Merchant Raina M, Finne Kristen, Lardy Barbara, Veselovskiy German, Korba Caey, Margolis Gregg S, Lurie Nicole
Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response, 200 Independence Ave SW, Washington, DC 20201. E-mail:
Am J Manag Care. 2015 Jan;21(1):65-72.
Health insurance plans serve a critical role in public health emergencies, yet little has been published about their collective emergency preparedness practices and policies. We evaluated, on a national scale, the state of health insurance plans' emergency preparedness and policies.
A survey of health insurance plans.
We queried members of America's Health Insurance Plans, the national trade association representing the health insurance industry, about issues related to emergency preparedness issues: infrastructure, adaptability, connectedness, and best practices.
Of 137 health insurance plans queried, 63% responded, representing 190.6 million members and 81% of US plan enrollment. All respondents had emergency plans for business continuity, and most (85%) had infrastructure for emergency teams. Some health plans also have established benchmarks for preparedness (eg, response time). Regarding adaptability, 85% had protocols to extend claim filing time and 71% could temporarily suspend prior medical authorization rules. Regarding connectedness, many plans shared their contingency plans with health officials, but often cited challenges in identifying regulatory agency contacts. Some health insurance plans had specific policies for assisting individuals dependent on durable medical equipment or home healthcare. Many plans (60%) expressed interest in sharing best practices.
Health insurance plans are prioritizing emergency preparedness. We identified 6 policy modifications that health insurance plans could undertake to potentially improve healthcare system preparedness: establishing metrics and benchmarks for emergency preparedness; identifying disaster-specific policy modifications, enhancing stakeholder connectedness, considering digital strategies to enhance communication, improving support and access for special-needs individuals, and developing regular forums for knowledge exchange about emergency preparedness.
医疗保险计划在突发公共卫生事件中发挥着关键作用，但关于其整体应急准备措施和政策的公开报道却很少。我们在全国范围内评估了医疗保险计划的应急准备状况和政策。
对医疗保险计划进行调查。
我们向代表医疗保险行业的全国性贸易协会——美国医疗保险计划协会的成员询问了与应急准备相关的问题：基础设施、适应性、连通性和最佳实践。
在被询问的137个医疗保险计划中，63%做出了回应，代表1.906亿名成员，占美国计划参保人数的81%。所有受访者都有业务连续性应急计划，大多数（85%）拥有应急团队的基础设施。一些医疗保险计划还制定了准备工作的基准（如响应时间）。在适应性方面，85%有延长索赔申请时间的方案，71%可以暂时中止先前的医疗授权规则。在连通性方面，许多计划与卫生官员分享了他们的应急计划，但经常提到在确定监管机构联系人方面存在挑战。一些医疗保险计划有协助依赖耐用医疗设备或家庭医疗保健的个人的具体政策。许多计划（60%）表示有兴趣分享最佳实践。
医疗保险计划将应急准备作为优先事项。我们确定了医疗保险计划可以采取的6项政策调整措施，以潜在地改善医疗系统的应急准备：为应急准备建立指标和基准；确定针对特定灾难的政策调整，加强利益相关者的连通性，考虑采用数字策略加强沟通，改善对特殊需求个人的支持和服务，以及建立关于应急准备的知识交流定期论坛。
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