Combatting the Costs of COVID-19-Related Care Deferral

May 13, 2021

As the United States begins to emerge from the COVID-19 pandemic, many are breathing a sigh of relief. A return to more normal living also means a return to regular preventive healthcare and a greater willingness to address urgent care issues.

During the pandemic, people were often reluctant to visit the emergency room or their doctors’ offices, for fear of contracting COVID-19. Healthcare practitioners are now beginning to see the fallout from months of deferred care. People who ignored heart pain, for example, face a higher risk of health problems in the months and years ahead. Many individuals also missed their routine cancer screenings. As a result, the director of the National Cancer Institute believes that over the next ten years, the country will see an additional 10,000 deaths from breast and colorectal cancer.

The stress of the pandemic has also manifested itself in physical and emotional ways. A recent survey conducted by the American Dental Association found that over 70% of member dentists have seen increased numbers of patients who have been grinding or clenching their teeth. In addition, mover than 60% have seen patients with chipped and cracked teeth caused by stress-related conditions. Adults and children alike are suffering from mental health issues due to pandemic-related stress.

Risk-Based Forecasting Can Help Health Plans Deal With Pandemic Fallout

The lull in healthcare expenses that many health plans saw during the pandemic is expected to be short-lived. One expert predicted that a health plan covering 1,000 employees could face $300,000 more in costs this year due to patients who failed to manage their chronic diseases. This is just the tip of the iceberg. Additional costs will also come from missed cancer screenings, healthcare symptoms that went ignored and more.

In a world of value-based care, deferred care is particularly problematic for health plans and providers. When patients and members experience negative health outcomes, value-based care providers and payers are penalized.

The good news is that payers and providers have access to more data than ever about members and patients. They can use this information to predict the risk associated with different individuals. Risk-based models analyze each person’s utilization and health-care conditions, as well as the healthcare services that they used (or didn’t use) during the pandemic. Health plans and health systems can identify members or patients who are at a high risk for health problems in the coming year and engage them with care management services, as appropriate.

HMS has developed a comprehensive suite of integrated population health management solutions to help healthcare organizations with these initiatives. Elli stratifies individuals based on advanced predictive analytics, identifying who is in a healthy category and who needs attention. Patients with a medium-risk for healthcare issues can be engaged with Eliza, while those at the highest risk can be passed directly to Essette for care management.

With the right interventions, payers and providers can mitigate the impact of the COVID-19 on patient health, as well as on their bottom lines. To learn more about how HMS can help, feel free to contact us.

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