Emily Li

When the levee breaks on chronic conditions

January 15, 2021
By Emily Li

One of the major contributors to the federally declared disaster in New Orleans after Hurricane Katrina was the massive flooding that occurred once the levees surrounding the city could no longer hold back the water. When they broke, they unleashed raging rivers that washed over the streets and quickly placed large sections of the city several feet under water.

Now, some 15 years later, another type of flood is ready to occur. Only this time it isn’t limited to one city, or even one region, but instead is preparing to overwhelm the entire country: The flood of patients/members with chronic conditions who will be seeking care once the latest COVID-19 surge has passed.

Health plans and providers recognize that within this river of patients some have urgent needs to address significant care gaps while others are managing their conditions well. How to prioritize given limited resources during pandemic? That’s a problem, because focusing on the wrong patients/members first, (i.e., those who don’t have emergent needs and risks right now) can have a huge impact on healthcare outcomes and costs in the future.

Healthcare organizations also acknowledge that simply committing to closing care gaps isn’t enough. They need to understand the impact closing those gaps will have so they can set priorities and protect their most vulnerable populations not only from COVID-19 but from the long-term health issues their conditions can create.

This is where advanced analytics that goes beyond clinical information to incorporate social determinants of health (SDOH) factors adds tremendous value. It can help healthcare organizations sort through the pent-up demand to ensure all patients are receiving the most appropriate levels of care. They can also ensure that the organizations’ internal resources are being used to deliver the maximum benefit to all their patients/members.

Forecasting need
Step one in this process is using analytics to predict the regions, and patients/members, who will have the greatest need. By matching publicly available information on COVID-19 hot spots, which indicates where self-care on chronic conditions was likely paused, against existing data on patients/members, including underlying conditions, clinical gaps, and SDOH barriers, they can quickly prioritize their populations and generate a risk score for each. The higher the risk score, the higher that an individual should rise on care managers’ outreach lists.

Once they reconnect with patients/members, providers can use analytics to determine which interventions will have the greatest impact on reducing risk, as well as how they should be delivered. If hands-on healing isn’t required, providers might opt for a telehealth visit, supplemented by patient-generated data from consumer devices. Conversely, if laboratory tests, imaging, diabetic eye exams, or other tests are required, they will need to set up an office visit.

Shoring up elective surgeries
Predictive analytics can also be extremely valuable in helping healthcare organizations wind through the backlog of so-called “elective” surgeries. Prior to the latest COVID-19 surge it was estimated that it might take more than a year to work through the surgeries delayed by the pandemic. Given the current situation, that timeframe may be pushed out further.

Regardless of when they restart, analytics can help health plans and providers work together to determine which surgeries should be prioritized based on the long-term impact they will have on chronic conditions such as lower-back or knee pain. They can also help providers in dire need of revenue (which is nearly all these days) determine the financial impact of prioritizing some elective surgeries over others.

While health needs should always take priority, the ability to generate revenue quickly could help providers serve their populations more effectively in the long term by keeping the lights on.

Moving forward
Once health plans and providers understand needs and priorities, they can begin moving forward with their action plans, such as investing in more formal, HIPAA-compliant telehealth and remote patient monitoring technologies, deploying strategies to address SDOH barriers, increasing the number of care managers, purchasing supplies, and recalling or redeploying staff to prepare for the influx of patients.

Additionally, they should update analytics and dashboards to measure the effectiveness of each initiative to ensure it is achieving the expected ROI. This information can then be used to make the appropriate adjustments, after which they should rinse and repeat.

Build back stronger
While the immediate aftermath in New Orleans was difficult, an intelligent approach to rebuilding has safeguarded it against future category-5 hurricanes.

The same can be true for healthcare. By taking advantage of advanced analytics, health plans and providers can control the flood of patients with chronic conditions returning for care while setting themselves up for greater success in the years ahead.

About the author: Qijuan (Emily) Li leads EXL Health’s Analytics Center of Excellence (ACOE) to create analytical solutions and deliverables for Data & Analytics, Clinical Services, Pharmacy Services, and Payment Services. She specializes in applications of predictive models and behavioral economics to improve prevention and treatment programs for chronic diseases and oversees both the clinical informatics and analytics functions.