COVID-19 FAQs to help you answer client questions

PHILIP KAUFMAN: Good afternoon everyone. My name is Philip Kaufman. I’m the Chief Operating Officer for UnitedHealthcare’s employer and individual business. And thank you very much for joining us again today. It’s hard to believe that we have been having these calls since March of 2020 now and just back at that point it was just 1,200 cases in the US, about 30 deaths. And when you think about the trajectory and the journey that we’ve been on since then, I think all of us would have hoped and wished at this point we’d been out of it. Clearly, we are not.

As usual, today we are going to try to present to you a lot of data and information to help you better manage through it, to help give you strength and confidence that you need that we’re going to be able to get through this. With that said, while we show a lot of data, we never forget that each one of these data points is an individual, is a person, is a human being. This has impacted so many people so deeply in terms of their friends and family and loved ones, so we never want to lose sight of that. But on the flip side, we want to be able to give you the tools and resources that you need to be able to manage through. Whether you’ve been with us for one of the 52 webinars that we’ve done or this is your first time, we’re just really glad that you’re here.

It’s been about seven weeks since we met last and we’ve got a good line up today. As usually, we’re going to have Dr. Rhonda Randall, our Chief Medical Officer. She is going to cover a whole list of questions that I’m sure you have in terms of the new variant, vaccine boosters, the new treatments, what you can expect going forward, can you get COVID twice, et cetera. So she’s got a really good line up today.

I’m really happy to introduce Nia’Be Mitchell, who leads a lot of our member experience. Nia’Be’s going to talk to you today about how do we really get to your individual member and help engage them in improving their health, whether it be COVID or just general health concerns. We’re going to come back to Dr. Randall to talk about America’s health rankings and some of the insights we see there. And then finally, I will close out talking about the vaccine mandate, vaccine reporting, the No Surprises Act, the CAA, and a number of the other new administrative, regulatory, and operational requirements that we’re managing through.

Before we start, just a few housekeeping items. The call is being recorded today. It is available for replay. If you’re a UMR rep your UMR rep can send that. If you are a customer, your UMR rep can send this to you at the end of the call. We’ve got a really broad group of people on the phone and a broad group of customers. And within that group sometimes you might have different features, different products. And so we kind of speak generally here, but just want to say that our UnitedHealthcare teams and UMR teams and All Savers are there for you. Contact them. It’s our job to get you the answers to your questions.

Finally, I do want to encourage you to use the Q&A box available to you. We track those through the call. We try to get as many of those questions and we try to address those in the Q&A portion or even sometimes when we’re talking real time. For those we don’t get to, it’s important for us we grab that and we try to capture it in our frequently asked questions document that we post out on our websites.

Finally, I’m not going to read through the usual legal disclaimer that we show here, but just emphasizing that what we’re going to show you here today is for your best use but please contact your legal and tax advisors or your clinical advisor in terms of how best to respond to any situation.

Finally, before I hand it over to Dr. Rhonda Randall, I just wanted to say again, we’re really deeply grateful for you and your commitment to UnitedHealthcare. And I want to let you know that while we have been in this COVID pandemic for a long time and people are tired out and they’re worn out, I can just tell you there’s thousands of people here at UnitedHealthcare who wake up every single day and we are still really focused on helping you to be able to manage through this. And most importantly, helping your members manage through this. Make sure they stay healthy, make user they don’t lose sight of their overall health and make sure that they are able to live happy and productive lives. So we don’t lose sight of that. It’s a core part of our mission. We’re still very focused on it.

PHILIP KAUFMAN: With that, I’m going to turn it over to our chief medical officer, Dr. Rhonda Randall. Rhonda, go ahead.

DR. RHONDA RANDALL: Thank you, Phil. I hope that everyone is starting off 2022 with a happy and healthy new year and we’re looking forward to having an opportunity to present some new clinical topics to you but we are in a fluid situation and so a significant amount of the clinical updates that I’m going to share with you today are related to the global pandemic. Let’s go to the next slide.

We have received a lot of questions from you and these are some of the most frequently asked questions that we’re receiving. And I’m going to do my best to address the majority of them with you today. We can certainly come back to some of them in the Q&A if questions persist.

Let’s first start with a deep dive into the data as we always do. And I wanted to thank my friend and colleague Craig Kurtzweil for providing these for us. Craig is somebody who has been on these calls with us throughout the past couple of years and this is his data that I’m sharing with you. Let’s go to the next slide.

As we look at cases in the US and average death per day per capita, the light blue bars are showing you the number of cases and the dark blue line is mortality and number of deaths. And you’re seeing there since the beginning of the pandemic, the different waves, the very first wave being what is referred in the scientific community as wild type. Then you have the larger alpha wave followed by the delta wave that we just experienced this winter, and now we’re seeing the omicron wave come through. Let’s go to the next slide.

We saw over the fall, late fall and early winter, really a lot of outbreak in the central region, particularly North-Central region of the United States and that was quickly followed by some additional outbreak in the Northeast. But what you’re seeing now is all regions across the United States are experiencing significant upticks in the number of cases per 1,000. And it’s notable that this data that we’re looking at here in this report goes through the end of 2021 and even just within the last five days there have been some significant changes in movement in the data. Let me move to the next slide and we’ll talk a little bit more about what we’re seeing here.

