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Healthcare in a Post-COVID World: Are You Prepared?

chronic illness
Associate Vice President, Vertical Solutions Consultants

With a collective sigh of relief, we’ve moved into a new year with a COVID-19 vaccine on the horizon. We’re all ready for “normalcy,” but many plans will face new hurdles. Will you be ready to prioritize patients with chronic illness, folks who’ve blown off their routine screenings and now may have a chronic illness — or whose chronic illness has spun out of control?

An estimated 41% of people with chronic conditions like COPD, diabetes and congestive heart failure have avoided or delayed medical care, fearing exposure to the virus — including 12% who needed urgent or emergency care. Hospitals have reported a similar pattern, with a decline in overall admissions and emergency (ED) visits — including ED visits for heart attack, stroke, and hyperglycemic crises. These individuals make up the 5% of the population that accounts for 50% of annual medical expenses in a normal year.

By avoiding routine care, your members may be getting sicker and experiencing poorer overall health outcomes, which would then negatively impact your plan’s quality ratings. Even if there are concessions for 2020, these negative health outcomes could impact quality ratings for years to come, if conditions worsen too much now.

How a Decline in Chronic Illness Affects Your Plan

In a normal year, people with chronic conditions account for 50% of annual medical expenses. When these members avoid routine care, their health outcomes will decline — which negatively affects your plan’s quality ratings. Even if pandemic-related concessions are made, these negative health outcomes could impact quality ratings for years to come.

You can turn this situation around by embracing data and analytics solutions. This approach can turbocharge population health management in two ways: (1) improving individual patient outreach and engagement, and (2) predicting those patients who potentially need additional care and may require priority care as the pandemic ends.

Improving Patient Outreach

You can improve your outreach to patients via certain HEDIS and Star measures across five domains of care — including effectiveness of care and utilization. Bear with me, as this data really is a treasure trove for patient engagement.

Let’s look at a real-life example. Breast cancer screening, for example, is a service that benefits from increased outreach to patients. The HEDIS measure identifies women 50-74 years of age who’ve had at least one mammogram to screen for breast cancer in the past two years. Early detection reduces the risk of death from breast cancer and can lead to a greater range of treatment options and lower healthcare costs.

By reaching out to women in this target age group, healthcare organizations can increase the number of women who come in for mammograms — which will improve this HEDIS score. In this outreach messaging, you can explain safety protocols in place at the medical facilities and encourage patients to get regular screenings that could save their lives.

Data Can Help You Plan and Prioritize Their Needs

It’s also important to consider the social determinants of health that are affecting each member’s health. Job loss has led to financial strain, and social isolation can be a contributing factor to many diseases. Everyday activities like going to the grocery store for basic necessities or to the pharmacy to pick up medications have become risky. As members face these increased barriers, while avoiding medical care, the likelihood grows that their health will worsen.

Health plans can help mitigate the negative impacts of these new barriers by incorporating SDOH data into care management programs and quality initiatives. We can then understand why certain members are likely to be at risk for negative health outcomes, and which barriers the members face that health plans may be able to proactively address.

Now more than ever, you need insight into your member populations to help you plan for the post-pandemic world. Now is a great time for you to invest in tools to bolster your population health management programs.

The DNA of Healthcare

At LexisNexis Risk Solutions, our goal is to provide the healthcare industry with insights and innovations to improve outcomes, grow market share, reduce fraud and increase compliance.

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