COVID-19 forced providers to think about the balance between protecting patients from unnecessary exposure while ensuring they could still access needed services.
For UnitedHealth Group's OptumCare unit, that meant pivoting to providing care in the home as much as possible and scaling up programs previously targeting small groups of patients unable to see docs in person.
One such effort boosted in-home screenings for colon cancer by three times, with 100,000 tests sent to patients' homes last year under the pandemic, Daniel Frank, M.D., chief medical officer at OptumCare, told Fierce Healthcare in an interview.
Seven percent of the home tests came back positive, and then OptumCare was able to ensure those patients were scheduled for a colonoscopy or other appropriate, in-person test.
"We were really able to focus on the patients who were at risk, focus on those who had a screening test that was at risk," he said, "and then minimize the exposure to patients for an in-person procedure only to those who had an abnormal screening."
OptumCare used data analytics to flag the patients at risk for colon cancer and then reached out to them about the home test kits. While the kits included an information letter to describe the process, the clinical team also followed up four times by phone to check in with them.
If the testing results were positive or abnormal, the patient's physician or care team would reach out directly to explain what the results meant and schedule them for future appointments to ensure care was coordinated throughout the process.
Frank said OptumCare saw a 5% higher return rate under the expanded program than in previous years, and the increased engagement drove interest in expanding other home health options such as home testing for blood glucose among diabetic patients.
The program offers a number of lessons OptumCare can take to future home health endeavors outside of the pandemic scenario, Frank said. For one, the colon cancer program forced clinicians to rethink long-held beliefs about whether seniors would adapt to such tools.
"We overcame a preconception, particularly with our more senior populations, that they weren’t going to be interested in this type of care," he said. "First and foremost, I think we moved past that misconception and are starting with, always, what’s the best way to provide the care."
In addition, OptumCare found that there's still plenty of work to be done to prepare both patients and providers for virtual care. To assist patients who may lack the technology to engage in a virtual visit or screening, Optum deployed thousands of devices equipped with a cellular internet connection to enable such care.
Those devices would then be picked up when the visit was concluded or would be left with the patients if they needed more frequent check-ins, he said.
Scaling up virtual and remote options meant supporting clinicians who may not have been comfortable with the technology, Frank said.
"There are a lot of providers who are very uncomfortable with providing care this way," he said.
OptumCare is pairing its technology efforts with broader work targeting the social determinants of health, allowing it to identify patients who may have, say, transportation issues in tandem with those who lack an internet connection, Frank said.
"It's really about whatever the right thing is to do for that patient," he said.