Omicron first described in mid-November out of Botswana in South Africa. That’s the green line there, the significant increases in cases, where it went from undefined to on the day it was defined, about 20% of the cases and then within just about two weeks omicron made up the majority of the cases in that country. The next nation to report a significant surge in omicron cases was the UK, followed by France and now the United States that you’re seeing there. What you’re seeing is the countries that are seeing Omicron cases are seeing them with a very similar, incredible doubling rate. So moving from no cases to a few cases, to it very quickly taking over for delta and becoming the predominant strain. In the United States, if you were to follow this on the CDC’s website, and they have a really nice – if you look under omicron it’s color-coded purple and orange and other colors for other variants. If you looked at it yesterday like I did, you would have seen that omicron was responsible for about 58% of the new cases in the United States. And then if you looked at it again today you would see that it’s more than 80% of the new cases in the United States. So it’s pretty safe to assume that at this point forward, most of the COVID cases in the United States that are newly diagnosed are omicron. Now, testing and labs, the over the counter tests, are you testing whether or not somebody has COVID-19, it doesn’t tell you which variant they have. The commercial labs that can do that, it takes day to sequence the genomes to tell which variant it is. So really it’s best used at a public health level to understand what’s happening in a community.

And why this is really important is because of treatments. We know that the monoclonal antibodies, some of them are more effective against delta and others still retain effectiveness against omicron. So as physicians make those treatment decisions, it’s important to know what’s happening in a community, even if you can’t know it at a patient level.

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And just from yesterday to today, just seeing that doubling rate, we can assume that most of the cases in the United States that are going to happen over the next few days here are omicron. Let’s go to the next slide.

Also want to share with you what we see happening in the mortality rates. Mortality rates and hospitalizations, which will be the next slide I share with you, are what we really care about the most. This is something that is referred to in the scientific community as a case fatality ratio, which means for every individual that we know has a positive case, what is the likelihood that the individual who is positive will die from that disease. Now, what I have to note here is in the early stages of the pandemic and recently, where we have less tests than what we need, this case to death ratio is probably slightly over-reported. What do I mean by that? There are probably more cases in March and April of 2020 and December and January 2021/2022 than we can tell because a lot of people who are sick don’t have access to testing so they’re following the traditional quarantining, isolation, et cetera, but we don’t have that positive test on file. In other words, that 0.6% of what we see here is probably a worst case scenario. It may actually be lower than that. But without as many tests as we’d like to see, this is the best that we can tell for now. Let’s move into the next slide and we’ll look at hospitalizations.

This is our data, UHC’s data, looking at our admissions over time from January of 2020 when we first met with you and we were seeing just individual, single-digit cases and the first case reported in the United States and now into the end of December. We do have a little bit of a data lag generally, over holidays and weekends with hospitals reporting it and it certainly can be impacted by staffing issues of hospitals and case management departments as well. Although I do have data that goes up into last night, it is not as complete as we would like it to be to show it on the graph. But you cas see here each of the waves again, wild type, alpha, delta, omicron.

Now we’ll move and look into different populations. Comparing in blue our commercially insured members, to in red, our group Medicare and individual Medicare Advantage members. There you’re seeing for the most part, individuals over the age of 65 in the red line grouped in this population have a tendency to have more chronic conditions. They also have a tendency to be the individuals who got their vaccines very early in the course of the disease. And we hope that they got boosted. But this is where we’re seeing diagnosis. Again, this data may be slightly over-reported in that we don’t have all the vaccine data, particularly from early on, if we didn’t receive a claim from the administrative component. So what you’re seeing here, again, as far as these percentage is concerned, is worst case scenario. The percentages may actually be a little bit lower if we had additional vaccine information to include here. But I think the take home part of this slide is you really see that gap widening between a younger population and the senior population. Go to the next slide please.

So vaccines. I think the big news in vaccines since we last met is a booster for Pfizer’s BioNTech vaccine has been authorized for 12 years and older. So adolescents are now eligible for a booster if their parents desire and their physicians recommend that booster for 12 years and older. The other two right now are still only approved for 18 and above. We do know that mixing and matching is okay and we are still waiting for additional FDA approvals to come through. Besides the 16 and up for Pfizer, everything else right now is under emergency use authorization. And I am expecting Novavax to go before the committees of the FDA this month to have theirs reviewed.

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They submitted their data package on new year’s eve. They’ve been plagued with some manufacturing issues. So that’s one that we’ve been watching and will continue to watch. It would be nice to have a fourth option, especially this being a global pandemic that manufacture has approved in several other countries around the world. And one of the reasons that we’re seeing variants like omicron coming from South Africa is because of low vaccination rates and some other nations. So we’ve got to remember that this is a global pandemic and think about that as well. Let’s go to the next slide.

Treatments. This is going to look very similar to the one I shared with you in December with some notable changes on the bottom. We had talked in the past about Merck and Pfizer producing antivirals. Both of those have now received emergency use authorization from the FDA. They are oral treatments used in an outpatient setting. They pretty much have the same indication as the monoclonal antibodies. So thinking about high risk individuals. These are people who are high risk for hospitalization and/or death. Treatments that are similar to what we think about, Tamiflu for influenza, for example, getting those medications early on and doing our best to avoid hospitalizations and death in that high risk population.

