By JESSICA DaMASSA, WTF HEALTH

“[Employers’] top priority is getting their employees and their family members the appropriate care, but there are a lot of unknowns about how this is going to impact their actual total cost of care…”

As Covid-19 testing and treatment rise in U.S., many people — and their employers — may be starting to wonder: who is going to pay for this? How much is this going to cost?

Castlight Health’s CEO, Maeve O’Meara, talks to us about all-things healthcare cost, coverage and benefits administration, drawing from her position leading a company that focuses on helping people make sense of the health insurance benefits they receive through their employers or directly from health plans. 

What has employers and health plans most concerned? Making sure people are aware of changes to their plans so they know what’s covered (and what’s not), and when and where to go for care are the top of the list, according to Maeve.

Castlight’s recent publication of a ‘Covid19 Cost Analysis Report’ (link below) supports that point, outlining the variances in costs for Covid-19 testing and related fees. The key takeaway to note: While fees may be waived for the Covid-19 test itself, supporting services like doctor’s visits, chest x-rays, bacterial or blood culture tests, etc. are probably not and those costs can vary significantly depending on the point-of-care.

Ultimately, these costs are going to add up, and employers and health plans are already beginning to talk about what this will mean post-outbreak. “They’ve estimated how much it will cost to cover the covid test, how much will it cost to cover the actual treatment, and what are the implications in terms of how they think about 2021 and being able to contribute to employee plans,” says Maeve. 

“The offsetting factor here is that there is this massive delay of elective procedures — hips, knees, heart, there’s a lot in that bucket — and so how that cost and [those] services are offset is not at all clear right now.” 

In addition to the Cost Analysis Report, Castlight has also created an open-source Covid19 Testing Site Directory identifying 1,500 different testing sites nationwide and hoping to crowdsource more. 

Covid19 Cost Analysis Report: 

Covid19 Testing Directory:

https://my.castlighthealth.com/corona-virus-testing-sites/

Read the interview transcript here:

Jessica:

Hi, it’s Jessica DaMassa with WTF Health, What’s The Future Health. We’re bringing you a special series on how health technology companies are responding to COVID-19. And so joining me right now, I have Maeve O’Meara. She is the CEO of Castlight Health. So Maeve, it’s great to have you with us. Thanks for joining us.

Maeve:

Thank you so much for having me. It’s great to be here.

Jessica:

Great, thanks. So, for those who are not so familiar with Castlight, you guys have been around for a while. You’re more than 10 years old, publicly traded. And what you guys do is, you help people who are on commercial health plans, whether they get them from their employer, or they get them from a payer, you help them navigate their benefits.

Jessica:

So you’re sitting at this spot right now, where people are wondering, “Ah, is this covered? Is it not covered?” And employers are looking at you like, “Oh, my God. How are we going to pay for this?” So Maeve, tell us, what your customers are asking you. And I know you guys have some stuff that you’ve released recently, including a COVID-19 Cost Report, as well as a Testing Center Finder. And so those might be hints, I guess, of what they’re asking you for. But give us the scoop. I mean, what’s happening in these conversations with these employers, or these health plans that you’re working with?

Maeve:

Well, I think that what we at Castlight feel, is just incredibly lucky to have the opportunity to be part of these conversations and how do we better serve our consumers, our employees, health plan members. And ultimately, what they’re asking is exactly what our mission is, which is how do we help people navigate to the right care in the context of a pandemic.

Maeve:

And the conversations have really ranged quite a bit. So certainly, I think one of the first and foremost questions is helping communicate plan design changes. So as there’s been new legislation rolled out, and new guidelines, and new decisions to be made around the coverage of COVID testing, as well as the coverage of Telehealth. Certainly employers and plans are looking for our help to appropriately communicate the changes in plan design. Similarly, they’re looking for us to communicate and educate around COVID.

Maeve:

So, number of questions around, when is it appropriate to be tested, how to interpret symptoms, the education around how you actually get care. So it’s literally at the core of what we do. A lot of work around ensuring that we’re able to respond when people come in and search or call with COVID or flu-related questions.

Maeve:

And then the third bucket, I would say, is around helping their employees in the context of being in a more distributed environment. All of our buyer and customers are effectively in benefits groups. They’re helping to address effectively enabling their workforce in a remote way, and trying to keep them connected, keep them healthy. So, as we think about things like financial wellbeing, emotional wellbeing, bringing to bear those resources in the context of our platform has also been a big focus as people are really thinking about the whole person and thinking about that over the context of the life cycle of this pandemic.

Jessica:

I want to touch on that financial side of things a little bit, because you’re probably one of the few people I could talk to about this. So I’d love for you to weigh-in. I mean, what are some of the concerns there? Everybody’s struggling to find care and there’s a lot to cope with, in terms of our physical health, but alongside the challenges with the economy that we’re facing, we’re thinking about our personal economy as well and our financial health.

