Governor Bill Lee and his team of health officials in Tennessee seem to have it right when it comes to testing residents for COVID-19. What might be making a difference is who pays the diagnostic labs for the testing.

The World Health Organization recommends a positive test ratio of 10% or less as ideal—a low positivity rate means that testing is widespread and is reaching a diverse pool of the population. Harvard’s Global Health Institute recently recalibrated its estimates for how many tests should be conducted daily in the country. Turns out, the U.S. should have conducted 900,0000 tests per day by mid-May, instead of their previous estimate of 500,000-600,000 daily tests. This recommendation stemmed from changes in modeling projections that showed the U.S. outbreak was much worse than previous projections.

Per Harvard’s revised assessments, several states, especially those with large outbreaks like New York, Massachusetts, Connecticut, and New Jersey are nowhere close to the minimum testing target. 

Tennessee, however, seems to have its grip around the target number of daily tests. How is that? While a shortage of tests limits access for testing, states have added restrictions such as:

  • individuals need to display symptoms of COVID-19 
  • individuals should be in the at-risk category to qualify for a test

Unlike other states, Tennessee has removed all restrictions on who can get tested for COVID-19, and since April, the state has been covering the cost of testing its residents. Drive-through testing sites opened up throughout the state in April for any resident to get tested—not just those with symptoms— without an appointment and with assistance from the Department of Public Health nurses and National Guard medics. Governor Lee’s call to his state’s residents was, “When in doubt, get tested.”

As in other states, private labs have been conducting most of the tests in Tennessee as well, but the difference is that the labs have received upfront payment from the state. This avoids the paperwork that the labs have to file with the insurer—be it Medicare, Medicaid, or private insurance companies—for claims, although insurance companies are mandated to cover coronavirus testing and most of them have provided assurance that they are doing so.

Frank Basile, CEO of Aegis Sciences Corp. told Kaiser Health News that the upfront payment gives his company the confidence to put in effort and capital on conducting these tests. “If the state says they’ll just pay everybody 100 bucks every time you do a test, that strikes me as very smart policy,” Ashish Jha, MD, MPH, director of Harvard’s Global Health Institute, told NPR.

Tennessee is hopeful that the federal government will reimburse the state for this massive investment in testing-for-all that runs into millions of dollars per week.

So, how does widespread testing help? It can give health officials early knowledge on asymptomatic patients, prevent an outbreak, and in turn prevent a stress downstream on the healthcare system. Also, with insurance out of the picture, those who are uninsured can also get tested, which increases the reach of testing.