Industry Voices—At-home screening could save us from a mounting, multibillion-dollar problem

A male primary care doctor and his patient sit across from each other talking. Both are wearing masks
Roughly 3 million people have skipped necessary medical screening. The impact of this deferred care will be staggering, both in terms of human lives and in cost. (Getty/Geber86)

Much of the discussion around COVID-19 has followed an important and familiar formula—social distancing, flattening the curve, quarantining, developing and rolling out vaccines, and dealing with the day after.

These measures are critical, given the acute nature of the pandemic. At this stage, the general public is practically on autopilot.

But as more people are vaccinated and we start seeing the light at the end of the tunnel, the hidden toll of this pandemic will come to light. During the pandemic, diagnostic panels and cancer screenings, usually performed during annual physical exams, fell as much as 68% nationally, along with cervical exams (68%), cholesterol panels (67%) and blood sugar tests to detect diabetes (65%).

RELATED: Providers are evolving to offer home care during the COVID-19 outbreak. Here's how they're doing it

According to the Centers for Medicare & Medicaid Services, 21% of Medicare beneficiaries have forgone non-COVID-19 related care, and 32% skipped diagnostic or medical screening (e.g. tests for chronic kidney disease, cardiovascular disease, glaucoma, hepatitis C, etc.). This means roughly 3 million people have skipped necessary medical screening.

The impact of this deferred care will be staggering, both in terms of human lives and in cost. The 3 million Medicare beneficiaries who have deferred care are chronically ill people—many with comorbidities. But the care deference rates extend far beyond people on Medicare.

Those deferring care are our parents, grandparents, friends and neighbors. While our current focus is rightly on eradicating COVID-19, we could face another health crisis in its aftermath, as millions of people with chronic conditions resume care when they are sicker and more urgently need medical attention.

It's happened before. Previous pandemics, like SARS, have clearly shown that hospitalizations associated with chronic conditions, such as diabetes and hypertension, plummeted during the crisis but skyrocketed afterward. Missed primary care results in more frequent—and more expensive—hospitalizations down the line.

$1B alone for chronic kidney disease

To understand the financial cost of deferring care, we decided to take a look at the cost burden created by chronic kidney disease (CKD), a very expensive disease to treat that impacts 15 in 100 Medicare beneficiaries (many with comorbidities like diabetes and hypertension). We arrived at a staggering $1 billion in costs. 

Since 15% of Medicare beneficiaries have CKD, within that population alone, we can expect 1 million people with CKD will go undetected this year. Many of these people will go on to develop end-stage renal disease or have to go on dialysis for kidney failure. Based on an actuarial model of Optum’s medical and pharmacy claims data, the five-year total cost of care savings for detecting CKD at an earlier stage is $1,707. Overall, this results in $1 billion in potential savings from screening. The simplest way to screen for CKD is by completing an albumin-to-creatinine ratio (ACR) test—a urine test that indicates the presence of albuminuria and can provide an early indication of compromised kidney function.

So, what can we do? The first step is looking at why people are choosing to defer care. Forty-five percent of Medicare beneficiaries who deferred care did so because they didn’t want to be in a medical facility, and 35% didn’t want to leave their homes. Therein lies the solution—enabling people to test from home.

That’s why we’re partnering with the National Kidney Foundation (NKF) to offer our home ACR testing kits to people at risk for CKD, free of charge. We’re donating our testing kits to the NKF, along with a financial contribution, because we believe that bringing attention to the urgency of this problem is more important than our bottom line.

We know this alone isn’t enough. The world is depending on us—the healthcare industry—to bring creative and accessible solutions that will improve the health of our communities. This year, we have to widen our lens to make sure the health disparities gap doesn’t keep growing beyond repair.

Don’t overlook the power of early disease detection. Whether you’re a physician, digital health entrepreneur, health insurance executive, mother, father, sister, brother, friend—whomever—don’t let your loved ones lose sight of preventive healthcare because we’re in a pandemic. Where there’s a will, there’s a way.

Yonatan Adiri is the founder and CEO of Healthy.io. ​