Jessica:

So what are some of the things that you’re talking about there? I know you said making sense of changes around plan design. But, what do people need to really understand about their coverage? And also from your relationship with some of these large employers – some of the largest employers in the world – what are their concerns? What are they saying to you?

Maeve:

It’s been a fascinating set of conversations. So I’ll start with conversations with users, and what we’re hearing from users. And so, there’s just a huge amount of confusion for users, as I mentioned, certainly on, ‘Do I need to get a test? Do I need to get coverage? Do I have to pay for it? And then, if I have a positive diagnosis and need care, will that care be covered?’ So, there are certainly a lot of broad questions, which I think are primarily centered on what is the appropriate care. But affordability is certainly top of mind during this time of economic hardship and as people are looking at potential job loss, furloughs.

Maeve:

So, one of the reasons that we released the Cost Report, which we’ll talk about a little bit more, was to demonstrate that there actually is an incredibly large variance across a number of dimensions. Certainly across the nation, the cost to get tested or evaluated for COVID varies quite dramatically. That’s also true within cities. And it’s a double-digit variance within San Francisco, as an example.

Maeve:

You know the third area of variance is really around site of care, and whether you actually go into an emergency room, Urgent Care, to your primary care doc, or Telehealth. And then the fourth is, of course, based on your underlying conditions, as that will influence the set of services that you have to evaluate you.

Maeve:

From a user perspective, I think one of the areas has been, “Is this going to cost me anything?” Because there’s a lot in the news that would imply COVID testing is free, “don’t worry about it.” And some people are asking the question of, “But is it really?” And right now, how that evolves is not clear, in terms of what will be covered, will treatment be covered. So that’s really on the user side. 

Jessica:

When I read through the COVID-19 Cost Report that you guys published, this was like a couple, maybe a week ago, right?

Maeve:

Mm-hmm (affirmative).

Jessica:

One of the things that struck me, is it’s just the COVID-19 test that’s covered.

Maeve:

Right.

Jessica:

But, the other testing that goes along with it, any type of chest scans, any other kind of blood cultures that need to be done. That’s the stuff that’s not. And that’s the stuff that starts to add up. And then beyond testing, if you are symptomatic, I mean, some of the cost discrepancies between what was going on – in a place where healthcare costs for major diseases often cause bankruptcies – I mean, this really is scary.

Jessica:

So, kudos to you for putting this out. Are you guys updating this? I know that your initial poll, like we said, looked mostly at testing, and was looking early on in this epidemic, at what was going on, pulling claims data, and adding to it from there. But, as this continues to go, and claims do get in and get processed so hospitals can get paid and continue making money – are you going to continue to provide updates on this? What’s the plan?

Maeve:

Absolutely. We’ve seen a lot of inbound interest from local health departments and local cities around really understanding this. We covered a set of cities in the report, but certainly not all geographies. So I think that there’s the question around, “Well what about my geography? And what is there to know? And how do I think about that?”

Maeve:

Clearly the question of hospital capacity is taking a premium interest, in terms of ensuring that people have sufficient capacity to care for their populations. But there’s also a lot of, “If we can triage people effectively, can we make this more affordable to our citizens?”

Maeve:

And then I think you made a really good point around how this evolves because our report really covered three different levels of testing, which is really a function of the severity of your symptom. And so as we start to have more data on people being treated for the condition, to your point, certainly we’ll start to see variance in how people test and evaluate, which has already changed, right? People who have already had the symptoms, the CDC is updating it regularly, but then also the cost of treatment, what is required in treatment. Right now, we’re still in the early stages of observing this, but we will absolutely be making that information available as we go forward.

Jessica:

I think it’s going to be increasingly important to individuals to look at this regardless of where you get your plan, or where your plan comes from, or how you get your health insurance. It’s kind of a benchmark, proving that costing, which I think, as we’re on shutdown and different people’s economic conditions evolve, so too will there be this greater need for understanding the cost of things. So thanks for putting that together.

Maeve:

Oh, absolutely.

Jessica:

And continuing to update it.

Maeve:

You also asked an about employer response in addition to user…

Jessica:

Yeah. I’m really curious about that. They’ve got to be freaking out. I mean, I can’t imagine that they are not just really concerned about taking care of their people.

Maeve:

They are. In terms of their top priorities, absolutely, it’s taking care of their population. And that’s come out just so strongly in so many ways. It’s actually been super inspirational for us to get to partner with them. But as you think about the cost, there have been some really fascinating conversations about the implications…

Maeve:

Certainly, there’s the legislative uncertainty around the consistency of what will be covered, and as we work with large ASO employers, they are making decisions around how much more do they cover, what are additional services. And certainly, I would say that the majority of employers that we work with have moved to also cover Telehealth, and try to ensure that people are getting efficient and effective screening.