Now, these drugs are being manufactured. There is a limited supply available right now. I understand that Walmart pharmacies are a significant source of distribution and only certain states have received supplies so far as that supply chain comes online and ramps up. So the access to these right now is very limited to the highest risk individuals and I expect that in the future once we see more supply come online, the questions that you probably all have, what about other populations, what about prophylaxis and so forth, those are things that will be able to be answered in the future.

The last slide I have here is just to share with you a little bit about how each of those are covered. For the most part we are covering administration fees if they are done through the medical benefit for things that are ingestible or a dispensing fee for the oral antiviral pills. Generally, those dispensing fees, we’re waiting for it to be determined, but I would anticipate they’re going to be in line with the dispensing fees for other oral antiviral medications, which are fairly standard, unless we receive guidance otherwise.

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DR. RHONDA RANDALL: And then I wanted to introduce to you if you haven’t had the honor to meet her before, our colleague Nia’Be Mitchell. Nia’Be is the Vice President of Member Experience and Implementation for UnitedHealthcare’s employer and individual and going to share with you what we’re doing around member advocacy. Nia’Be.

NIA’BE MITCHELL: Thank you Dr. Randall. Good afternoon everyone. I’m so excited to be here to talk to you a little bit about advocacy and how we support our members. As we have our advocacy discussion today, I just want to remind you, as Phil mentioned, that while plans and products may vary across the audience, the principles that I will share are the same.

Here at UnitedHealthcare we define advocacy as knowing that someone is looking out for you. And our role is to guide the member as they’re navigating this complex system, especially with the unique challenges that we’ve had over the last two years. Our goal is to meet each member where they are and then help them get the most out of their benefits. In 2021 we used the data and trends that you’ve seen not only to define action, but also to anticipate the types of inquires that we would receive when a member calls us. We continue to educate members related to cost and coverage of their benefit, specific to COVID and beyond. As the impacts of the pandemic ebbed and flowed, we promoted virtual care options. We saw a population get more comfortable with virtual solutions. And proactively, even when a member wasn’t calling us specifically to find care, if we saw that they went out of network as an example, or went to the ER, then we gave guidance on virtual visits for future reference, explaining those benefits but also those potential cost savings. For those concerned about potential exposure, we encouraged, educated, and helped members find COVID testing.

And as discussed in prior briefings, the rise of mental health needs has increased and we were here to help members navigate to virtual solutions, both as part of their plan benefits but also to educate on external solutions as appropriate. One thing that we were excited about as we enabled the ability for our agents to proactively promote tools, such as Sanvello, for on demand emotional support for our members who were eligible.

Thinking about how we keep members stay informed, digital advocacy is also key to helping members stay connected. In order to deliver that personalized support we want to make sure that we’re getting the most out of every single touch point and every interaction. We have the ability to see if the member is registered in our online portal and if they’re not, we help them get set up and make sure that they’re informed about our mobile app, all to ensure that they’ve to easy access to information and tools at their convenience.

This included specifically for COVID a resource center that’s available both publicly and with a member’s plan specific information when they are signed into myUHC.com. And there we help guide members online symptom checkers, testing centers, and those vaccines when those became available. When we think about the value of vaccines, we were here to answer questions related to not only cost and coverage and the different options that Dr. Randall shared, but also questions related to concerns about safety. But our goal was to make sure that we could help them find that information. And in many cases our agents could actually see vaccine dose information that we pulled into their tools to assist with those questions. We used that information to remind members to either start or complete their series.

So now as we’re heading into 2022, with the impacts of the pandemic continuing and the latest variant spreading more quickly than ever, it’s even more critical to ensure that we are here to support members holistically. I’m going to focus on three areas that are critical to supporting the members in what we refer to as whole person care. I touched on telehealth and virtual visits a bit already and our focus in that area will continue to remain front and center, particularly in this season of not only cold and flu, but the increasing infection rates for omicron, as Dr. Randall shared. So reinforcing those virtual care options to offer convenience when maybe the PCP is not available, either due to increasing demand on their side or their own staffing impact. So making sure that we’re guiding them to get the care that they need.

I’m going to spend some more time here in just a moment to share how we address social determinants of health and connect members to resources that can address life factors that impact overall health. And I’m also going to talk to you about how we’re continuing to increase our ability to guide members to mental health solutions across the continuum of needs that may vary, as demand and impacts increase.

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Let’s move to the next slide to talk about social determinants of health. As we think about the effects of the pandemic, they can be far reaching, including socioeconomic life factors that can affect a member just as much as a medical visit in determining their overall health. As you know, we leverage data and analytics and we use that to build predictive models to help support members who may need additional support in such area as access to food, housing, transportation, financial stability. We made this information available to our agents and our nurses in their tools so that they’re able to not only respond when a member is expressing a need for support when they call but also if they don’t say anything directly. We can take a question about a claim or filling a prescription and then help identify needs that go deeper. This could include getting them connected to resources to help them save on utility bills so then that eases their ability to pay for a prescription. Helping them find lower cost transportation to get to care appointments. And also to help with veteran specific services and support that we know resonates with that population. We’re able to help find a resource and program locally in their community, help them get connected or guide them to our online resource, UHChealthierlives, which leverages a database at findhelp.org where they can get connected at their convenience. 

