By: Dr. Gary Call, Chief Medical Officer, HMS
As the country begins to get back to a sense of normalcy following the past pandemic-fueled year and a half, it is time to return to regular, routine preventative healthcare and care of chronic diseases. Understandably, many people delayed their routine care during the pandemic as they were hesitant, and often reluctant, to visit their doctor’s office in fear of contracting the virus, transportation problems and less access to providers for non-emergent care. As a result, we are just now starting to see and understand the repercussions of such care deferral.
Since 2020, there was a significant decrease in hospitalizations for several diagnoses, including heart failure, stroke and chronic obstructive pulmonary disease (COPD) to name a few. For example, a lot of individuals missed their routine cancer screenings during the pandemic, and because of this, the National Cancer Institute anticipates that the country will see an additional 10,000 deaths from breast and colorectal cancer over the next decade. Another expert predicts that a health plan covering 1,000 employees could face $300,000 more in costs this year due to the large patient populations that failed to manage these chronic diseases.
In addition to the threats posed to the wellbeing of these individuals, in a world of value-based care, deferred care is particularly problematic for health plans and providers. While costs during the pandemic were down for health plans, that bill is going to come eventually. Additionally, when patients and members experience negative health outcomes, providers and payers are impacted or penalized. Patients who ignored their health issues during the pandemic face a higher risk for future health problems and with those problems, higher cost care. To get ahead of the pandemic-driven fallout, strategic, proactive and predictive care management will play a pivotal role in effectively managing and reducing costs for this patient population moving forward.
Aiding in the Pandemic Fallout with Risk-Based Forecasting
Health plans must begin thinking about the potential impact of delayed care and screenings when forecasting for the coming year. While forecasting costs for the next year will be difficult – given 2020 was an anomaly when it comes to health events and utilization trends – health plans have the ability to forecast another important piece of the puzzle: patient risk.
Armed with more access to more patient data than ever before, payers and providers can utilize predictive analytics to forecast the risk for health problems associated with different individuals. These risk-based models can be used to analyze each patient’s conditions, as well as the health services they did or didn’t use during the past year of deferred care. These insights enable payers and providers to identify members or patients that are at a higher risk for future health problems and proactively engage them now with preventative care management services. With such large numbers of patients at higher risk it is likely that outreach capabilities will be overwhelmed. Predictive analytics offer a rational way for payers and providers to appropriately prioritize high risk patients and assure that health outcomes are maximized for their populations. Barriers to healthcare are likely to persist as the pandemic effects lessen (negative economic impacts, transportation issues, household disruptions, etc.). Data analytics platforms that can account for Social Determinants of Health (SDOH) will be especially critical to fully address the needs of at-risk populations.
By using predictive analytics to its fullest capabilities, payers can identify risk as early as the point of enrollment and continuously monitor their members moving forward. By monitoring patients and members on a monthly basis, organizations can make proactive, data-driven decisions based on risk indicators related to individual’s medical conditions, patterns in utilization, social determinants, controlled substance utilization and other factors. With the right interventions, payers and providers can mitigate the impact of the COVID-19 pandemic on patient health, as well as on their bottom lines, which is of great importance right now as the healthcare system works to recover from the financial impact of the pandemic.