What Happens to Quality of Care in the Age of COVID-19?

By Anne Davis
May. 19, 2020

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In our last blog post, we offered a summary of the changes that CMS has made to Medicare quality reporting and payment policies. Without a doubt, these modifications are necessary measures in the face of COVID-19. The healthcare system is struggling to keep pace with patient needs and the additional flexibility is welcome.

Providers have modified their operations in response to changing regulations, care can still be provided in office as well as through technology. Recent articles have highlighted the reality of postponing care and treatment.

For example, a newly published CDC study shows that routine vaccination of American children dropped dramatically in March and April.  In addition, adults experiencing symptoms associated with heart attacks and strokes appear to be staying away from hospitals and doctors’ offices. Physicians and public health professionals fear that deferring treatment for serious conditions will have a long-term impact on the healthcare system.

Routine Care Is Taking a Backseat During COVID-19

In most cases, appointments for preventive care, as well as monitoring of chronic conditions, have been cancelled or rescheduled for the second half of the year. This is for the safety of both the patients and the providers. These types of appointments, however, are critically important for maintaining health. Preventive care and consistent disease management could reduce the likelihood that individuals will get COVID-19 or lower the severity of symptoms if they do.

Providers and plans are taking different approaches to support the needs of individuals with non-critical needs. For example:

  • Telehealth consultations. Telehealth is a useful option during times of quarantine and sheltering in place. In fact, Medicare will now reimburse for telehealth services at the same rate as in-person office visits. Telehealth isn’t well-suited, unfortunately, for all services. Telehealth visits may be a poor match for orthopedic, cardiology, or dermatology Lab tests and other diagnostics also require in-person visits to healthcare facilities. While the Centers for Medicare and Medicaid (CMS) have supplied providers with telehealth toolkits, technology remains a barrier to implementation. Many medical offices and rural communities may not have the infrastructure or Internet connectivity needed to support widespread telehealth services for patients.
  • Healthcare can be brought into the home with the audio/visual component of telehealth as well. Plans are utilizing the visual component for medication reconciliation and other environment-related barriers that may be captured through this medium. ChenMed, which operates Medicare Advantage plans, is asking clinical staff make home visits to administer tests to patients. ChenMed also has drivers who are dropping off groceries and medical supplies to high-risk members who should not go outside their homes during the pandemic.
  • Educational Outreach Campaigns. To help their members stay ahead of the evolving public health crisis, some health plans have initiated COVID-19 communications and rapid messaging programs to support their members throughout the different phases of the pandemic. However, there is definitely room for improvement when it comes to customer engagement. In fact, the recent D. Power 2020 U.S. Commercial Member Health Plan StudySM highlighted a perceived gap in health plan communications to their members. Sixty percent of privately insured U.S. health plan members reporting that they were not contacted by their health plan with guidance or information related to COVID-19, and nearly half (48%) say their health plan has not shown concern for their health since the pandemic began.
  • Prioritizing Preventive “Well” Visits for Vulnerable Populations. Provider offices have changed their operations to ensure that essential preventive care visits (well-baby, well-child, prenatal, postpartum, etc.) still happen. As communities begin to reopen, providers will need to prioritize addressing open care gaps for vulnerable populations and the most acute patients first.

Quality Care Still “Counts”

CMS and the National Committee for Quality Assurance (NCQA) intend to collect data next year for measurement year 2020. We still need to work to close gaps in care. In order to close care gaps related to both preventive care and management of chronic conditions, health plans must identify which vulnerable populations they need to reach, determine how best to reach them, and develop messaging that has been proven to successfully change behavior. An individual’s unique clinical, non-clinical and social determinants of health should be reflected in the communications they receive. For example, consider the following cohorts when developing and deploying COVID-19 communications:

  • Low Income Households: According to a recent brief by the Kaiser Family Foundation, more than one in three non-elderly adults with household incomes below $15,000 are at higher risk of serious illness if infected with the coronavirus, compared to one in seven adults with household incomes greater than $50,000.
  • People with Type 2 Diabetes: Research has found that individuals with type 2 diabetes are at higher risk for worse COVID-19 outcomes. However, better glycemic control is also associated with significant reductions in adverse outcomes and death.
  • Individuals with Cardiovascular Conditions. Pre-existing heart conditions can put people at higher risk of negative outcomes from COVID-19. A JAMA study published in March found that close to one in five hospitalized COVID-19 patients in China had heart damage and that heart damage significantly increased risk of death.
  • New Mothers. Behavioral health is a growing concern as COVID-19 induced isolation continues. Experts are finding that sheltering in place is leading to higher levels of postpartum depression and anxiety among new mothers.

What Can We Do to Maintain Positive Health Outcomes for Everyone?

Just as it will take the community as a whole to combat COVID-19, we all must join together to ensure that all people receive high-quality care for acute conditions, as well as preventive care and chronic disease management.

Healthcare delivery beyond the four walls of the provider office is our new reality. We must advocate for extended broadband access throughout the United States. Inroads have been made in the area of virtual schooling. It’s possible that similar collaborative efforts could be launched to improve access to virtual healthcare services. Broadband advocates have long been championing for expanded broadband access in underserved areas. Amid the COVID-19 crisis, there are a number of initiatives currently underway to accelerate this expansion and keep vulnerable populations connected.

Proactive messaging to vulnerable people is essential. This requires technology solutions that can segment populations, automatically send messages rapidly, and provide practical and actionable advice. Implementing a technology platform can streamline communication to patients and members during the current pandemic, as well as during future times of need.

Empowering and encouraging people to take prevention into their own hands can also be effective. Eating nutritious food and engaging in physical movement can positively affect a person’s overall wellness and long-term health. By delivering this type of information to patients’ and members’ smartphones and mobile devices, healthcare systems and plans can reinforce the idea that prevention really is in the palm of their hands.

As we navigate through the COVID-19 pandemic, circumstances can feel overwhelming. This journey is more likely to be a marathon than a sprint. With that in mind, we must not lose sight of the bigger picture for patients and members. Addressing the high-priority needs of individuals with COVID-19 is critical, but we must also remember the importance of preventive care and chronic disease management to long-term health.

Until next time, be safe and be well.

 


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