Usage through that URL is tracked and we are expanding our reporting to not only learn more about the types of resources that our members use but use trends to continue to further enhance our support in this area. Actually recently, new this year here in January, we will take that predictive modeling information and then actually display opportunities directly to members on myUHC.com on our recommendations page. So again, getting in front of the member when they’re not telling us about that need so that we can help so that we can help them to get that support and care.

As we move to the next slide and talk about emotional health, the pandemic has reinforced that connection between physical and mental health. These two go hand in hand on a two-way street. If your workforce is on their game mentally, then they’re more likely to take of themselves physically and stick with their care plan. If they’re taking care of their body then they’re better able to manage stress and anxiety up through more serious needs.

Employers have always had concerns about employees needing mental health support and over the course of the last two years we saw mental health call volume go up. Members calling in directly and indirectly, seeking support. This could range from needing help finding a mental health professional, to expressing worry and concern about the uncertainty of the virus, seeking guidance on what options are available to them and their families with kids at home, virtual learning, and that fatigue and burnout that many of us have experienced.

No matter where the call starts, we are enhancing our capabilities to better support guiding members across that continuum of case, connecting the dots between behavioral, medical, and pharmacy. We now have additional behavioral health solutions that we’ve added to our dashboard tools as part of next step action, so that we can proactively promote resources for members who are eligible. Again, that enables us to provide that personalized support and address unexpressed needs by promoting solutions based upon that member. Some of these include the Sanvello app as I mentioned, behavioral health case management. We’re excited to now add virtual behavioral coaching and virtual therapy for members who are eligible. And in some cases we can easily send a text or email with a link to download the app or register and enroll. Again, promoting that digital advocacy so they’re making it easy and convenient for all of our members.

We have a roadmap for future enhancements, to not only continue to help guide members to mental healthcare that best meets their needs. But again, continuing to enhance our support across that continuum, continuing to make enhancements on myUHC.com. We look forward to keeping you posted as we evolve with our members and their evolving needs. With that, I’ll turn it back over to Dr. Randall, our UnitedHealthcare employer and individual Chief Medical Officer. Dr. Randall.

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NIA’BE MITCHELL: And with that, I’ll turn it back over to Dr. Randall, our UnitedHealthcare employer and individual chief medical officer. Dr. Randall.

DR. RHONDA RANDALL: Thanks, Nia’Be. One of the things that I hoped to spend a significant amount of time with you today was the newly released America’s Health Rankings Annual Report. But since we devoted most of our time to what’s changed with the pandemic, I’ll be really brief today and hope to bring this to you in greater detail next month.

I hope most of you are familiar with this report. If not, your account management team certainly can help you. If you are looking for more information, it’s on the website at AmericasHealthRankings.org. It’s produced by the United Health Foundation. It’s the 32^nd annual report. This report contains 81 measures of our health. It’s broken down at a state level and at a subpopulation level so you can see differences in, with ethnicity, gender, age, geography, education obtainment, income levels, and more.

But there were a couple that I wanted to point out to you because this is the first annual report that includes significant data from 2020 so we really start to see the direct and indirect effects of the pandemic on our nation’s health. This is not UnitedHealthcare’s data. It’s America’s data. It comes from three dozen different public health sources and it’s really put into a report that comprehensively looks at social and environment, economics, our health behaviors, the clinical care we receive when we go to the doctor or hospital, health outcomes and behavioral health and more.

So there’s just a couple of findings I wanted to share with you very quickly today. The first one on the next slide, the most devastating finding in the report was from 2019 to 2020. The death rate went up in the United States 17%. And as we look at from other sources what explains that, about two-thirds of it can be explained with COVID either the leading cause or contributing factor on the death certificates. The other one-third, some of the things we saw increase, and I’ll share with you in a moment, an increase in drug deaths. We also saw earlier on increase in heart disease. I expect that a significant amount of that was care that didn’t occur that needed to occur for people who were having chest pain early on during the pandemic and didn’t go to the emergency room, for example. We also saw some increases in Alzheimer’s disease that can’t be explained solely by COVID. So some interesting findings there. Let’s move to the next slide.

Mental health, we’ve been sharing with you with our own data and what we’ve been seeing nationally. This is a survey that’s done from the CDC every year that asks adults about frequent mental distress. That’s defined as people who experience mental distress 14 or more days a month. And it went down surprisingly slightly on a national level but that can really mask what was happening underneath. So here’s what’s happening in the subpopulation data. Females were experiencing higher rates of frequent mental distress than their male counterparts. Those who had lower incomes, 2.3 higher rates of mental distress than those who make more than $75,000 a year. And multiracial adults almost three times more likely to experience frequent mental distress than Asian adults. Let’s move to the next slide.

