COVID-19 FAQs to help you answer client questions
Our response to the coronavirus (COVID-19) is focused on helping you and your clients get access to the information and services you need. Below is a library of frequently asked questions (FAQs) by category that we’ll continue to update as COVID-19 details evolve.
Please note that this information is for employers, brokers and consultants. Our UnitedHealthcare members can find answers to their questions in our COVID-19 resources.
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UnitedHealthcare COVID-19 Briefing November 11, 2021 Opening Comments
PHILIP KAUFMAN: Good afternoon, everyone. Thank you for being here with us this afternoon. My name is Philip Kaufman. I’m the chief operating officer for UnitedHealthcare’s commercial division. And we really appreciate you taking the time out and we really appreciate you taking the time out to join us today. Any day is a great day to thank a veteran, but I want to particular on today on Veterans Day, I want to call out and thank all the veterans who are either on the phone with us today or work within your respective organizations, want to thank you for your sacrifice, your dedication to our country, the example you set for all of us. We hugely appreciate it, so thank you. As usual, we hope to have put together a great agenda for you today. I’ve got with me Craig Kurtzweil, who is going to talk about some of the most recent trends. Try to give you some additional insights in what we see going on within the COVID space. And we always try to be able to bring to you some of our propriety information, not just what you might see in the headlines out there. So Craig will do a nice job of bringing that today. We’ve got Dr. Randall with us, who will talk about a variety of things. Talk about vaccine for kids, talk about all the different treatments that are out there, including some that are newly emerging. She’ll also talk about some things that we want to keep front and center, one of which is adolescent mental behavioral health, and then the second is staying on top of flu season. Then finally it’ll come back to me. I will start to cover a lot of questions that we’ve had on the vaccine mandate. What our expectations are, how it looks, how it might function, as well as what I’ll call an outlook for 2022 and some of the different trends that we see there. Before I jump to that, just a few housekeeping items just as a reminder. For those of you who have been joining on these calls it’s going to be very repetitive for you, but we try to do our best to cover the information in a broad fashion. In certain cases, whether you have UMR or All Savors, what we talk about today, it might be a little bit different, depending on your plan configuration and dynamics. So we always encourage you to reach out, to talk to your UnitedHealthcare rep or your broker for more details. The other thing that I want to make sure to emphasize is please type in your questions as we go. We read those throughout the course of the call. Those get fed back to myself and Dr. Randall and Craig and we try to answer some of those at the end of the call. Whatever we don’t get to, we gather up and we try to make sure that our frequently asked questions documents that are out there on the web are up to speed and we try to put as many of the answers there as we possibly can. Finally, just before we start, the legal disclaimer here, which is on the screen. I’m not going to go word for word, but high level, please consult your formal legal and medical advisors for any advice. And this call does not constitute legally binding and influential documents.
UnitedHealthcare COVID-19 Briefing November 11, 2021 Data Insights
CRAIG KURTZWEIL: Thank you, Phil. Craig Kurtzweil. I lead our center for advanced analytics here at United and I’ll be walking through some of our data insights as far as where we see COVID today and where we see COVID heading into the future. Before I jump in, just note, I will be spending time looking at some macro impacts of the trends and the drivers and opportunities and those kinds of things. But also recognize that under each one of these stats, every case, every mortality, obviously matters at a granular level, so just keep that in mind as we take it up a level and look at the macro view, that every individual matters as it comes to this pandemic. So let’s jump in and look to see where are we from a pandemic perspective. Bringing back some of our ways of viewing this, looking at the number of cases that are coming through, the mortality, the positivity rate and also adding into this view of the vaccination rate, you can see that it’s been a bit of a roller-coaster ride. We have seen the surge in cases in the winter months. Summer months, obviously a big lull in cases. But then the delta wave came and you can see how that rapidly impacted the number of cases coming through. We had seen, four, five, six consecutive weeks of declines in cases. Over the last couple of weeks we have seen a bit of a plateau. I’ll talk about that a little bit more. Overall, the vaccination rate of fully vaccination is approaching 60% for the US population, while positivity rate and mortality rate are starting to decline. In the next view we’ll look at a little bit of a time lapse view of what this delta wave has taken, as it’s moved across the United States. As this plays forward, you’ll see as we’ve seen in the past, the spread of the disease. We’ll start with the view of what things look like in April, and as we push play we’ll start to see the progression start to move and the spread of the disease start to change. And what happens as you start to get into the June and now July time periods is the delta wave starts to show up. Look what happens in Missouri, as that’s the first instance of where that peak started to occur. It starts to make its way down into Arkansas, into Louisiana, then starts to move east, across the Mississippi, Alabama, Georgia, Florida. And then after about a four to six week span it moves on to the next state and starts to move north and now we’re into Kentucky and Ohio and Indiana. And as it starts to spread, it moves further north and now you see Idaho, Montana, Wyoming, Colorado start to spike, and where I’m at here in Minnesota, starting to spike as well. So it has made its rounds. It’s making its way across the United States, starting in Missouri