By Victor Collymore, MD
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, hopefully in the not-too-distant future, when the immediate danger has passed. At that point it’s very likely that, just like with an actual earthquake, the healthcare system will begin to feel the significant aftershocks of COVID-19 in the form of neglected chronic condition management during 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 co-morbid chronic conditions such as diabetes, chronic heart failure (CHF) and chronic obstructive pulmonary disease (COPD). As a result, the fear of acquiring this life-threatening virus may cause patients with those chronic conditions to neglect or avoid regular care for their other conditions including ongoing need for preventive care.
For example, people with diabetes may forego diabetic eye and foot exams either because they fear acquiring COVID-19 at the doctor’s office, or because their full health attention is focused on the virus. 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 just trying to recover.
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.
However, it doesn’t have to stop there. 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, which are at moderate risk, and which have low risk.
Here’s an example. Suppose a provider has two patients with COPD and hypertension – two of the high-risk factors for COVID-19. One 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, and where there is easy access to healthy foods and a nearby pharmacy that delivers. The other lives in the part of town where housing is primarily made up of small apartments, most residents take public transportation to minimum wage jobs or are already receiving public assistance, the nearest grocery store is six miles away, fast food is abundant, and the nearest pharmacy is a bus ride (or two) away.
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 newly unemployed with receiving government financial support), thus removing some very difficult barriers to remaining healthy through 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.
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.