A couple other things in behavioral health. We saw a 4% increase in drug deaths. That means 93,000 more Americans died in 2020 compared to 2019 from non-prescription drug use. And we see that percentage of non-prescription drug use up as well. Over the 32 years of this report we’ve seen smoking go down. Unfortunately, we’re starting to see e-cigarettes pick up. That’s concerning.

And then last but not least, I want to leave you with I think some good news here on the last slide. For 2020 we saw flu vaccines hit a record high. It’s still not as high as we want it. The healthy people 2030 goal is 70% of adults getting their flu vaccine. 47% is the highest we’ve ever achieved and that was an 8% increase over the prior year.

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DR. RHONDA RANDALL: Now I’m going to turn it over to our Chief Operating Officer. Welcome back, Philip Kaufman.

PHILIP KAUFMAN: Thank you Dr. Randall. I appreciate it. I’m going to switch over here and cover some policy updates. I’m going to start with mandates, which I know has been top of mind for a number of you. There’s been a lot of confusion in this space. And if you go to the next slide, there are actually, I think it’s worth reiterating this, there’s actually three different mandates that are out there. There is an OSHA driven large employer mandate for employees 100 plus. There is a mandate for any organization which accepts – by CMS which accepts Medicaid or Medicare. And then there was a third mandate applying to anyone who accepts dollars through a government contract.

On the right hand side here there are some links for you to go and this is where we get some of the latest and greatest for our information for each one of these. This is an area where I do want to emphasize, please lean on your legal counsel to give you specific guidance for your business. But I’m just going to cover this at a high level with what we know.

The large employer mandate was basically put on hold by the fifth circuit of appeals. There were a lot of lawsuits all of the country and they were in the fifth, the sixth, the ninth. They do kind of a ping pong ball drawing and they would consolidate into the sixth. A three judge panel in the sixth circuit said two to one, actually we do think it can go forward. Then there was an appeal to the Supreme Court. The Supreme Court is going to hear oral arguments on this on Friday. We don’t know when precisely a decision would come out. I will come back to my prediction on that in a second. But they will hear oral arguments on Friday. At that point we’ll have a little better sense, assuming the judges ask questions, of which way they might be leaning and whether or not we think it would survive.

In the interim, OSHA has said we are not going to issue citations until February 9^th. Those two data points together leads me to believe that the Supreme Court will issue a decision sometime late January or early February. As an employer, this puts you in a really difficult spot because they’re basically saying, look, we’re not going to issue citations if you use good faith efforts to comply. So we realize it’s a difficult position for all of you to be in, not really having clear guidance. The best I can tell you is watch those Supreme Court arguments on Friday. I’m sure you’ll see a number of articles giving a sense of how they think the different justices are leaning and whether or not they think that mandate will survive.

Number two, this is also going to be heard at the Supreme Court on Friday. This was held through a different appellate circuit. And so this is on hold right now but arguments on this will be on Friday. This one was a little even more complex, if that’s possible, in the sense that it was held in certain states and put on hold not in others. So it’s a state by state framework. But that will also be heard at the Supreme Court on Friday. Finally, there is a third mandate for government contractors. This one is currently on hold. It’s working its way through the courts and we don’t have a resolution date. So that’s the latest and greatest on the different mandates that you may be facing as an employer.

Let me shift gears into testing. And apologies, I’d love to spend more time on each one of these but there’s so much to get through today and we want to save a little time for Q&A. A really common question we get is what do you cover in testing and what don’t you cover? You’ll hear these terms from us a lot, which is what is a diagnostic test? Sometimes we’ll say it’s diagnostic and then sometimes we’ll say it’s surveillance. During the public health emergency, we are required to cover, all of us, whether you’re self-fund or fully-insured, diagnostic test for COVID at zero cost share. A diagnostic test is typically prescribed by a physician and it’s intended to identify a current infection or whether you’ve been directly exposed to somebody. So that for me is pretty straightforward.

The surveillance gets a little more gray. But the best example I have on surveillance is I want to take a trip to Mexico and I need a negative test to come back. That’s a surveillance test. I haven’t necessarily been exposed to anyone. I don’t have any symptoms of COVID. I want to kind of use it to operate a normal life.

Another example would be if the employer mandate, the OSHA mandate goes into place, it says either you need to be vaccinated or you need to test weekly.

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That would be surveillance testing because you’re not technically symptomatic and you haven’t been exposed.

Following on this we always get questions of can you really tell in certain situations and could someone just lie and say I’ve been exposed? Absolutely. This is a space where certainly there’s a lot of gray but as you line it up from a definitional standpoint, I think this is helpful to start with. And to be clear, diagnostic testing is covered at zero cost share. Surveillance testing is not, health plans are not. Whether you’re self-funded, you are not required to cover that.

If you go to the next slide, there was I’ll call it, a little bit of a new wrinkle to this and the President issued an executive order in early January. The text is pretty small on the right hand side here but I assume at this point most of you have heard about this. The President said in addition to covering regular physician prescribed tests at zero cost share, we think it’d be a really good idea if health plans covered at home test kits at zero cost share.