and working around the east and now headed out west, where we’re starting to see a higher prevalence of the condition. In the next view, I’ll show you a side-by-side view of what things look like today. So looking at our seven-day average on the left-hand side, you can see that a good portion of the United States is basically light shades of yellow, light shades of orange, where there’s very little-known disease in those populations compared to what we’ve seen in the map you just saw. But we continue to see high rates of the disease in states like Wisconsin, Minnesota, it’s not shown on here but Alaska, and the mountain states where we’re seeing continual high rates of COVID-19. On the right-hand side is a granular view, county by county, of vaccination rates. So you can see that it’s starting to even out a bit. Most of the map is in similar shades of blue. Other than some pockets in the south, a good portion of the country is achieving much higher vaccination rates than we saw last time. As we move forward, we can start to take a look at a state-by-state view. So as you know, we’ve been trying to track things from not only a case level perspective, but also a vaccination perspective because we know the combination provides at least some sort of protection against the disease. And overall, as a country, we just topped 80%. So 80% of the population has either had at least one shot or has had a known case of COVID. And yes, we do know that known cases of COVID is not actual COVID because there are many individuals that had COVID and did not realize it. So actual percentage of people with expected COVID with vaccination is north of 80% for sure at this point. As you look at it in various states, you can see a wide variety, with Rhode Island approaching almost in the 90s and other states down in the low 70s. As we move forward, we can start to look to see what does that look like when we overlay the combination of known COVID plus vaccines, those are the bars you see here, against case rate. And you can start to see that we started to come down as we reached that 70, 75% [PH 00:04:32] corridor of protection, things started to change and the delta wave started to take a downward turn. Now, again, it has plateaued for the last couple of weeks but it’s an interesting view of what sort of rate of protection do we need for the case rate to start to fall. And obviously, this is a national view. It is very dependent on what you see state by state. As we think about vaccinations, we do want to make sure we can continue to start to show the impact of that. You’ve seen lots of headlines around the efficacy of vaccinations. This is just an interesting view of looking at those states that have the top ten highest vaccination rates, those are the blue lines, and the bottom ten vaccination rates, that’s the red line. And you can see that the delta wave was very different for these two state cohorts. The less vaccinated state saw a tremendous peak due to delta on both the case rate perspective and a mortality perspective. We’re back to even from a case rate perspective. Both those states are performing similar. But again, the delta wave was a very different experience, depending on where you live based on the vaccination rates. And as Phil mentioned, we want to not only provide a view of what you can see from third party data, but what has UnitedHealthcare seen? So as we look at our admissions across star UHC book of business, you can see we’ve seen the same sort of roller-coaster ride in that peak, in the December, January time period, followed by a lull in the summer and then the delta wave hit us as well. We have seen, as you can see, very steep declines in the number of admits that are coming through for COVID over the last couple of months now. In the next view we take a look at some of those cases that are being admitted for COVID, even after being vaccinated. We know that overall this is a very percentage, but you can start to see some differences among the population. The blue line is looking at the percent of our E&I, our employer and individual book of business, of COVID cases that are admitted after having been vaccinated. And overall, it’s about 97% of the time we’re seeing that our COVID cases that are coming in and being admitted, are unvaccinated. But that’s a little bit different within a Medicare population. As you start to see that red line start to ramp up, where now we’re starting to see 20, 25, 30% of some of those admission, COVID admissions, being for that vaccinated population. Now, that being said, you can see in the bars that both the employee and individual and the Medicare number of admits continues to drop. Even though there are more cases that are coming through as vaccinated, it’s a much lower end that we’ve seen historically. The next page provides you a little different view of that. Again, we know that 97% of all of our commercial admissions for COVID are for unvaccinated individuals. For that 3% that is vaccinated that are having COVID admissions, you can see that it is skewed towards those individuals that were vaccinated months ago. If you look at the members that were vaccinated four to six months ago, that’s about 41% of the individuals that are being admitted after being vaccinated. And another 20% had their last vaccinations over six months ago. So in combination, over 60% of our breakthrough cases admissions were from people that were vaccinated over four months ago. And again, 97% of all of our admissions are for unvaccinated individuals. If we go forward, one last view for you to take a look at. It’s been a long ride following the pandemic. Just wanted to give you some perspective of cost. Treatment patterns have changed, the availability of different sort of treatments are now much more widespread, and the cost of a COVID deployment has changed dramatically as well, so as mortality has changed and as treatment patterns have changed. In the early days of COVID in March of 2020 we saw the average COVID case being over $10,000 per claimant and that has really leveled out. As you look at really the last year, and especially in the last couple months, we’re at about $2,300 for a COVID claim coming through. Some of those being extreme, ICU, ventilator admissions. Some of those just being testing positive and not having symptoms. So overall, about $2,300 per COVID admission in our book of business.