Maeve:

But, one of the things that I thought was interesting…I was part of a conversation just earlier this week, with this discussion around, how much is this? They’ve estimated how much it will cost to cover the COVID test, how much will it cost to cover the actual treatment, and what the implications are in terms of how they think about 2021 and being able to contribute to employee plans because the offsetting factor here is that there is this massive delay of elective procedures. 

The family of elective procedures certainly includes hips, knees, heart – there’s a lot in that bucket – and how those costs and services are offset is not at all clear right now. My high level view is just a lot of people are being incredibly thoughtful: their top priority is getting their employees and their family members the appropriate care, but there’s a lot of unknowns about how this is going to impact their actual total cost of care, and, therefore, has implications for 2021.

Jessica:

God, I haven’t even thought about 2021! I mean even, I’m thinking too, as you’re saying that, it’s not even just the elective procedures, but all of these shelter-in-place babies that might be born, nine months from now, my goodness.

Jessica:

I want to give a moment to talk about this testing site directory that you guys have put together because this was really impressive too. You guys really pulled a lot of comprehensive data. So, back me up and talk about what kinds of data you’ve pulled into this in order to put this directory together. Can anybody access it, or do you have to be a Castlight member to use it? Give us the scoop on this.

Maeve:

We made it publicly available a couple of days ago, but put out a press release about it today. And this was really a pretty manual effort, to be honest. When we were observing what questions people were asking to our call center and our care guides, the questions that we could see them asking in the application, it was very clear that people were seeking testing for a wide variety of reasons, including psychological safety. And so it was very clear that this was an unmet need.

Maeve:

So, we started thinking about the whole thing that Castlight was founded originally to do, which was help people find care and access care. And we really felt a responsibility to meet this need. In terms of the “how do you meet that need?” That really became, in many ways, a labor of love, in terms of really doing it pretty manually. 

Maeve:

Over a hundred people across the company came together, and we assigned state-level captains. We spoke to all of the local and state health departments, or engaged with them in some capacity, and really sourced now close to 1500 different lab sites. And to be clear, we don’t believe that this is every lab testing facility. It’s incredibly hard to actually get a truly robust set.

Maeve:

But what we wanted to do was get sufficient scale that we could make available to the public. We view this to be a responsibility and something we can do for the community. Then, we made it open source, such that people can either edit or correct information and certainly submit other places that they know of, because it really is, I mean, based on the state, it can vary from a hospital that you can go to a church basement that is only available on these hours. It is incredibly specific.

Maeve:

A couple of things I just want to mention about it, because we do have some debates internally around the supply of testing and whether this is appropriate to put out and if it is a public service. And ultimately, there’s absolutely a demand for this, but we wanted to first ensure that we were providing enough context that many people should NOT get tested. The CDC has been very clear that some people should not be tested at this time. So that was point number one.

Maeve:

Point number two was actually getting a sufficient scale that we could service our users in a positive way. And then third was actually being very specific, because the rules and requirements for testing actually vary dramatically based on the location. This is such a fluid, dynamic dataset, that we need to be able to crowdsource and actually help keep it up to date. We’ve had an incredible response today since we put out the press release because many people really feel that they need to be tested and that they have family members that need to be tested.

Jessica:

I love that you guys are opening this up and letting other people contribute information to it. I think that there are a lot of people who are doing similar things in different parts of the country, who are very deep, but not broad. I also think that it’s commendable that you guys are taking this information in and validating it then adding it to the directory so that other people can use it.

Maeve:

Definitely.

Jessica:

How are you guys doing? What’s the update from Castlight? Clearly you’re busy doing this, but I things are going okay?

Maeve:

Honestly, times like this are when you just really appreciate why you got into healthcare. Being able to play a role, even if it’s small, has been such a privilege and such an opportunity. So the company morale is honestly just, I mean it has been so inspirational. I think I shared with you. We did a hackathon a couple of days ago, had 175 people submitting ideas, so we’ve talked about a couple of the things we’re doing. But how quickly we’re able to move, how quickly we’re pushing out product, how quickly we’re able to share analytics with the broader community has been incredibly energizing. So Castlight just feels lucky that we have a role to play and are trying to do the best that we can in playing that role.

Jessica:

Awesome. Well Maeve, we will put the links to both the Testing Site Directory, and to the COVID-19 Cost Analysis, in the notes on YouTube, and also on The Health Care Blog, in the blog post, so that people can take a look at both of those resources and use them as they will.

Jessica:

I’m Jessica DaMassa with WTF Health. Thanks so much for joining us. You can find more of these interviews with leaders who are helping out with the COVID-19 response from the health technology side, up on my YouTube channel. That’s youtube.com/wtfhealth. Thanks for joining us.