This article is second in our series examining the long-term impact of COVID-19 on health and healthcare issues for the self-insured industry.
Chronic conditions are the leading cause of death in the United States, as well as the primary driver of our $3.5 trillion annual healthcare costs. Long before COVID-19 hit, providers, payers and self-insured employers grappled with the challenge of ensuring that patients with chronic illnesses receive effective care.
Recent surveys indicate many patients have put their chronic care needs on hold during the pandemic, potentially leading to more expensive scenarios in the future. Consider these findings from a recent survey:
- Seven in 10 patients reported a negative impact on their ability to manage their high-risk conditions due to COVID-19, with one in four expressing a high impact.
- One in three patients reported a reluctance to leave their homes for treatments, with 70 percent sharing they were more worried than usual about their health at this time.
- Less than 40 percent of respondents felt prepared to manage their health during COVID-19, with more than half expressing concern they would lose access to essential care.
- More than one in 10 patients reported they were unable to receive their medication.
Even with heightened safety precautions that have made office visits and routine care widely available again, many patients have been slow to return – especially for people with long-term conditions like asthma, heart disease and diabetes, who are at significantly higher risk of severe illness from COVID-19.
As the health industry adapts to consumerism by adapting care deliver to meet the evolving needs of consumers, so too must payers and self-insured employers. Here are five solutions that take significant steps towards improving service and care for chronic disease patients during the pandemic and potentially beyond:
1: Telehealth and virtual care
Expanded telehealth access has been the key component of the rise of virtual care utilization, allowing care continuity while all parties maintain physical distancing. Combined efforts by the federal government, individual states, private insurance companies and self-funded groups have facilitated telehealth as a viable care option during the pandemic, lowering regulatory barriers that had limited its use and the reimbursement of services. According to the American Medical Association, physician telehealth adoption is now estimated at 60-90 percent.
In addition, a survey by Accenture in July 2020 reported that providers were largely able to maintain or even improve on the patient experience with virtual care technology, which also includes live video, audio and instant messaging. With 41 percent of respondents taking advantage of virtual tools – the majority of them for the first time ever – patients reported more personal interactions, faster response times, and the convenience of managing care from home. Virtual care and telehealth are proving especially useful for chronic disease patients in rural and remote areas.
2: Patient-centric care navigation
For self-insured employers, brokers and third-party administrators, care-coordination solutions like NaVcare help members navigate their health journey more effectively, delivering personalized service and guidance for high-quality care and improved outcomes. Real-time data-driven insights, combined with in-depth health plan knowledge, are critical for identifying patients with complex, chronic conditions. Providing those patients with comprehensive care management helps avoid more serious and costly health events.
Informed by data – including claim, pharmaceutical and demographic data –NaVcare tailors services to each employer and illuminates individual care needs for members. Care navigators facilitate virtual care when available for enhanced patient convenience and engagement as well.
3: Behavioral health integration
People with chronic diseases are more likely to experience depression or behavioral issues as they often face impaired mobility and loss of independence. According to the Center for Medicare Advocacy, 43.8 million U.S. adults struggle with mental illness each year, and 26 percent of those are Medicare beneficiaries – a population that is highly vulnerable to the effects of isolation, increased stress and more limited access to regular care, even before the pandemic.
Traditionally, the care delivery models to address physical and behavioral health have been independent of each other. More and more, providers and health organizations are acknowledging the significant correlations between physical and mental health, turning to integrated care solutions that treat the whole person and deliver improved outcomes with lower costs – up to 10 percent savings in the nation’s overall healthcare expenses, according to the American Psychiatric Association.
4: Prescription cost management
Following a national trend that has continued for the past decade, costs have risen for chronic disease medications and depression/anxiety drugs during the pandemic, with total prescription spend predicted to reach $610 billion in 2021. Before COVID-19, one in three Americans did not take their medications as prescribed because of high costs, but during a global pandemic, forgoing medications involves even more risks for chronic care patients and incurs even higher costs in the long run.
Cost-containment solutions for self-insured employers, brokers and third-party administrators include a range of PBM solutions and specialty medication case management services. Such solutions create long-term reductions in medication spend while passing on lower costs to members and delivering highly personalized case management services and advocacy.
5: Remote patient monitoring
Recent studies connecting COVID-19 to long-term heart and lung damage, among other serious conditions, accentuate the benefits of remote monitoring technologies for high-risk patients. As it tracks and transmits vital signs in real time, remote patient monitoring allows providers to regularly check pulmonary function, blood pressure, body temperature and other physiology for proactive management of changes in disease progression.
A joint report from AHIP, the national association of America’s Health Insurance Plans, and C-TAC, the Coalition to Transform Advanced Care, concludes that remote patient monitoring is among the most efficient and effective tools available to manage chronic disease — particularly in older patients with diabetes, heart failure, and chronic obstructive pulmonary disease.
Solutions for today and tomorrow
Patients with chronic illnesses are more vulnerable to some of COVID-19’s most significant threats. As the global health crisis continues to present new challenges in treating patients with long-term conditions, it also has opened up new opportunities. It is exciting to be part of the evolution of solutions that will serve patients well beyond the pandemic – showing us all the next level of smarter, better, faster healthcare.
Rob Gelb is Chief Executive Officer of Vālenz™, one of the nation’s leading data-driven, medical cost containment and care management organizations offering expanded solutions to support the self-insured industry.
Through a complete health administrative ecosystem, Valenz connects cost and quality data on a single-source, end-to-end analytics platform for smarter, better, faster healthcare. Valenz solutions integrate data from comprehensive care management services (Valenz Care), high-value provider networks (Valenz Access), claim flow management (Valenz Claim) and solutions for payment integrity, revenue cycle management and eligibility compliance (Valenz Assurance) into the ecosystem. More information is available at valenzhealth.com. Valenz is backed by Great Point Partners.
About Great Point Partners
Great Point Partners (“GPP”), founded in 2003 and based in Greenwich, CT, is a leading healthcare investment firm, currently with approximately $1.8 billion of equity capital under management and 28 professionals, investing in the United States, Canada and Western Europe. Learn more at www.gppfunds.com.