UnitedHealthcare COVID-19 Briefing November 11, 2021 Clinical Updates
CRAIG KURTZWEIL: With that, I’ll take a step back and hand the ball over to my good friend Dr. Randall, while she [INDISCERNIBLE 00:00:04]
DR. RHONDA RANDALL: Thank you, Craig. Always great insight that you layer onto the data that we have available. What I want to share with you next is putting a little bit of the clinical meaning behind what Craig shared with you. Hi, this is Dr. Rhonda Randall. I lead the clinical organization for employer and individual. And I have some visual aids for you today. I in the past have just spent more time addressing you directly, but I really thought that some of these backdrops would be helpful to help sort it all out because as we get further down, we have more and more innovation, more therapies coming online, more approvals for vaccines for different groups and just wanted to lay it out here so that you have the backdrop understanding of what we’re looking at here. We know we have three vaccines today that have at least emergency use authorization. Indications in one that also has some indication that is full FDA approval. And I wanted to look at the different ones with you. So we have two vaccines of course, that are messenger RNA vaccine. That’s Pfizer and Moderna. And then Jansen being a viral vector. The ages on here are what’s changed significantly since the last time we were together. Pfizer has its emergency use authorization down to the age of five now, and that’s starting to be administered to children all around the country for both mass vaccination sites as well as pharmacies and pediatrician and family physician offices coming online with the availability that vaccine and storage requirements, making it more amenable to being delivered in physician offices, for example. I get a lot of questions about vaccinating this age group and I’ve said it before and I’ll continue to say it. I truly believe the best person to have a shared decision-making conversation with the parents is your personal pediatrician who knows your family’s risk, knows your child’s risk, et cetera. And for those who are hesitant to vaccinate their children, I still say the second-best way to protect them, if you’re not ready to do that yet, is to vaccinate the adults and older children in the family as a start. We do not have the other two vaccines approved under the age of 18 yet. They are both being studied in those age groups and I hope that by the next time we meet I’ll have more information for you there. I think really what I wanted to spend most time on today was really this idea of for a while we’ve been saying will we need a booster, yes or no? And I think we really are probably reframing our thinking as a medical community that the two messenger RNA vaccines are very likely to be three shot series, like a lot of the childhood vaccines we got. Some of them were two, some of them were three, some of them were four shots in the series until we had full immunity. For now, those vaccine third shots for the messenger RNA have emergency use authorization for three cohorts. Those over the age of 65, and I want to take you back to Craig’s data. I think it was your slide 13 that showed really the Medicare population pulling away with some of those hospitalizations related to breakthrough vaccines. There’s a couple of reasons for that. Number one, they were the first group to get their vaccine so they’re starting to see that waning immunity over time. And then the second is it’s a more vulnerable population that had higher hospitalization to begin with. So you add those together and it’s not all that surprising to see. The other two cohorts that are currently eligible for that third shot for messenger RNA are those who are at high risk because of a chronic disease and those who are at high risk because of their work. So individuals who work in healthcare settings, first responders, those who are frontline workers that come in frequent contact with the public, for example. The. Johnson & Johnson looks like it needs to be a two-shot series. That second shot is approved for all populations under the emergency use authorization, so two to six months out with that shot. It actually looks like the second shot gives very good efficacy. Even though the first shot wasn’t quite as strong as the other two messenger RNA vaccines, it looks like we’re getting very good response from the second shot of the Jansen vaccine. So I would encourage those of you and your employees who did get that vaccine in the last six months or more, it’s time to get your second shot of that one. There also have been some studies and the CDC has approved using mix and match when necessary and there maybe even some indicator data that suggests that mixing and matching could be beneficial. The FDA versus EUA, everything on here is EUA approved with one exception. Pfizer has full FDA approval for individuals over the age of 16. And there is a fourth vaccine that is not on this list because it is not approved yet, but we did hear yesterday that Novavax has asked the FDA to review its vaccine, hopefully by the end of this calendar year. That’s expected to be a two-shot series. It’s different formulation than the three that are here today. It is a protein-based vaccine and nanopartical, very similar to flu shot or a measle shot, for example. I’m looking forward to having the opportunity for that one to be reviewed. It would be nice to have a fourth choice. Let’s move to the next slide. I’m not going to go through this line by line with you, but I did want to bring with you today, there’s an awful lot of