Health care, post-COVID: New challenges and opportunities for patients and providers

“As the public health emergency comes to an end, along with many corresponding funding and regulatory flexibilities, stakeholders have an opportunity to make strategic plans, respond quickly and decisively, and succeed in the new environment,” the report concluded

The COVID-19 public health emergency (PHE) is officially over. However, insurers, providers, consumers and other stakeholders continue to sort through the implications for both the short and long term.

“With the PHE expiring, much of the funding and flexibility that helped expand testing, vaccination, coverage and access to care is also coming to an end,” according to a report from McKinsey & Company. “Although Congress has recently extended certain accommodations through 2024, the federal government is set to continue phasing out a majority of the funding and regulatory support initiatives currently in place, with many expiring concurrent with the end of the PHE.”

Related: The end of the public health emergency: Action items for health plan sponsors

The “The end of the COVID-19 public health emergency: What’s next?” report details how the end of the PHE affects several aspects of health care.

1. Vaccination. Medicare and private payer in-network coverage for vaccination will continue, although patients may see out-of-pocket costs associated with vaccine administration. Medicaid will continue coverage for at least a year after the PHE ends. The government recently announced it will allocate $1.1 billion in additional funds that will provide vaccines for the uninsured through at least a portion of 2024.
2. Testing. As an essential health benefit, COVID-19 tests will be required coverage for individual and small-group private payers, and other private payers are likely to cover some tests. However, testing coverage requirements for large-group payers will end along with the PHE.
3. Treatment. Beyond existing grants, there are no publicly announced plans for additional federal funding, advanced purchasing or procurement of COVID-19 therapeutics, although the Biden administration has requested more funding from Congress. If government coverage ceases, private payers likely will need to make coverage decisions about these therapeutics based on use patterns, clinical benefit and patient demand.
4. Access to care delivery. The uncertain future of government coverage and financial support for care related to COVID-19 may prompt providers and patients to prepare for a greater out-of-pocket burden for such services and treatment.
5. Providers. The regulatory landscape will continue to influence provider investment decisions as many systems seek to expand ambulatory and telehealth service offerings. In a tight health care labor market, it is particularly important for providers to prepare for the rollback of site-of-care and workforce flexibilities, such as expanded scope of practice for non-physicians.
6. Private payers. Private payers will be required to absorb the costs of COVID-19 vaccination, testing and treatment that previously were shouldered by the federal government. A likely increase in claim volume related to treatment, testing and vaccination stresses the importance of use-management efforts, particularly in the context of ongoing COVID-19 waves.
7. Manufacturers. The end of large-scale federal advance purchasing of COVID-19 products such as tests and vaccines could affect the country’s health care industrial base. Manufacturers will run the risk of having insufficient dedicated manufacturing capacity in the event of a potential future surge, which could lead to downstream public health consequences.

“As the public health emergency comes to an end, along with many corresponding funding and regulatory flexibilities, stakeholders have an opportunity to make strategic plans, respond quickly and decisively, and succeed in the new environment,” the report concluded.