During these unprecedented and unpredictable times, health organizations around the world are on the front lines of the battle against COVID-19. Health plans hold the responsibility to act as a beacon of hope, trust, and guidance to their members during this global health crisis. Providing members with timely and proper care is nothing new, but when humanity has been introduced to a new, highly contagious, and deadly pathogen such as COVID-19, unforeseen challenges arise.
As a partner with health plans, Decision Point is trying to do its part. At no cost to our clients, we are providing a line-of-sight into which members are at the greatest risk and which ones will likely need the most help.
I sat down with Dr. Reza Alam, Medical Director here at Decision Point, and Phil Johnson, one of our Senior Data Scientists, to discuss these various challenges and what health plans can do to help ensure members receive the care they need.
Why is it so crucial that health plans pinpoint the members within their populations that will likely be most vulnerable to the effects of COVID-19?
Dr. Alam: COVID-19 has presented a unique challenge to our health system. With health plans and providers already tasked with delivering needed care to millions of people with various ailments, the introduction of a brand-new pathogen makes it more difficult to deliver the right care to the members that need it most and in a timely fashion. More than ever, plans need to prioritize members based on their anticipated needs and manage resources accordingly. Moving through this pandemic without having a proactive plan in place will likely lead to displaced deployment of resources and eventually a decline in the quality and timing of care. Protecting the high-risk and vulnerable population against COVID-19 is now a high priority for any healthcare system. Data shows that this population is more likely to use up resources quickly and have a poorer prognosis if infected.
What’s the first step a plan can take in order to stay ahead of the curve?
Dr. Alam: The first step is for the plan to identify its most vulnerable members that are at high-risk of complications related to COVID-19. These members fall into two buckets:
- Members that already have a diminished immune system based on an underlying chronic condition or based on immunosuppressants they’re taking. We’re talking about members that have autoimmune disorders such as Lupus and Crohn’s disease or members that are undergoing treatments such as chemotherapy.
- Members who have a fairly healthy immune system but are dealing with chronic conditions that would make battling COVID-19 difficult. These are members that have conditions such as heart disease, diabetes, and asthma. Another thing to note, is that as this particular coronavirus targets the respiratory system, it’s important to take a hard look at members that have any form of respiratory chronic illness.
I’m sure these two groups will comprise a rather large segment within a plan’s population, especially a Medicare population. How can health plans dig a bit deeper to evaluate risk more proactively?
Phil Johnson: Good question. The idea here is to not only identify the specific high-risk clinical factors for COVD-19 (as Dr. Alam described earlier), but to proactively anticipate (i.e. predict) who will likely need the most help.
Our current process at Decision Point is to deploy machine learning and artificial intelligence to stratify and prioritize members that are at the greatest risk relative to COVID-19. We leverage clinical and administrative data in tandem with social and situational determinants of health to predict future avoidable events (such as hospitalizations and ED visits). We want to understand which members within the population are most likely to need the most help given the combination of clinical and non-clinical factors that impact their health. Clearly, this analysis can’t adjust for proactive measures that the member is taking (such as social distancing, hand washing, etc.), but what we’re trying to get at is which members will likely need the most help right now.
As we know, data is only as good as the action that follows. How are we advising our clients to take action on this data, and can you give an example?
Dr. Alam: Once a plan has finalized their list of vulnerable and high-risk members, they can strategically align their resources around specific actions targeted at improving outcomes. Important resources to consider leveraging during this crisis are things like telemedicine, medication delivery to the home, at home medication administration and other home-based care services. One example would be to identify and offer in home transfusion and training to those members recieving chemotherapy or biologics at transfusion centers or hospitals. By realigning these resources more effectively, targeting the right types of services to members that have been deemed the most vulnerable and high-risk can greatly reduce the impact of this pathogen to those members and to the health plan itself.
We all have been focusing greatly on physical health during this time given the effects of the virus, but it seems that mental health has taken a backseat to the conversation. Should plans anticipate the aftereffects of the pandemic to include an increase in mental health needs?
Dr. Alam: Mental health is a very important concern both during and after this crisis. Although we all need to be focused on containment and physical care in order to ensure the health of Americans, we need to consider the effects that prolonged isolation and economic downturn will have on members. With experience in predicting hospitalizations relating to self-harm, suicide attempts, and other mental health related episodes; we are currently working on an updated set of models that will help our clients identify which members will be most vulnerable to the indirect effects of this crisis as they pertain to mental health. If we can predict which members are likely to be most impacted from a mental health standpoint, plans can begin to support their members earlier minimizing overall adverse mental health and related outcomes.
Stay healthy and stay tuned for more updates regarding ways in which health plans can improve their approach to battling COVID-19 and elevate care for their members. If you have questions for us or if you would like to talk to us about implementing a similar approach at your organization, please don’t hesitate to reach out. Through teamwork, virtual connectivity, and thoughtful action, we’ll make it through these hard times with grace and emerge better than ever.