therapies and really want to thank all of the research and development that went not only into the vaccine but into these therapies. As a physician, we want to have all of the above in our armamentarium. We want to have vaccines to prevent serious disease and we want to have treatments that are in the outpatient setting, early treatments, even prophylaxis, and then treatments for individuals who get severe disease requiring hospitalization. And we have quite a few of them on here. The ones that I have on the top of this slide in the darker blue are medications that either have FDA approval, like dexamethasone, the steroid that’s been around forever and is available generically, and then those that are newer and have emergency use authorization. The majority of what is on this list are monoclonal antibodies. Most of them are given either as an injection or more frequently, an infusion. They are for the most part, approved for moderate to severe illness in high-risk individuals. So this is preventing hospitalizations for high-risk individuals. The other one that’s on here is the anti-viral [PH 00:07:40] rem to severe that is for hospitalized individuals needing an antiviral. But what you see on the bottom of the slide, still indicated earlier, there are three drugs we’re watching. Two of them are oral antivirals. So think if you will, how we use Tamiflu for influenza, for example. So these would be pills available in the outpatient setting, again, it looks like for high-risk individuals. One of them, the Merck drug, they have already have a date on the calendar at the end of this month to be reviewed by the FDA. Pfizer’s has been – it is pending submission to the FDA. And the AstraZeneca, which is a long-acting monoclonal antibody, for individuals who are unable to take the vaccine because of a medical contraindication, for example, could receive that long-acting prophylactic drug. And they have filed for the FDA to review for emergency-use authorization. Let’s move on. I want to share with you something that we have been following very closely and the resources that we have around behavior health, with a special focus today on the adolescent population. Let’s go to the next slide. This is coming from our claim data. And just to orient you to what you’re looking at on the slide, the pale blue line is 2019, the navy blue dark line is 2020 and the teal blue line, if you will, the third one there, is 2021. And these are age bands of claims that we have received for suicidal ideation. Not suicide, but the intent and thinking about suicide. And you can see here in all age groups where that’s trending and the spike that we’ve seen, particularly in the adolescent population. It’s the highest we’ve seen over the last three-year period. Let’s go to the next slide. The first two data points on here, the first three, come from the CDC and the next come from the American Academy of Pediatrics in a publication that they shared recently. For those of you who follow me on LinkedIn, you’ll notice I posted this about a month ago. It’s something that we’ve been following and really concerns us. The American Academy of Pediatrics has declared this a state of emergency around child and adolescent mental health. So you’re seeing more children visit the emergency room for mental health emergencies, more self-harm, self-injury, and suicide in the adolescent populations. And an alarming number of kids who’ve just experienced trauma. The death of a primary or a secondary caregiver during the pandemic. So some really alarming statistics. And then I want to share with you next some things to look out for and some things that I hope that you’ll share with your employees. And these are resources that are available from UnitedHealthcare and Optum. Your account management teams can get these resources for you. You can share them. This is an import time of year as we come into the holiday season, to share these kinds of resources. Kids are dealing with more stress. They’re dealing with fear. They’re dealing with anxiety. They’re dealing with pressures of social isolation from their peers. I often always get questions around their use of social media in addition to that. With kids, they don’t experience anxiety and depression and share the same words that an adult would. They don’t necessarily say I’m feeling down or I’m feeling helpless or I’m feeling hopeless, some things that we all might be used to saying or hearing from a loved one who’s an adult with anxiety or depression. For kids it may be a significant change in their social behavior. It may be a significant change in the way that they’re participating or not participating in school. It may be that you’re seeing some changes to their grades or their academic performance. You may see changes in their eating and sleeping patterns. It could be a variety of things that maybe different than you see in adults. We want to get these kids to support right away. It’s always good to start with the pediatrician. More and more schools have these resources available. Many of you have resources available through EAP. I want to remind everybody about our tele-behavioral health solution, we can often get kids seen very quickly. Waiting for an in-person visit can sometimes take weeks or months. And navigate to the right resources. We also of course, have the apps like Sanvello for individuals who are going through stressful situations. I wanted to offer our support. Ask you to really help share with us and communicate to your employee base this is something that we recognize, something that we should all be looking out for, and where to get help.