We absolutely support the effort to try to get as much testing out there as possible. We think it’s a really positive thing. However, there are some challenges with this and some concerns that we have. They’re defining the final rules right now and they have said that those rules are going to be released by January 15^th. We have not seen any additional guidance yet beyond the fact that this policy would not be retroactive. So when they put it in place you wouldn’t be able to say I bought ten test kits last year. I want to submit for those reimbursement now. So it would not be retro. But beyond that we don’t have much guidance yet.

Our concerns are is that if you take away the physician order and the cost share, this could exacerbate the extremely severe supply shortage of test kits that we already have. So we’re concerned about hoarding, people just going to buy 10, 15, 20 kits and the shelves just being cleared out. We’re also concerned that it makes it more difficult to track the course of the disease. As Dr. Randall pointed out earlier, when you do a home test you don’t sequence that to understand if it’s delta or omicron. Further, there’s a pretty high error rate when you take the home test and you kind of lose track of what’s happening out there in the population when you don’t get that data back.

And then finally, there’s the cost aspect. And if you’re sitting there and you’re a self-funded employer and you’re saying I’ve got 500 people and let’s just assume each one of those families buys five test kits for the year. That’s an additional $62,000 expense. There’s different arguments on, five, Phil. We bought 10, 15 of these last year. Or is that conservative, is it aggressive? I don’t know. But my point is there’s for sure a cost implication for employers and we just want you to be aware of that as we move forward.

I will tell you that UnitedHealthcare continues to advocate for what we call common sense regulations around this. So again, testing is a very good thing. We want to support it. But we also think all those concerns that I talked about before, we think there needs to be some guardrails to protect against those.

Given that this could be effective January 15^th, if you go to the next slide, I just want to walk you through, we’re already working on a process to put in place, an electronic process. I think given time, I’m not going to walk through it step by step, but at a high level, you would log into our portal, you’d select the type of COVID test kit. We’d validate that it’s FDA approved. We might ask you some questions saying was this for travel, was this for because you’ve been exposed, et cetera. Depending on those questions, you would be reimbursed or would you not. They’d submit through our portal and then the claim reimbursement would be handled automatically. We have to work ahead on this. So we’re already working on a process so these test kits can be reimbursed.

You can imagine this is not something that normally we’re used to doing, in the sense that we’re going to get receipts from Amazon and someone says I bought three test kits on Amazon. Here’s my receipt. It’s a very different framework and we’re just trying to get ahead of the ball here and try to think about the different implications of that type of structure.

I think it’s really important to come back to some of the COVID quarantine guidelines on this next slide. I’m going to pull Dr. Randall back in here. As Dr. Randall gets ready to come back on, I just want to say that I think these are welcome from our standpoint, these revised guidance. I think that over the last several weeks, practically, there have been some really significant shortages in medical facilities, not because of necessarily COVID cases, although they are higher, but because so many staff members have tested positive for COVID and going on extended quarantine periods. That’s making it more difficult.

[00:10:00]

Some of these are important to what I’ll say, keep the economy and the country going. But Dr. Randall, why don’t I bring you back in here and have you speak to these a little bit and maybe outline the guidelines. Because I think as people think about return to work and your office environment, these are important considerations.

DR. RHONDA RANDALL: Thank you, Phil. The ones that we’re showing you here are the updated guidelines from the CDC for the general public, so for most of your work sites. If you are operating a healthcare facility, that guidance is different and I would refer you. You’re probably already familiar with it if you’re a healthcare provider. That guidance is different so I just want to call that out. And it can be a little confusing here to follow this algorithm.

Those who test positive, we isolate the sick. We quarantine the exposed. Isolation means that you’re in a separate part of your house. You’re staying in your own bedroom. You’re not mingling with your housemates. That is stay at home for five days and then after symptoms have completely resolved, that means fever free with no medication, no acetaminophen, no ibuprofen, for example. And then after that isolation ends, you can interact with others but it’s recommended to mask for an additional five days.

Those who were exposed, it’s different based on whether or not you’ve received a booster dose of vaccine or the length of time since your initial series. I won’t read all of that to you here. But I wanted to really call out that this guidance came out, it’s recent, it’s more nuanced than the previous guidance that we had. So this might be something, it’s on the CDC’s website, that you might want to just print out and make sure that whoever’s writing your occupational health and safety has the latest and greatest updated information. Thanks, Phil.

PHILIP KAUFMAN: Thank you Dr. Randall. We’re going to bring Dr. Randall back in the Q&A and hopefully we’ll get to a number of other questions you’ve got on vaccine efficacy and boosters during that period. So hang tight. If you have questions about those, we’ll get back to that in a few minutes.

Let me just talk about No Surprise billing. As a reminder, there were very significant pieces of legislation that were passed last year. One of those was No Surprise billing. That holds that if you’re a member and you go to out-of-network emergency care or air ambulance or certain other out-of items network and services, you are held harmless or you should be held harmless in that situation. That, when effective, 1/1 of this year, it applies to fully insured and self-funded customers.

Without covering it in exhaustive detail here, first of all, the supply is much more to self-funded customers than it does fully-insured. For fully-insured we’ll pretty much administer half. It certainly applies to your members and your employees in the sense of their experience. It should improve their experience when they run into out-of-network situations. So that’s the hope.

