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For the better part of the last few years, terms in the healthcare space like “Medicare for All”, “preexisting conditions”, and “if you like your doctor you can keep them” have been making their rounds in the news cycle and are well documented. Recently the healthcare and care management systems have been in the news but not for the same reasons. In January 2020, a new term burst onto the scene “2019-nCov” better known as the Coronavirus. This virus originated in Wuhan China and has spread very quickly, not only within China itself but the rest of the world. The speed and severity of the virus were severe enough that the World Health Organization (WHO) declared a Public Health Emergency of International Concern (PHEIC). According to the WHO, a PHEIC is “an extraordinary event which is determined to constitute a public health risk to other States through the international spread of disease; and to potentially require a coordinated international response.”
As of February 13, 2020, in China alone, there have been 59,804 confirmed cases which have resulted in 1,367 deaths in a very short period of time. Many experts believe these might have been underreported making the situation even worse. The responses to address this virus and emergent situation have been swift and widespread. Different organizations and governments have collaborated, shared information, developed policies and procedures to provide preventative measures, as well as taking corrective actions when symptoms arise.
Although seemingly unrelated, these care management responses to this virus are not unlike the changes needed elsewhere in the current healthcare system. The need for such highly coordinated and efficient care is much more pronounced and obvious in the face of a viral outbreak such as the Coronavirus then day-to-day conditions. Fears of a condition quickly spreading in an uncontrollable manner create an emergent response, but illuminate some of the same principles needed in the healthcare system nonetheless. Case in point, health risk factors such as high cholesterol, hypertension, and diabetes take much longer to manifest but are indicators of serious future medical conditions. These three factors contribute to higher incidences of heart disease, stroke, diabetes, and kidney disease, all of which are amongst the top 10 causes of death in the United States in 2017. Void of the sense of urgency, over time these conditions work in the same way to affect more people with deadly results and in larger numbers. Some of the guidance coming from the WHO regarding managing the Coronavirus can be applied just as well to today’s common everyday system. Take for example the following excerpts of the advice from the WHO during the January 30, 2020 emergency meeting.
“Implement a comprehensive risk communication strategy to regularly inform the population on the evolution of the outbreak, the prevention and protection measures for the population, and the response measures taken for its containment”
This excerpt from the WHO is a major pillar of care management. A comprehensive approach to communicate, educate, and treat or manage conditions within a population is one of the first steps in affecting outcomes. To be effective, the care management process must have systems of outreach not only to the members with a targeted condition such as diabetes but also for those members who are at risk of acquiring it as well. As demonstrated by the WHO for the Coronavirus, the first step is outreach, educating, and monitoring. In the example of members who have or are at risk for Type 2 diabetes, providers could begin by screening for early signs of the conditions such as regularly monitoring impaired glucose tolerance (IGT) and impaired fasting glycemia (IFG).
If appropriate, intervention programs response measures could include proactively educating members on lifestyle changes to lower their IGT and IFG or begin insulin treatment to lessen the chance of further complications. This coordinated effort to identify those who are either at risk for or in the beginning stages of a medical condition could produce positive outcomes. Providers coordinating doctors’ visits, insulin administration, healthy eating habits and ongoing symptom recognition to the individual member could increase member adherence and serve to reduce medical costs.
Many studies support this conclusion, the Journal of Clinical Outcomes Management established that “Diabetes patients face challenging self-care regimens, and these challenges can interfere with glycemic control and increase the risk for diabetes complications … For this reason, patients must feel comfortable discussing their self-care challenges so that their physician can individualize treatment prescriptions and recommendations, thereby increasing the likelihood of treatment success” Two-way communication between the patient and their primary caregiver is key, and the first step of an effective care management and population health management process.
“Share relevant data on human cases”
On its surface, sharing relevant data seems to be a no brainer and must already be widespread in today’s health care system, but this isn’t always the case. Even amongst a provider’s own healthcare system, data sharing isn’t as up to speed as it should be. In an August 2019 survey, the Center for Connected Medicine/HIMSS Media found that “tech executives at U.S. hospitals and health systems find nearly a third indicate their data-sharing efforts are insufficient, even within their own organizations, and fewer than four in 10 say they are successfully sharing data with other health systems”.
On its surface, sharing relevant data seems to be a no brainer and must already be widespread in today’s health care system, but this isn’t always the case.
Effective data sharing, particularly with external health systems, has many barriers. For instance, HIPAA and patient privacy laws are strict and punitive when not adhered to. Some HIPAA monetary penalties can be as high as $50,000 a violation, and can result in mandatory training or employee termination, or depending on a judge’s ruling, come with up to 10-year jail sentence. Even unknowingly violating the regulations carries serious penalties. In April 2017, “the remote cardiac monitoring service CardioNet was fined $2.5 million for failing to fully understand the HIPAA requirements and subsequently failing to conduct a complete risk assessment”. Even the best electronic medical records fail to effectively communicate with others. Health Data Exchanges are being created to eliminate this communication problem; however, they are in the infancy stage of development.
These barriers to data sharing are well documented but the potential benefits to securely sharing data mustn’t be ignored. Data sharing between providers both in and out of a system will help in a multitude of ways. More readily available access to patient medical information will help doctors across the healthcare spectrum make more informed decisions. Things like medical history, prior conditions, and possible drug interactions either the provider or member would have otherwise failed to discuss could be automatically displayed. A report containing a joint statement of the seven leading hospital and health systems agrees that “Enhanced ability to share relevant information, including patient matching, reduces costs in time and resources for patients and insurers by avoiding duplicative services, as well as for clinical and administrative staff by devoting fewer hours to these tasks”. One interesting way data can be shared is between providers and the patients themselves. In the age of smart devices test results can be shred to an app on a cell phone or, or member-generated data such as fitness and activity levels could be shared with the provider via smart fitness or medical devices. There are more and more avenues for patients to monitor medical conditions from home. In recent years we’ve seen new products such as blood pressure cuffs, smart cell phone glucose monitors, or even apps that emit sounds into the ear canal to diagnose ear infections. All of this data can be connected and shared to the provider faster and more efficiently to give better care.
There’s nothing like attention-grabbing headlines of an impending epidemic virus to get swift and efficient healthcare kicked into high gear, and rightfully so. When something becomes important to a system, events can happen fast. For example, the Chinese response to the outbreak. Once the seriousness of the virus was clear, China built two hospitals in just over a week to help address the outbreak. Care this highly coordinated and emergent isn’t needed regularly, it would be logistically and financially unfeasible. However, there
are still lessons to be gleaned from the impact of focusing on highly efficient care for superior medical outcomes. In many ways, the healthcare system can be focused on other aspects rather than improving outcomes. Let this outbreak be a case study on taking action to improve quality care. Rather than letting conditions deteriorate into a full-blown crisis, let us focus our efforts on preventing it in the first place.
About the Author
Sean Lorentz, ASA, MAAA is a Consulting Actuary at Axene Health Partners, LLC and is based in AHP’s Temecula, CA office.