UnitedHealthcare COVID-19 Briefing November 11, 2021 Policy Updates
PHILIP KAUFMAN: For those of you who may have joined a little bit late, Phil Kaufman with you again here, chief operating officer for our employer and individual division. And I know there are a ton of questions on the vaccine mandate, so I’m just going to jump in with that and cover that ground right away. When we talk about this, there’s actually three different mandates. First, there is an OSHA mandate for large employers, 100 plus. I’m going to spend the bulk of the time on that one today. There are separate actual mandates for those of you who might be providers on the phone who accept Medicaid and Medicare. There’s also separate requirements around government contractors. So there’s actually three different mandates. And I think it’s important here to highlight that the legal stay that has been issued by the fifth circuit only applies to the first. So if you are a government contractor or if you accept Medicare and Medicare as a provider, you still may be subject to regulations. I don’t typically get into legal forecasting, but I think in this particular case, because you look to us for insight, I do want to share that the fifth circuit is pretty widely known as the most conservative circuit in the nation. It has 17 judges on it. Of those judges, 12 are Republican appointees. I like to think whatever a judge is appointed by a Democrat or Republican, they all look at the law the same and that’s the way I think. But outside observers sometimes have a different view on that. So I just think that’s an important datapoint for you to have, as you think about will the stay be extended and what’s likely to happen. We don’t know when there will be either a permanent injunction or more information, but it could be as soon as a couple weeks, but it could go longer than that. So we’ll keep monitoring this on your behalf. If you go to the next slide, even though it’s stayed, I am going to talk a little bit about what’s in that OSHA mandate, in the hope that it gives you some insight into if it does come into play, how it works. I think some of the things that I’ll talk about will also apply to whether it be a state-based mandate or the contractor mandate. The first thing is, is the implementation date for most of the requirements is December 5th. If you have an employee who says, I don’t want to get the vaccine. I want to go for the weekly testing option, the employer or the insurance company is not required to pay that. I’ve already gotten some questions on that in the chat. If an employee says, I’m unwilling to be vaccinated so I want to do the weekly testing, that is their expense. Now, the employer can choose to pay for it, but they’re not mandated to pay for it. The requirements apply to private employers with 100 or more employees. They do not apply to employees who do not report to the workplace. This is a big nuanced but if you have someone who’s a telecommuter, they’re never going to come into the workplace, the mandate would not apply. It gets a little trickier and there are populations that are saying yes, they’re a telecommuter but we need them to come into the office. Or they’re going to have meetings with other people from the office. Technically, by the letter of law, then those individuals would need to be vaccinated. The mandate does exclude any employees who work outdoors. A couple other things here, and I’m not going to go word for word on the right side here, but different elements that I think are important to understand, which is if you have an employee who says, for whatever reason, whether it be a religious belief or some other belief that they say, I don’t want to be vaccinated, not only do they need to test weekly, but they need to wear a mask in the office and when around their coworkers at all times. The OSHA expects employers to keep a record of all of those tests. And there’s another provision in there, which I don’t fully understand how it might be enforced, but it says that they are requiring employers to report any COVID hospitalizations. The tricky thing I don’t fully understand there is, is that hospitalizations only because someone perhaps got COVID on the job or if someone got COVID outside the workplace and was hospitalized, do you have to track that anyway. I think these elements are important in understanding the legislation and the regulations because this isn’t just a one and done. It’s not just, okay, we’ve got to figure out who’s vaccinated and not. There’s really an ongoing element of this. And what you saw from Craig earlier, while the breakthrough infections are really low and we hope that they stay that way, they are going to continue to happen, unfortunately. And so you’re going to continue to have very isolated but real breakthrough cases in your population. And so now does that create a perpetuity reporting requirement for you to continue to come back? We will continue to give the information we have. But as it’s written today, you would have to continue to report on COVID cases and hospitalizations, regardless of whether it’s vaccinated or unvaccinated individuals. This legislation is – I shouldn’t say legislation. This rule, this emergency rule, is actually north of 500 pages. I’ve already seen a ton of questions in the chat on this so if we flip to the next slide, we’ll post this link in the chat as well. There is a very comprehensive set of FAQs that are out there from OSHA. The link to it is right here. So you can go out, they’ve got a gazillion different questions that they’ve answered with their interpretation, keeping in mind that as we sit here today, the fifth circuit has put enforcement of this on hold and we will continue to keep you updated. I’m going to shift here into talking about proof of vaccine tools. We’ve been talking about this for a number of different sessions. And if you go back in history, we originally thought that maybe you might need a proof of vaccination for cruises or international travel. New York City emerged pretty quickly as you might need it for restaurants and gyms. But over the last several months, the number of places that have required you to show vaccinations has really increased exponentially. Again, when we talk about this, I’m always cautious to say that we realize that some people think that this is incredibly important to get businesses and the economy back functioning again. There’s another group that says this is an incredible infringement upon their personal rights. And so we obviously respect both of those views. But we just want to be realistic in saying that because there are a lot of places requiring it, we want to be able to provide tools to you and your members to the extent that someone challenges them and says we need to see proof of vaccination, it’s easy for them to do so. We’ve worked hard to continue to evolve our ecosystem around what we’re able to show. And just to refresh on that, if you go to the next slide, on the left-hand side here, what I’ll call the most basic is the vaccine record that we have. And so if you go to myuhc.com and if we have your digital record from the pharmaceutical company or from the physician of you getting the vaccine, we’re able to show that automatically. In the case that we don’t have it, you are able to digitally upload a photo and a verification and you saying I have gotten the vaccine and we can put that in there. We are also working really hard with the various state registries to incorporate the data that they’ve gathered from for example, mass vaccination sites into our records. It’s a slow-going process, but we’ve made some. And I would say today we’re at about 30% of our membership, depending on markets, that we’ve got in here. But our hope is actually over the next actually two to three weeks, we’re going to get that up to 60, 70%. And so we’re able to source that information other places. When we do have a verified record, sometimes we’re able to go a little bit further and produce what’s called a verified QR code. There’s a number of different organizations around the country, clear, and different people have come together and said we’re going to try to have one standard around a