Behind the scenes, there’s a lot that goes on between the provider and the insurance company. One of those things is calculation of how much should they be paid and what’s the negotiation? You’ll hear this word the QPA. It determines the qualified payment amount. At least out of the gates the way that’s going to be calculated is, in my mind, which is pretty fair, which is we’re going to take the average of what we pay in-network for network contracted providers and that’s what we’re going to pay to the provider for that service. The provider has the opportunity to accept that, reject that. There’s a whole IDR process that you go through so I’m not going to go into extensive detail here.

But I just want to show you for self-funded clients, we’re ready to go. We’re ready to go. We’re ready to administer this. The government website is not quite up yet to the portal where some of this is administered, but we’re set on our side. And there’ll be some bumps and bruises as we start this process but as we roll out into the new year we’re ready to see how this works. Again, our hope is that it really benefits the member at the end of the day.

A few other aspects of this I’m just going to cover quickly. New ID cards are coming to the members. There are new required fields on the ID cards. This is at renewal. I just want to keep emphasizing that. If you’re a 5/1 or a 6/1 renewal, don’t have to worry. At your renewal date the new cards will be produced. In terms of directories, we always, every single day, try to keep our directories really up to date. In some cases now if a provider doesn’t validate that their information is up to date, they might be suppressed in the directory, but we won’t deny the claims. We’ll just try to keep trying to get their updated information.

And then finally, 7/1 still coming and we’ll keep updating this, advanced cost estimates and saying for any given treatment or procedure, I’d like to know what the cost is in advance. So more to come on this over the next few months.

[00:15:04]

I’m going to pivot here into vaccine tools and talk about the different things that we’ve made available to members that we think are more important than ever in terms of helping manage through this pandemic. I just want to say that these tools have been up for a period of time now. What you see on the screen has now been accessed over two million times. So these are heavily used by the members. There’s different ways you can get there. There’s different versions. At this point at the start it was just what I’ll call web-enabled. Now it’s web and mobile enabled so you can get there through our different assets. I regret to say it’s still not available for you at All Savers. I’m sorry. We’re working on it. We’re working as fast as we can to try get it built up. But for the rest of our customers, you can access your vaccine record. So if you need to go to that sporting event or that play or whatever else, you can – either we’ll grab the electronic record or you can self-report it and it puts together a record for you.

On the right hand side we’ve enhanced this to put together a QR code. The advantage of this is this works with a lot of the services, like Common Pass and Clear. So if you’re in some higher need situation, we expect over the next year or two, you to need a digital record, this QR code would work or it should work in those situations. So we continue to try to advance this. And lots of these records are being produced, thousands of them every single day. So it’s been a really useful tool for our members.

I also want to go to the next slide and talk about the reporting available to you. If you’re a very, very small client, five, six, seven employees, you might not be able to get this. But for all of our larger clients, you can get a report. We have actually produced over 100,00 of these reports. It talks about all your COVID information. And I just want to note here that we’ve added booster vaccine doses onto the report. So now there’s another field there for you to be able to track and monitor. We continued to press this as a helpful tool.

[END]

PHILIP KAUFMAN: I’ll take a breath there. I’ve gathered up a ton of questions as we’ve gone through today and I want to jump in because I know a lot of these are really pressing for folks. Let’s start, Dr. Randall, with a couple for you. The first one is can you get COVID twice? If you do get it twice, should I be nervous? Is it just as dangerous as COVID the first time? So if you could start with that one, that would be great. And maybe within that you could weave in just, again, talking about the importance of boosters.

DR. RHONDA RANDALL: Sure. One of the things you probably have heard a little bit about recently, if you hadn’t before, is something called immune escape. This is whether you have natural immunity or immunity from a vaccine and as that virus mutates, like all coronaviruses do, they’re slow mutators. The common coronaviruses that cause the common cold mutate every year. That’s why there’s different common colds that come around and now we see that we’re on at least our fourth variant with COVID-19. So we are seeing particularly with omicron, there’s enough mutations there that individuals who had their primary series and were recently boosted or individuals who had a COVID infection, particularly more than three months ago and get exposed, we are seeing reports of second COVID infections or COVID infections following vaccinations. But what we are hearing from a lot of those reports is there is still some immune response, both from vaccine as well as natural immunity, that’s causing that second exposure to result in a milder case. Less likely. So what you saw in the hospitalization data, for example, individuals who have their primary series, individuals who have been boosted, much less likely to be hospitalized or die.

PHILIP KAUFMAN: I just think we can’t emphasize that enough. And Dr. Randall and I have been saying this. And we very much understand the political and religious and moral issues with taking a vaccine. But just the data is just crystal clear that if you do have your full course of vaccine, the odds of you having a serious illness is so much less, even if you get COVID first time or a second time. It makes a really, really big difference. We won’t flash that side up again, but when you look at our under 65 population and you look at hospital admissions for COVID, it’s still 97, 94%, 92% on any given day if those individuals are unvaccinated. The data is just really compelling that the vaccine is effective at preventing severe illness. I think the new information it may not be as effective as we all would have hoped of just getting COVID overall, but again, that severe illness piece, it really matters.

DR. RHONDA RANDALL: That’s correct.

