Guest Column | October 5, 2020

Addressing America's Looming Healthcare Gap Crisis During COVID-19

By Suzanne Cogan, Chief Commercial Officer, SPH Analytics


While putting off care during the initial onset of the coronavirus made sense, continuing to do so will affect long-term outcomes. Here’s how providers can get patients back on track.

Chronic and preventive care has taken a hit amid the COVID-19 outbreak, with at least one report suggesting primary care visits are down as much as 60 percent.

While temporarily putting off preventive and elective care may have been necessary in the initial months of COVID-19, this trend carries long-term risks: If patients don’t receive non-emergent care, health outcomes will decline. And for many patients — like the 40-year-old woman who forgoes a breast cancer screening, or the senior who avoids a flu shot — the consequences could be dire.

While helping patients navigate healthcare during this uncertain time is critical, some patients say doctors and health plans aren’t doing enough. According to results of an SPH Analytics national consumer survey conducted in May, only 37 percent said their health plan reached out to them with information regarding COVID-19, and even fewer said their personal doctor reached out (29 percent). Moreover, only 50 percent of consumers were aware that their health plan offers telehealth services, which are an essential aspect of preventive care and chronic care management during the current pandemic.

As the industry heads into the fourth quarter of 2020, stakeholders will need to do more to close care gaps and ensure patients are getting the level of care they need to prevent disease and keep chronic conditions from flaring up.

Why Gaps Matter

According to one study, some 60 percent of American adults now live with at least one chronic condition, such as coronary heart disease, diabetes, or hypertension, while 42 percent have more than one, accounting for billions of dollars in healthcare spending every year. Unsurprisingly, the correlation between chronic illnesses and COVID-19 complications is strong. As the Centers for Disease Control and Prevention (CDC) noted in June, adults with one or more chronic conditions were considered to be at risk for hospitalization for COVID-19 because of an underlying condition.

And in the South, where the rate of new COVID cases is surging, the percentage of Americans with one or more chronic diseases is also higher than average. In 2019, Alabama, Arkansas, Louisiana, and Mississippi, ranked in the bottom five “healthiest” states, according to United Health’s annual “America’s Health Rankings” report, which accounted for risk factors such as the prevalence of obesity, tobacco use, and chronic disease.

Given these data, there are fears that the upcoming flu season, intermingled with COVID, could be a viral disaster of epic proportions if high-risk patients avoid essential care such as immunizations, cancer screening, cholesterol screening, and other preventative care measures. Consequently, the importance of swift action, as flu season approaches, cannot be underestimated.

There are also financial reasons why addressing care gaps cannot wait: Patient outcomes and performance are increasingly tied to financial incentives by private payers and CMS.

In May, for example, the CMS passed its Contract Year 2021 Medicare Advantage and Part D Final Rule, which doubled the weight of patient experience measures used to calculate Star Ratings for health plans. If patients’ ongoing care needs aren’t addressed, and the patient experience suffers, a payer could take both a financial and reputational hit.

Minimizing Gaps

While we’re still learning more about COVID-19 transmission and treatment, there is a lot providers can do now to be better off in the coming months. These four strategies can help payers and providers close care gaps, while simultaneously aligning with ongoing quality improvement initiatives.

1. Identify highest-risk individuals. Claims data and other tools that help stratify risk can show healthcare providers which patients should be prioritized, such as seniors over age 60 with chronic conditions like COPD, who are at high risk for COVID-19 complications. These patients should be the primary focus for messaging and outreach and may need special attention when resuming face-to-face visits.

2. Tailor Messaging. Most health plans believe they’re doing their best to connect with patients who are concerned about COVID or have ongoing health issues. But when it comes to reaching patients, efforts sometimes fall flat. To ensure messages reach their target demographic, providers will need to consider that demographic’s preferences when mapping out communications strategies (e.g., flu shot reminders). For example, Pew Research reported in 2017 that 59 percent of 65- to 69-year-olds owned smartphones, but just 49 percent of 70- to 74-year-olds did. This could mean text-based reminders are less likely to be received among those in the oldest age brackets. And for the highest risk patients or those who are less engaged in their healthcare (as measured using a healthcare engageability index), a higher-touch approach may be necessary, such as a proactive phone call to the patient to schedule an appointment while on the call.

3. Tout telehealth. Researchers predict virtual care visits will soar to more than 1 billion this year. But among those aware that their health plan offers telehealth, only 57 percent said they understand the cost to use it, and 69 percent said they feel adequately informed about telehealth, according to SPH’s consumer survey. Remind patients of their covered benefits and encourage them to use telehealth not only for vetting symptoms like fever or cough but for ongoing healthcare management needs (e.g., behavioral health counseling, smoking cessation support).

4. Follow up. As the situation with COVID remains fluid in some parts of the country, healthcare providers need to amplify their efforts to check in with patients. Patient surveys can help gauge the effectiveness of outreach and engagement tactics, quality of care rendered, and patient satisfaction. They also can help payers and providers see what isn’t working, so they can adjust.

As we head into flu season with COVID top of mind, staying healthy and preventing exacerbation of illnesses is more important than it ever was. Providers that double their effort to close care gaps now will have an easier time managing population health in the final quarter of 2020 and beyond.