QR code that everyone can use when the vaccine, proof of vaccine is required. And so we use that standard. And that’s where you need the electronic verification. So for that particular piece, you can’t just upload your own information. I have for work and individual, I’ve been traveling a decent amount around the country and I can tell you that I’ve used this tool multiple, multiple times. The vast majority of places, they want to see something. They just want to see something on a piece of paper. So they’re not necessarily looking for the QR code. So most of the tools that we have here should work. Just one point of clarification and I realize it’s less than perfect. We’re trying to do everything we can as fast as we can. And that is the UMR customers and All Savers, this isn’t available for them yet, so we’re working to get that up and implemented for that customer base as well. This also isn’t fully up on the myuhc app yet, not all the functionality. Some of it is. The left-hand side here is in the individual health record, but the right-hand side, the QR code, is not yet. We’re working to get that deployed in a couple weeks. So this continues to advance. We continue to work hard on this. And we continue to respect that not everyone agrees with the dynamic here. We just don’t want our members to get stuck in a spot where for whatever reason they don’t have their vaccine card, they lost it, they don’t have their phone, they’re still able to say okay, I’ve still got a way of being able to prove that I have been vaccinated. I’m going to pivot here into 2020 outlook and to try to give you some insight, whether you’re a fully insured customer or whether you’re self-funded, on some of the different trends that we expect for the coming year. And what I would say is ignore what’s on the slide. I’ll come back to this in a second. But ignore what’s there right now. I’m just going to talk thematically as I look out at the environment and say, okay, what’s going to happen in 2022? And I wrote down six or seven different things and I’m just going to give you my indication of what each one, the direction that each one is going to go and the cost implications for you. The first is that you’ve got actual vaccination costs. And you’ve incurred the bulk of those this year as your initial populations have been vaccinated. Many of the kids will be vaccinated before the end of the year. But you’re still going to have into next year, an ongoing booster cost, as Dr. Randall talked about. And that typically ends up being between $40 and $50, depending on the location per the – the government’s paying for the actual vaccine itself but $40 to $50 for the actual administration of that vaccine. And so you should fully except booster costs as you head into next year. Number two, as Dr. Randall pointed out, there has been an enormous surge in behavioral need. My hope, my prayer is that it starts to flatten out and go back in the other direction, but my fear is that it’s not. And there’s still a lot of really significant challenges out there. So we continue to expect increased behavioral costs heading into the next year. On the good news side, I do think based on the data that we’re seeing from Craig, COVID hospitalizations will continue to fall. We really think that those will probably stay much lower next year. And that will be a combination of vaccines, lower prevalence, and also importantly, much better treatment. Credit to the physicians out there who have just done, and the researchers who have done an amazing job of really developing better therapeutic treatments, as well as better pharmaceutical treatments for COVID. So we fully expect the hospitalization rate to be lower. And those hospitalizations are very expensive. So that’s a positive. Something we haven’t talked about in a while is long COVID. There’s still not enough information out there to make conclusive determinations on the long-term cost of this. It’s very real, so my comments here are not of does long COVID exist or not. But I would tell you is the cost of that has not showed up significantly in our data yet. Yet, being a very important word there, but we just haven’t seen that yet. So we’re watching that closely. We’re monitoring it closely. But as we sit here today, it doesn’t seem like there’s a huge surge in long COVID cost. The other dynamic that we talk about here is what’s called abatement, and are people avoiding their regularly scheduled medical services. We really haven’t seen a ton of that in 2021. We saw some of it in 2020, particularly in March and April. At first there was a lot of abatement. If anything, we see still catch-up care taking place. More flu shots, more colorectal screenings, more everything. There’s still some catch-up that needs to be done on that. I put dental and vision in that category too, of work that may have been deferred or delayed. So that’s catching up and we expect that catch up to continue into 2022. Finally, I would say one of the most significant factors that we’re watching really closely is inflation. And when you think about healthcare, healthcare is a very human driven business. All those fantastic doctors, nurses, clinicians, everything, their wages. And to the extent that their wages really start to rise, that pressure comes through our negotiated rates in the system. And so while we do have most of our negotiated rates are typically on a multiyear basis, we are watching that closely because we do think there’s very significant inflationary pressure out there. On particularly the human cost of a system, and we’re watching to see how that flows through. Just giving you a variety of factors there and how we see them. Again, for emphasis, if you’re a fully insured customer, you don’t typically have to think about that on a day-to-day basis. You get your fully insured rate and any risk on that positive or negative is UnitedHealthcare’s. If you’re a self-funded customer though, some of these things matter a little bit more in terms of your budgeting and forecasting and where things are going to go, so we like to cover it. Just to close out on what you see here in front of you, I want to – we’ve talked about the vaccine multiple times previously, and just to emphasize, the government pays for the vaccine. Either your health plan or you as an ASO customer pay for the administration. Monoclonal antibodies, that’s typically administered through the medical benefit. And those again, the monoclonal antibodies themselves, are paid for by the government but you will pay an administration fee if you’re self-funded, or UnitedHealthcare will pay it as the administrator. On the oral antiviral pills, the Merck and Pfizer pills that are under development, and frankly, we except approval on one or both of those within weeks. We don’t think it’ll be long and we think those will very quickly be coming to US market. The government has purchased the initial doses for those. Those drugs will be covered under your PBM benefit or your drug benefit. They will not be covered under the medical. As long as the government is paying for the drugs, we expect them to have a zero-dollar cost share, so they will be put on the zero-dollar cost share area of your formulary, or the preventative piece of your formulary, depending on how you have it structured. So it will be zero-dollar cost share to the member. The government will pay for it. There might be a small administrative charge paid to the pharmacy to distribute those drugs. So just a few important elements there. We’re a little bit ahead of the curve on the approval. They’re not there yet, but my guess is before the next time we come together, those different drugs will be approved. Just as a price point benchmark, the price that I’ve seen is $700 for a course of treatment for one of those regimens. So when you think about the emphasis on vaccination and on what I’ll call the best course of care, absolutely it just shows you again, that when you look at a vaccination costing $45, the average COVID case costing $2,000, the average drug treatment for this is going to be at a minimum $700, the vaccination by far and away is the most cost-efficient way of trying to manage this pandemic.