PHILIP KAUFMAN: I’m going to give one more to Dr. Randall and then Nia’Be, I’m going to come over to you with a question. Could you just talk about boosters? What is your latest and greatest advice on boosters, whether it be a booster for a 15 year old or a booster for a 25 year old or a booster for a 65 year old.

DR. RHONDA RANDALL: Thank you. Particularly now that we’re seeing the rapid spread across the R-naught, the transmission rate and the doubling rate of this variant, if it’s not already in your community, because it is so contagious, there’s an expectation that more than 90% of us are going to get it. And what you want to do is get a mild case of it when you get it. So if you haven’t already had your booster and you are interested in getting your booster, now is the time. Don’t wait for that.

This is a global pandemic so we also are looking at what’s happening around the world. Unfortunately, there are plenty of countries that don’t even have their primary series. So of course, you need to take all of this into consideration. The more birthdays you’ve had and the likelihood if you have a chronic condition, that makes it an even more compelling a reason to get the booster. For children and adolescents I do think a conversation with a pediatrician is a good one to have if you have a healthy child. Of course, if you have a child who has a chronic condition, again, that reason is more compelling. But when in doubt and when in question, if you need some of that advice, your primary care physician who knows your personal health, is the best one to ask.

PHILIP KAUFMAN: Thank you, Dr. Randall. Nia’Be, I’m going to come over to you. There were some questions on when you think about us trying to reach out to the members and understand their needs, how do we know? Can we predict who’s going to have a challenge?

[00:05:00]

What data are we using to be able to identify a member who has a need on a social determinant of health or a behavioral need or they haven’t had their vaccine yet, and how does that make its way to our agents and then what do they do from there?

NIA’BE MITCHELL: Sure. Thanks, Phil. From a social determinants of health perspective, we pull in several different data sources. This includes information that we’ve partnered with from providers, ICD-10 codes. We pull in health survey data, demographic and census data, financial and credit data. And we pull all that into our algorithm to help to predict which area may that particular member be most affected by. And it could be more than one. We then push that information to our agents and to our nurses with a specific starting point. It could be food insecurity or social isolation that we start with. But then we do have a short screening questionnaire that we’ll talk to the member through so that we can fine-tune the types of resources that we evaluate.

For the vaccine, again, promoting the vaccine, answering questions about it. It’s very exciting for us to pull in the data that you referenced, Phil, with a vaccine pass. We can pull in that information from Clean’s data but then also through the electronic records and we populate it directly into their desktop. So the agent can see right away you have Moderna dose one and if we don’t see dose two and the time has passed where you should have gotten it, then we can have that proactive discussion to remind them to finish out the series and then now to talk about boosters.

PHILIP KAUFMAN: That’s a great answer. Thank you. Really appreciate that. I’m going to just do a couple quick hits on administrative items that have been asked as we’ve gone through this. One was on the Merck and Pfizer antivirals. Is this going to be a significant expense for me as the employer? The answer to that is at least initially, no. The government has purchased the doses similar to they have for the monoclonal antibodies. As if you’re a self-funded employer, the only thing that you will be paying is a small dispensing fee for those drugs. Now, right now there’s limited availability but we do expect the supply of those to ramp very significantly. At least for the foreseeable future on this year, we do see the government paying for those drugs. I think as you go into future years that’s a little more of a question mark and we’ll come back to it at that time but right now you shouldn’t be expecting a huge expense from the drugs.

There was some questions on the vaccine pass. And just reiterating, those passes are available for anyone who can access myUHC. For those clients who have either UMR, All Savers, not available yet. We’re working on it. It’s taking us longer than we would have hoped but we continue to press in that area.

Let’s just do one more clinical question and then I’ll close out. Dr. Randall, talk about mild cases and long COVID. Are we hearing anything there in terms of the prevalence of long COVID and do we have enough information yet?

DR. RHONDA RANDALL: Still too early to tell. We are seeing some significant data from South Africa, from the UK, from Scotland, with the omicron outbreak that the cases related to this variant are more mild. Those that do get hospitalized having a tendency to be a slightly shorter length of stay, having less of a tendency to be in the ICU, for example. So I’m hoping that with the expectation that such a high percentage of the population will get exposed, that we’ll see most of those cases be mild. But we’re seeing across the United States in the last couple of weeks, tremendous increases in hospitalizations, just because of the sheer volume of infections that are going around the nation right now.

So still a little early to say if we’ll see very much long COVID with mild infections. We have a tendency to historically, over the last 18 months, see long COVID be more common for individuals who had more serious infection requiring hospitalization or ICU use, for example, in those who recovered in those settings. But that does not mean that individuals who have mild cases are immune to getting long COVID. So it’s going to be one that we’ll follow closely.

PHILIP KAUFMAN: Great. Thank you. I want to thank you all for joining us today. We hugely appreciate your trust and confidence in UnitedHealthcare. We had over 300 different questions come through in the Q&A. I do want to remind you, your UnitedHealthcare rep, as well as your broker and consultant, should be your resource to answer those questions. My expectation is that, and it’s our job to get you those answers to the best of our ability.

[00:10:00]

So know that we will continue to work to do that. Thank you very much and we will schedule another one of these calls for about a month, six weeks from now. Have a great day, everyone.