs you can attach to e-mails, how-to videos you can share or embed, and social media posts you can retweet or share. We recently updated the detailed how-to Health Check video on the Extranet.
Next week we will be sending you the Blueprint for Wellness and Health Check completion file so you can target the reminders to individuals who have not earned their full incentives.
One of the things we take pride in with HealthFlex is our robust offering of well-being programs. To help your participants learn more about these programs—and find the ones that are right for them—Wespath's Todd Creviston is happy to lead a well-being webinar that walks them through all their options. Creviston is a health promotion manager and benefits educator.
If you are interested in hosting a well-being webinar for your participants, please contact us at wellnessteam@wespath.org.
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