UnitedHealthcare COVID-19 Briefing November 11, 2021 Q&A
PHILIP KAUFMAN: Okay. We’ve reached the point in the call where we open it up for Q&A. As usual, we love your feedback on this. So you see a web address there. For those of you willing, and you go there, give us the feedback on the call. We would love that. Thank you. I’m going to jump into Q&A with Craig and Dr. Randall. Let’s start with a few clinical questions, Rhonda, that I’ve pulled up here. The first is, can you go back to mixing and matching on the vaccines and your view there and when you should or should not mix and match? Oh, no. We don’t have audio for you still. Okay, well, just give her one second and see if it’s like a double mute issue. Oh, shoot.
DR. RHONDA RANDALL: Can you hear me now?
PHILIP KAUFMAN: Oh, yes we do. Okay, good. We got you.
DR. RHONDA RANDALL: I’m not sure what that setting was, but we got it fixed. Okay, great. So I think I’ll start with this. None of these vaccines have head-to-head trials, first of all. If you’re thinking, is one better than the other? We haven’t compared them to each other in a head-to-head trial. But we can really start to see that there are, each one of these vaccines really to me, has certain populations that probably is the vaccine first choice. But I really encourage everyone to have that conversation with their personal physician. Mixing and matching in general, I stick with the one that I started with. But there may be some good reasons to switch. And again, look at that emerging data. Some of it suggests that if you got an mRNA vaccine and then a J&J or a J&J and then an mRNA vaccine, that has very good immunity associated with it. So when in doubt around that, ask your personal physician.
PHILIP KAUFMAN: Thank you, Dr. Randall. Let’s keep going with vaccines. A bunch of questions on – and an emphasis that the dose for children for vaccines is different than the adult dose. I had a very good question come in saying my child is 11, happens to weigh more than my 12-year-old. Should I wait until they turn 12 and get the adult dose or how should I think about that if they’re right on the border?
DR. RHONDA RANDALL: It’s a great question. I would go ahead and go in, talk to their pediatrician. In most cases if that were my patient I would be giving them the pediatric dose. The medications for the treatments on the other hand, are adjusted by weight, for example. Maybe you get them started on the pediatric series and then when they’re ready for their booster they’re going to get boosted with the adults. Another thing to note there too is the third series of Moderna is half the dose of the first two shots. So for those of you, the Moderna first two shots are 100 micrograms. The third shot is a 50-microgram shot.
PHILIP KAUFMAN: That’s great. Let’s shift into behavioral health. There’s questions on the lack of access to therapies within behavioral health and it’s difficult to find an in-network provider. Maybe I‘ll start with this one Dr. Randall, and I’ll hand it over to you. We worked really hard over the last couple years to expand our network and to try to get many more therapists in. But with that, I just want to recognize it’s still very difficult. And personally I’ve had to go through this too and it’s really hard to sometimes find the right therapist, and we’re very cognizant to that. We’re working really hard to try to be able to increase that supply. I think as Dr. Randall mentioned earlier, tele-behavioral can be an important gap filler before you can find someone face to face. But I will just emphasize that we see this the same way as supply of therapists is a really significant problem and one that we’re working really hard to address. But there are no quick answers because the training, the expertise that it takes to be able to function in that space, it really takes a long time to be able to build and train for that.
DR. RHONDA RANDALL: You’re absolutely right. We have seen over the last few years. The good news is that more and more people are getting their degree as mental health professionals. But the types of licensure for mental health professionals varies quite widely, from those who have masters level clinicals, the whole way to psychiatrists and phycologists. Even within those, many of them have a niche. Do they work with families? Do they work with substance use? Do they work with individuals who have chronic medical conditions along with behavioral health conditions? So finding someone that is the right degree plus is a good fit for you personally, that’s something that we want to help with. Tele-behavioral health and licensure across state lines has really made a significant difference. There are ten times more licensed mental health professionals per capita in the state of Massachusetts than there is in the state of Mississippi, for example. And getting those individuals licensed across state lines is really helpful.
