Industry Voices—Why health plans are well positioned to aid patients with chronic conditions amid COVID-19

The COVID-19 pandemic has brought into focus the complex nature of chronic disease management, and more broadly, the need to adopt a healthcare model that better supports this population.

Currently, chronic disease affects approximately 133 million Americans, and 40% of adults have two or more conditions. COVID-19 has only exacerbated the chronic disease crisis, disproportionately impacting those with underlying conditions in both hospitalization and death rates. For those in public health, this has made one thing abundantly clear: people with chronic conditions need additional avenues of support.

One of the most pressing concerns stemming from the pandemic is the inability for many people with chronic conditions to consistently reach their doctors.

One in four patients with a chronic condition has had trouble accessing their physician during COVID-19. A variety of reasons can account for this: specialists have been thrust into primary care roles and are inundated with COVID-19 questions from their patients; many physicians are only permitted to see patients under emergency-related circumstances; and fear of exposure to the virus is preventing some patients from actively seeking out care.

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These compounding factors have underscored an overarching theme—consistent care for patients with chronic conditions has been severely disrupted during the pandemic.

What many patients with chronic conditions may not realize is the role health plans can play in filling gaps in support between doctor’s visits. Under the current circumstances, these patients can lean on health plan-provided care management teams who are well-positioned to provide long-term support during the ongoing crisis and beyond.

Why health plans can help

In general, there are several reasons why care management systems primarily reside with health plans over other healthcare organizations, such as providers. Critically, health plans have the financial motivation, data, and service infrastructure to be able to deploy technologies that provide unique insights into the needs and behavior of the patient to enable early interventions.

Despite this advantageous avenue of support, one important finding Wellframe unveiled in the company’s recent survey is the fact that nearly one in three patients with chronic conditions were not familiar with the term care management. However, when briefed with an explanation, 79% of those chronic patients who have had trouble accessing a doctor during the pandemic thought that increased access to virtual support from care managers would be helpful in the treatment of their condition. In short, care management is a solution with low awareness but high appeal among those with chronic conditions.

When it comes to providing holistic support, health plans have another unique advantage: a clear window into the patient journey. Health plans typically have access to a patient’s network of treatments, claims, payments, benefits, and providers—information that creates the full picture for a patient. Importantly, this can also include social determinants of health and mental health care—two areas that have been amplified by the current public health crisis. 

Mental health needs and social barriers are often difficult for providers to uncover, given limited appointment time. In fact, a 2018 survey of primary care physicians demonstrated that while doctors want to provide high-quality care, 85% admitted that they do not have enough time to address all of their patients’ clinical concerns and 66% said they can’t address behavioral and social concerns—and these were pre-pandemic percentages. Fortunately, care managers can offer a broad range of clinical programs in a single solution that streamlines resources for mental health care and assists with challenges associated with social determinants of health, including unemployment, childcare, and social isolation.

Adherence to a prescribed health regimen or therapy is critical for all patients, but particularly those living with chronic conditions. Despite the importance of these care plans, the World Health Organization (WHO) has reported that as many as 40% of patients with chronic conditions do not adhere to their treatment regimen. Adding to these difficulties, Wellframe’s research found that over half of respondents have not even received a healthcare regimen for their chronic conditions. Additionally, more than one-third of patients are not fully confident in managing their conditions.

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Whether a patient has a complex treatment plan or no plan at all, health plans can leverage integrated care teams to provide guidance on how best to approach each treatment path. For example, health plans can support multimorbid patients with polypharmacy by boiling down their treatment plans into easy, comprehensible checklists, and proactively remind them to consume their medication. Ultimately, this level of support leads to improved adherence and reduced medical interventions. 

Looking forward

As access and utilization shifts due to the COVID-19 pandemic, health plans, now more than ever, are well-positioned to help patients manage chronic conditions by deploying technologies that provide more frequent and personalized support at home. However, with the number of patients with chronic conditions rising to an estimated 164 million by 2025, in conjunction with the fact that 80% of health outcomes are determined by nonclinical factors, healthcare will need to move towards a more holistic and proactive approach under the value-based care model.

This approach will ultimately require that we drive toward highly collaborative models of support between health plans and providers.

While there has been progress toward this model, as evidenced by the growing number of accountable care organizations (ACOs), continued partnerships between providers and plans will allow providers to leverage plan-provided care management systems and integrated solutions to yield better outcomes for their patients.

As many of the key players across the healthcare continuum evolve their role and approach to care, health plans are in an ideal position today to further empower and support members with tailored, intuitive and accessible health support and guidance.

Jacob Sattelmair is the co-founder, president and CEO of Wellframe.