Right now, the world’s attention is focused on COVID-19. This is most appropriate as it has hit the world like a global earthquake, disrupting lives on an unprecedented scale.
However, there will come a day when the immediate danger has passed. At that point, it’s very likely that the healthcare system will begin to feel the significant aftershocks of COVID-19 in the form of neglected chronic condition management throughout the pandemic.
The Centers for Disease Control and Prevention (CDC) has confirmed that the people who are at the greatest risk of severe illness from COVID-19 are the elderly and those with multiple comorbid chronic conditions such as diabetes, chronic heart failure (CHF) and chronic obstructive pulmonary disease (COPD). As a result, the fear of contracting this life-threatening virus may cause patients with chronic conditions to neglect or avoid regular care for their other conditions, including the ongoing need for preventive care.
For example, people with diabetes may forego diabetic eye and foot exams because they fear catching COVID-19 at the doctor’s office, or because their full health attention is focused on the virus. The economic effects of stay-at-home orders and lockdown of many businesses may cause patients with CHF or COPD to reduce their medication dosages to stretch their supply or stop completely if they must choose between purchasing medications or having enough food to eat.
Regardless of the cause, if their conditions deteriorate over the coming months, the increase in patients with serious complications could put further pressure on an already strained healthcare system trying to recover from COVID-19. It would also be a huge setback for the transition to value-based care as the healthy habits and care practices providers were attempting to instill in patients will be quickly forgotten.
While there is little that can be done to stop the aftershocks of an actual earthquake, the same is not true for those generated by COVID-19. At the most basic level, one of the most important steps both health plans and providers can take is to use predictive analytics to monitor utilization of services for chronic conditions so they can uncover care gaps and remediate them before conditions become catastrophic. Predictive analytics can also be used to target the most vulnerable populations in need of telehealth visits to manage chronic conditions, while also providing prescriptive insights on how best to do outreach and what resources to use for effective engagement. Additionally, analytics can provide visibility into medication data to ensure they are being taken as prescribed.
By incorporating demographic, socioeconomic and social determinants of health (SDOH) data into the analytics, health plans and providers can gain a far more detailed picture of their populations and determine which patients are at the greatest risk of having their chronic conditions deteriorate over the next few months, who are at moderate risk, and those that have low risk. Understanding these layers of risk will help health plans and providers focus their care management efforts, which are likely more limited than usual, due to the work required to battle COVID-19 in the most effective manner.
Here’s an example. Suppose a provider has two patients with COPD and hypertension – two of the high-risk factors for COVID-19. The first patient lives in a fairly affluent part of town whose residents have white-collar jobs, overwhelmingly live in single-family homes, and own late-model vehicles, where there is easy access to healthy foods and a nearby pharmacy that delivers medicine. The second patient lives in another part of town where housing is primarily made up of small apartments, most residents take public transportation to minimum wage jobs or are receiving public assistance, with the nearest grocery store six miles away. Fast food is abundant and the nearest pharmacy is a bus ride (or two) away with no delivery services.
Analytics that only look at high-risk health conditions would classify both as having the same issues. When the additional data is factored in, it becomes clear that the second patient is at far greater risk of becoming part of the post-COVID-19 aftershock. While it is important to uncover and close care gaps for both, it is likely that it will take far greater time and financial investment to keep the second patient compliant with his/her plan of care.
By performing these analytics across their entire patient populations, health plans and providers can concentrate their resources where they are most needed. They can also explore working with community-based organizations to help address SDOH issues (such as arranging healthy food deliveries or assisting the unemployed with receiving government financial support), thus removing some very difficult barriers to remain healthy throughout the pandemic.
This is not a short-term proposition. COVID-19 itself could continue to disrupt life as we once knew it for many months to come. The longer it lingers, the longer and more severely we will feel the aftershocks as well.
Nevertheless, with comprehensive data and the right analytics, health plans and providers can minimize the damage of the aftershocks, drive healthier outcomes, and reduce costs for all at a time they will need it most.
About Victor A. Collymore, MD, FACP
Victor A. Collymore, MD, FACP is the Vice President and Chief Medical Officer at EXL Service, a multi-national company, where he oversees utilization management, coordinates disease and care management, and liaisons with pharmacy, sales and marketing, data and predictive modeling departments, and life sciences.
His professional business experience includes being the Chief Medical Officer of Community Health Plan of Washington for more than four years, Medical Director at Evercare/United Health Group, Chief Executive Officer of Providence Physician Group, Vice President of the PeaceHealth Medical Group, Medical Director of Care Coordination at Group Health Cooperative, Associate Medical Director and Hospitalist Chief at Kaiser Permanente in Colorado, Assistant Chief/Program Director of the Internal Medicine Residency at Kaiser Permanente in Los Angeles, and Associate Clinical Professor of Medicine at UCLA.