PHILIP KAUFMAN: I’ll add on to that, Rhonda. Something that we’ve seen is that actually as we sit here today, if you look at our outpatient behavioral visits, over half of those are delivered audio-visually. And so while in the medical side of it telehealth, it really spiked up at the beginning stage of the pandemic and then it came back down, it’s higher than what it was, 10%. But behavioral health has stayed very high. North of 50% of all the visits are delivered in an audio-visual fashion. Just a tip might be if you’re having a struggle maybe within your local area, finding a provider, feel free to maybe reach a little broader because many of those providers may provide services in an audio-visual manner.
DR. RHONDA RANDALL: One of the other things I’ll say, a benefit of working with an organization like UnitedHealth Group and Optum is the partnership with apps like Sanvello or for people who are dealing with stress but might not necessarily need formal therapy, we’ll want to get those people to those resources so that we’re not over-burdening the few therapists that have availability at the time. And then the other thing is the EPA. The employee assistance program sometimes, particularly for adults, some of those stressors that are in your life that are more socioeconomic and legal and other words in nature, we can help alleviate some of those stressors for you.
PHILIP KAUFMAN: Absolutely. I’m going to shift gears here and I’m going to tackle a couple questions on testing and vaccine pass. The first is just to clarify the difference between what I’ll call diagnostic testing for illness versus surveillance testing. Diagnostic testing for illness means that you have been exposed to somebody with COVID. You think you may have COVID yourself. And typically, that is ordered by a physician to be able to test. Surveillance testing is, it can take a variety of forms, but it basically means there’s no indication that you’ve been sick or been exposed. And it’s just you’re using that for a purpose other than medical care. For example, a number of schools do surveillance testing. Sometimes you may need a test to travel. That would be a surveillance test. What we’re talking about here, to work, for example, that’s surveillance testing because you haven’t typically been exposed. There’s some question here of like how can UHC tell the difference? It’s really complicated. There’s a lot of kinds of things that go on with the claims behind the scenes. But I can just tell you, one of the big ways we know the difference is volume. We can really quickly see if someone’s being tested every single week, it’s very unlikely that they’ve been exposed to COVID every single week. And so you can really tell from a lot of the volume dynamics within the claims. There’s some questions here on vaccine pass for UMR and All Savers and when will we have those. I’m sorry that I don’t have a date for you. I’ll just assure you that we continue to work really hard to bring that up. We will post step by step instructions and how to use these and try to get to the different things on the vaccine pass. So we’ll work on those and we’ll get those out there. There’s a question on will you add booster to the vaccine pass? And I would tell you maybe, eventually. But as we sit here today, every what I’ll call regulatory or non-regulatory body that requires proof of vaccine is not asking to show the booster. So really right now that hasn’t come into play. We may at some point if that becomes the case in the future, we may add that. But as we sit here today, it’s not a requirement wherever you might need to use the vaccine passes, so we don’t plan on adding that element in there. Just going through the list here. Rhonda, do you want to talk a little bit about the different treatments. And the one we keep getting is ivermectin, if I’m pronouncing it right, and why isn’t that approved and what’s the dynamic around that. So could you talk a little bit about that piece?
DR. RHONDA RANDALL: Ivermectin, an anthelmintic that’s been around for a long time. Another one that kind of gets lumped together as hydroxychloroquine. Both of those medications available for a long time. Both generic, both very inexpensive. Both have other indications, relatively low safety risk profiles, for example. What they don’t have is the double-blind placebo-controlled studies that we like to see with that rigor for COVID, but more and more data emerging. It is not right now on the official list. You didn’t see it on my – I listed medications that have approval for the use in COVID. But that some prescribers are having shared decision-making conversations with their patients and making the determination whether or not that therapy is appropriate. Now, there may be some local regulations that prescriber or dispensing pharmacist, et cetera, need to take into consideration and that can vary throughout the US.
PHILIP KAUFMAN: Great. Thank you, Dr. Randall. I am going to bring us to a close today and wish you all a very happy Thanksgiving. I am exceptionally thankful, along with the UnitedHealthcare team, for putting your faith in us. Continue to put your faith in us. Know that every single day we work super hard on your behalf. And we hugely appreciate and we’re going to really work hard on getting people back to health. That’s one of our key focuses here and really as we heard towards 2022 and really trying to maintain and keep the different populations healthy. You’ve seen a lot from us and us trying to, for example, launch different things with Apple Fitness Plus and Peloton, into the population and we’re going to continue to push that extremely hard. We appreciate your business. Thank you all. I hope you have a great Thanksgiving and thanks for being with us here today.
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