Engaging Early and Often to Manage the Boomerang Effect of COVID-19

The COVID-19 pandemic continues to prompt many people to delay diagnostic testing and obtaining necessary medical care, leading to a decrease in both procedures and diagnoses. The result is the creation of unexpected utilization patterns, which the industry is only beginning to understand and attempt to reconcile.

While some patients delayed care for just a few months, others – including those with chronic conditions – have not yet returned for follow-up care and routine health screenings such as colonoscopies and mammograms. Researchers have predicted that patients will emerge with more serious health conditions, including later-stage diagnoses and more advanced stages of diseases such as cancer and certain cardiac-related conditions.

Consider these findings:

• Nearly half of Americans (47%) said they delayed or canceled health care services since the pandemic started.
• Among households with delayed care, most contain people with chronic illnesses who should be getting routine medical attention.
• Advanced cancer diagnoses are currently on the rise because many people decided not to get screening tests in 2020 that may have indicated the presence of cancer earlier.

Engaging early and often to prevent long-term health consequences and increased costs caused by delayed care has never been more critical. Guided by insights from biometrics, utilization data and paid claims analysis, self-insured employers can identify gaps in care and engage members with real-time interventions, providing navigation to the right care path before serious issues occur.

Today’s technologies deliver insights from patient data, clinical drivers and social determinants of health to identify members at risk before their condition deteriorates. Once identified, care coordination to connect them with key resources 24 hours a day is possible. This level of continuous, evidence-based engagement guides better long-term health decisions while allowing self-insured employers to target the 5-15% of claims that drive up to 70% of health plan spending.

Self-insured employers will position themselves well to offer this level of support for their members through:

• Concierge-level navigation for advocacy, education, and direction of quality care that results in positive medical experiences
• Predictive analytics combined with member-centric services during the patient journey
• Full-service care management programs that identify at-risk members and offer personalized services to improve health outcomes
• Guidance and information on what is covered by a member’s benefit plan, managing co-pays, controlling out-of-pocket expenses, and accessibility to care
• Using the power of data-driven solutions to provide the right care at the right place at the right time

But it is not just about engaging the member. Establishing a central point of contact for everyone across the care continuum, from members to care providers and payers, delivers comprehensive care with transparency.

With the right tools and information, delivered in real time, self-insured employers will find actionable information at each step in the life cycle of a claim. From high-performance network design through comprehensive and complete bill reviews, data-driven insights lead to health care costs that are fair, defensible, transparent and consistent for everyone.

Long before the current health crisis began, we have embraced the Vālenz^® core promise of delivering smarter, better, faster healthcare. Although COVID-19 has created numerous challenges, maintaining the health and well-being of our clients and employees is more important than ever. We remain committed to early health engagement and ensuring the right care paths to keep everyone strong, vigorous and healthy.

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Rob Gelb is Chief Executive Officer of Vālenz®, an ecosystem of data-driven solutions that creates new opportunities for self-insured employers to control costs while empowering members to lead strong, vigorous and healthy lives.