How the Healthcare Industry Can Close Gaps in Care Caused by COVID-19

May 17, 2021 - According to the Centers for Disease Control and Prevention (CDC), an estimated 41 percent of adults in the United States either delayed or avoided medical care, with nearly one-third forgoing routine care (32%). The government agency went on to further state that avoidance of urgent and emergency cases was more prevalent among those with underlying medical conditions and Black and Hispanic adults. And deferred care comes at a cost, with the CDC noting that delayed or avoided care likely increased morbidity and mortality associated with both chronic and acute health conditions.

As a result, the pandemic has contributed to numerous gaps in care, which should prove a challenge to payers and providers responsible for high-risk and rising-risk populations. With the nation approaching a return to normalcy, health plans are working feverishly with their provider and service partners to identify strategies for bringing individuals back for routine care to address the complications caused by delays and deferments.

"Whether it's a health plan, provider, or company offering the services to both, there's no time to waste when engaging members or patients," says Vice President of Health Plan Strategy at Wellframe Susan Beaton.

"Many individuals clearly thought they could or should continue to put off provider visits and screenings," she continues. "The healthcare providers and health plans responsible for them both have an urgent need to ensure those individuals come in for care.  Many are relying heavily on partners to help understand where the gaps are and what efforts providers and plans will need to take to mitigate and close those gaps."

Telehealth proved to be essential to improving access during the pandemic, with more than 30 percent of all visits in 2020 conducted via this modality. But telehealth is no replacement for in-person care, screenings, and other procedures necessary for managing chronic disease and reducing health risks.

"Most companies, employer groups, and health plans have relied on telemedicine during the pandemic to help maintain that physician-patient relationship," Beaton maintains. "However, it didn't fill the gaps that we're now seeing, such as identifying folks who potentially could have a new diagnosis that went undiagnosed via telehealth as well as screenings and procedures."

The time is now for health plans and providers to work as partners to leverage digital engagement to connect with individuals and communities effectively to welcome the patients back in person.

"It must be thought of as a partnership because health plans are holding providers accountable to those same gaps in care, and providers want to get those patients in to fill those gaps. The challenge becomes using the data and engagement tools they both have to reach out to and ensure these folks that it is safe to come back," Beaton adds.

Even the vaccination process can provide an opportunity for engagement that leads to closing care gaps. A patient visiting a doctor or pharmacist for the COVID-19 vaccine can lead to a scheduled in-person appointment or a telehealth visit followed by a visit in person at a later time.

Where health plans can provide an obvious benefit is around data, and not just the data they do have.

"Health plans have data about who hasn't been in from the year before for routine services. They don't have any claims for those members being submitted, and they potentially know who was at risk before," says Beaton.

Health plans can also work with pharmacies to identify medications prescribed for a new condition that lacks a diagnosis on a claim. "That then leads to more outreach to engage those members and help them set up an appointment," Beaton notes.

Another avenue for closing care gaps comes by way of health plan call centers.

"During the pandemic, the volume of phone calls about health coverage and benefits surged," Beaton acknowledges. "That was a huge opportunity to work with customer service reps that are asked or answering those benefit questions to triage to those care management folks at the health plan. Nurses have the best reputation. They are one of the most trusted professions, but some people may not know their health plans have those case managers available to them."

Leveraging nurses and case managers can engender trust with members that leads to follow-up action. "That trusted relationship helps members get back to their physicians for that in-person care," Beaton states. Or the provider can assess the need for in-home care for those at greatest risk.

While a focus on in-person is necessary to address changing health risks during the pandemic, it will likely benefit from being complemented by technology.

"Technology has done a lot for us this last year," Beaton reveals. "And I hope that continues with building the relationships that people have with their providers and health plans, even if they go back to in-person care. Today, the focus must be on engaging individuals long-term, and extending the longevity of that relationship beyond simply the phone."

The coming year will be crucial to improving the health and wellness of individuals and populations the pandemic forced into isolation. If payers and providers work together and alongside other service providers, they can be instrumental in restoring what was lost in the past year.

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Wellframe partners with health plans nationwide to reimagine member relationships. With solutions for care management and advocacy, the Wellframe Digital Health Management platform empowers health plans to become a trusted advocate for all their members' health needs. Learn more at wellframe.com.

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