SCHENECTADY — After squeezing evolution that might normally take several years into a few months, MVP Health Care is entering the second year of the COVID pandemic with some permanent changes in place and some others still to come:
- MVP members used telemedicine 10,000% more in 2020 than 2019, and the remote technology is expected to be a permanent part of the health care scene, if not quite at pandemic levels.
- The Schenectady-based health insurer may swing to an operating loss in 2021 after six years in the black, if members catch up on all the diagnostic tests and preventative care they skipped in 2020.
- Addressing the social determinants of wellness — the non-medical things in people’s lives that diminish their health, and which proved so damaging with COVID — will continue to increase in priority and importance.
“I think the pandemic has changed the trajectory of healthcare, and how healthcare is delivered to patients and our members,” CEO Chris Del Vecchio said Thursday, the one-year anniversary of the World Health Organization declaring COVID-19 a global pandemic.
Beyond health care itself, the business model for delivering it changed during the pandemic, with insurers and hospitals that normally compete with one another collaborating instead.
“The virus was and is bigger than any one individual or organization,” Del Vecchio said.
MVP has about 1,800 employees maintaining a network of 54,000 providers at 2,100 facilities in 70 counties across New York and Vermont for about 700,000 insured members.
2020 revenue was roughly $3.5 billion.
Its imposing headquarters on State Street is, in normal times, the workplace for 900 people, the largest single workforce in the downtown district.
Now, only a handful of people are working there — all but 60 MVP employees are still remote.
“I don’t think it’s going to be an easy time for people to come back to work,” Del Vecchio said, noting the continuing effects of the pandemic on the public psyche even as infectivity decreases and vaccination increases. There’s a tendency, he said, to underestimate the stress and anxiety involved in a prolonged crisis.
That said, MVP happened to be very well-prepared for remote work when the need suddenly arose a year ago — it had invested in mobile and remote technology to create flexibility for its employees working across MVP’s wide footprint.
Not everyone is hunkered down at home: MVP has had employees out at community events all through the pandemic, and that continues now with volunteers at vaccination sites.
There’s also talk of using the nearly empty MVP parking garage in downtown Schenectady as a centrally located mass vaccination site that’s both open to fresh air and sheltered from sun and rain, but no decision has been made, nor is there enough vaccine available yet to keep such an operation going.
Another big role for technology at MVP was telemedicine, by which doctors interview, diagnose and order treatment for patients via video links on computers or smart devices, with all the benefits of face-to-face conversation but none of the potential germ transmission.
MVP set up a virtual emergency room in two weeks, Del Vecchio added.
MVP members went from about 9,000 telemedicine visits in 2019 to 925,000 in 2020, a 105-fold increase. The surge was even greater among members living in the Capital Region: 180 times more visits in 2020 than 2019.
“Televisits are still up significantly” in 2021, despite medical offices being open and patients being more comfortable using them, Del Vecchio said.
One trend so far in 2021 is a result of the stress and anxiety Del Vecchio mentioned: Behavioral health visits now account for 49% of telemedicine visits through MVP, compared with 17% in 2020.
“I do believe telehealth and telemedicine is here to stay,” Del Vecchio said, calling it a game changer for health care — meeting people where they want to be seen. Some of the hands-on things, such as X-rays and sutures, can’t be done via telemedicine, but it can handle the first step of determining whether the X-ray or stitches are needed.
As the value of telemedicine was being demonstrated, so was a key limitation: Not everyone has the internet connectivity to use it.
MVP is involved in pilot programs to put access points in public places such as libraries, fire stations and community centers to address this shortfall, Del Vecchio said.
MVP also went the other way, making 600,000 phone calls to its most vulnerable members during the height of the pandemic in recognition of the fact that they might not be able to reach out on their own, Del Vecchio said.
These steps all were part of a rapid transition forced upon the industry a year ago.
Del Vecchio recalls being at a conference on an unrelated topic with his counterparts in New York City on March 10, and each time there was a break between sessions, talk turned immediately to the coronavirus.
“We need to do something much different from what we are” was the recurring theme, he said. “That was kind of a sobering event.”
What the pandemic means for MVP from a business perspective remains to be seen.
2020 saw a lot of members postpone medical care that would have generated bills for MVP to pay, but it also saw a lot of additional costs, both necessary and voluntary, that MVP had to pay.
The non-profit insurer set up testing sites, donated sanitary equipment, helped food banks and contributed to the COVID emergency relief fund.
“It all adds up,” Del Vecchio said. “But as a nonprofit we look at the community as a shareholder.”
On the negative side, he said, the state imposed Medicaid reimbursement cuts that were both significant and retroactive. Also, MVP can’t just keep all the premium payments it didn’t spend — it has to refund them if they exceed certain percentages, so there’s not a windfall there.
Finally, there may be a surge of healthcare to pay for in 2021, as patients regain confidence about going to medical facilities.
“We think and we hope more and more people will seek the care they’ve been putting off for the last year,” Del Vecchio said.
MVP runs on a narrow profit margin and operated in the black from 2015 to 2019, Del Vecchio said. It also expects to be in the black again for 2020 when the accounting is done.
“That said, we don’t know about 2021,” he added.
A longer-lasting effect of the pandemic may be the increased focus on community health, Del Vecchio said. In late February 2020 MVP announced $800,000 in funding for six Capital Region non-profits to address the social determinants of health.
The ensuing pandemic — the first COVID case was confirmed in New York two days after the announcement — showed the importance of this kind of work, Del Vecchio said.
“I’ve seen an opportunity for companies like MVP to be so much more than a health insurer … here’s a gap, we want to help fill the gap with solutions.”