When COVID is no longer a public health emergency, what happens to healthcare?

Is the pandemic over? 

In September, when President Joe Biden suggested during a 60 Minutes interview that it had come to an end, the nation collectively paused to consider whether or not his statement was true. And while the answer to that question varies greatly depending on who you ask, it's clear that our relationship with COVID-19 is shifting. As restrictions and safety protocols continue to soften, a more pressing question emerges: What will healthcare and benefits look like once the pandemic is over? 

On January 27, 2020, the U.S. Department of Health and Human Services (HHS) declared COVID-19 a public health emergency (PHE), which created certain flexibilities within the healthcare industry to help the nation address the impact of the virus. That has included simplifying access to vaccines, creating HIPAA allowances to more broadly enable the use of telehealth throughout the pandemic, and most notably, requiring Medicaid programs to keep people continuously enrolled through the end of the PHE to avoid lapses in coverage. 

For nearly three years, the PHE has been repeatedly extended, though it's expected to finally expire in early 2023. Despite regulatory challenges created by the impending end of the PHE, it's impossible to ignore the cultural shifts COVID created — and the fact that for many consumers, their relationship to healthcare has forever changed. As we move into 2023, a new sort of "new normal" will likely emerge, but it will take significant effort and communication between healthcare providers, systems, insurance carriers, employers and employees. 

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"We went into this pandemic with this PHE and with lockdowns, not trying to eradicate COVID but to minimize hospitalizations and deaths — and while it didn't happen overnight, it did happen," says Michael Strazzella, head of federal government relations at law firm Buchanan Ingersoll and Rooney. "Trying to maintain that level in kind of an open, non-PHE, non-lockdown world, becomes challenging."

For the healthcare system, pressure's still on
Doctors, nurses and other healthcare professionals have felt the strain of the pandemic, driving departures from the industry and creating staff shortages in already-overwhelmed hospitals and facilities. As we move beyond the emergency status of the pandemic, Strazzella predicts, the snowball effect of changes will only put more weight on the healthcare system. 

"In a normal world without COVID, if I got the flu, I probably would have stayed home, drank tea with honey while riding it out with a humidifier," he says. "But now, I'm going to go to the doctor and wonder if it's the flu or if it's COVID — and that's two tests for the doctor to run, two tests to send to the lab, more supplies, more man hours." 

That new pressure on hospitals' staffs and bottom lines could lead to additional personnel shortages and even limited elective surgeries if facilities once again become too stretched. In addition, the Kaiser Family Foundation predicts that up to 14 million people will lose existing healthcare coverage once the PHE comes to an end; states will be required to build plans to prioritize renewals and address a potential influx of uninsured residents. 

"We've got a really big social responsibility to make sure that we've got the right benefit designs, the right product designs, and making sure that we're engaging with our employers for education," says Brandon Cuevas, chief growth officer at UnitedHealthcare. "We have to make sure they're aware of what could be happening to employees who are enrolled in Medicaid and may lose coverage." 

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Amid the uncertainty, however, some silver linings may emerge. Patients and providers alike were forced to get comfortable with virtual care and telehealth during the pandemic. Now,

Strazzella anticipates we may see some of the COVID-era regulations that brought ease to telehealth — like allowing providers to deliver telehealth services across state lines and prescribe medication without in-person visits — made permanent. 

"We have seen report after report that it did not increase Medicare claims the way a lot of people believed telehealth would as far as volume and overutilization," he says. "Going into 2023, we need to recognize what some of the challenges within the healthcare delivery system will look like, and think about how we rebound from some of this as far as the rollback or unwinding of the PHE goes." 

A push toward personalized care
As we continue to emerge from COVID restrictions and get back to a pre-pandemic level of social activities and interactions, consumers may be reconsidering how their health insurance supports a post-COVID lifestyle. 

"Every year employees should do a review of the past year of services they've used and what they're going to need moving forward, and think about what the best plan is for them, whether it's an HSA or an HMO or a PPO," Strazzella says. "In recent years, some people did base that plan on their COVID behaviors. Now that we're coming out of the pandemic, and with possible changes in leadership and majorities in the House and/or the Senate, we're going to see various proposals that are trying to support employers bringing people back to work. What does that mean for your lifestyle, and how does that translate into the healthcare you're going to need?" 

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As employers anticipate that shift, UHC's Cuevas says they're turning to insurance organizations to find innovative ways to provide better care while managing costs. Digital tools remain a vital way to do that, especially when it comes to managing high-impact conditions like musculoskeletal (MSK) concerns, as well as women's and maternal health. But the embrace of the digital creates new opportunities to use data and predictive analytics to support a member's complete health — and proactively communicate with them to boost care. 

As an example, Cuevas points to issues around maternity: If a member is pregnant, UHC can reach out to make sure that person is aware of other maternal solutions, programs and resources available to them, even helping them locate and select physicians. 

"It's a little bit like when you watch TV and see a commercial for a plumber: you never remember or think about the plumber until you actually have a plumbing issue, but then you of course can't remember what the hell that number was," Cuevas says. "For us, we want to make sure that our members don't have to remember everything that's available to them in terms of healthcare. By using predictive analytics and engaging frequently with our members, we can make a proactive outreach to make sure they can access the care they are going to need." 

Additionally, UHC is looking for new ways to incentivize ancillary programs, working with employers to find ways to get employees to engage in healthy activities — from exercise to regular dental checkups — that can lead to long-term health benefits.

"As we continue to find ways to bundle medical coverage with ancillary products, we know we can get savings because when everything works together it's better for employees' health," Cuevas says. "And by integrating all of those tools together across our customer service touch points and digital platforms, employees get a great experience that they engage with more frequently." 

A deeper relationship with the way we work
While employers will be driving conversations with insurance providers to find ways to improve care while keeping costs low, employees have also emerged from the pandemic with a greater awareness of the role their employer can play in whole-person wellness. 

"COVID brought about this true understanding of the brevity of life, and I think employees now understand the importance of working for organizations that value them as a total human," says Brittany King, senior manager of talent acquisition, talent intelligence and diversity at Kraft Heinz. "I'm not sure I'd call it a shift in how employees and employers communicate, but I think there's going to be a deepening in that relationship." 

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King points to the historic disconnect between HR's benefits offerings and the needs of the employee population, but suspects we're on a forward path to more honest communications and requests. Consider the 133 million Americans managing a chronic condition: As a push to return to the office gains momentum, many of these workers will need accommodations to support their productivity, whether via remote work or accommodations put in place at their office. 

Kraft Heinz recently started working with a new digital tool, Disclo, which helps organizations manage accommodation requests with ease, while maintaining compliance with HIPAA and ADA requirements. By streamlining the process — and prioritizing employee privacy — Disclo is creating ease for employers and employees alike, and enabling organizations to better support an often overlooked community of workers. 

"The hope is that employees will feel more empowered to do what they need to do and ask for what they need," King says. "We're taking all the guesswork out of accommodation. I believe in elevation through education, and I think that companies who perform the best in terms of DEI and inclusive excellence will be those companies who speak to people first, with policies and processes." 

As employees continue to speak up and seek out supportive benefits and policies, it's likely that they'll be seeking whole-person care not just for themselves, but for every member of their family. Strazzella points to mental health support — a need that has gone from nice-to-have to vital over the course of the last three years — as an area where employees are poised to demand more.

"People need to take a close examination of what their mental health benefit is, and if they have family coverage — children have struggled through COVID socially and academically,  and anxiety has been high," he says. "As families are in need of more services, and in need of understanding out-of-pocket expenses, they need to talk to their employers now, as things are getting decided, to ensure there's that opportunity for what they need."