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Chronic illness patient surges: how can payers prepare?

According to the CDC, six in 10 adults in the U.S. have a chronic disease such as heart disease, diabetes or a chronic lung disease – and four in 10 adults have two chronic conditions or more. Even further, approximately 80% of adults aged 65 or older have at least one chronic condition, and 77% have at least two. Chronic conditions such as heart disease, cancer, stroke and diabetes – which cause almost two-thirds of all deaths each year – must be proactively monitored via regular screenings or checkups by healthcare professionals, and patients with complications should seek medical care as soon as possible.

However, the COVID-19 pandemic has had a dramatic impact on the delivery of care for patients with chronic conditions. To decrease the risk of transmission, providers have deferred elective and preventative visits – including annual physicals – and converted in-person visits to telemedicine consultations where possible. Meanwhile, many patients have been more reluctant to seek medical care and risk exposing themselves, even when under mounting pressure from their healthcare team. In fact, data shows that early in the pandemic, the number of visits to ambulatory care practices declined by nearly 60%.

This fear of exposure is not unwarranted, as patients with chronic conditions are at high risk for severe COVID-19 complications. A CarePort analysis showed that COVID-19 patients with multiple underlying conditions are at high risk for mortality. For example, a 65-year-old with an underlying health condition such as hypertension, diabetes, chronic kidney disease and/or obesity has a similar mortality rate – 16 to 19% – as the 75-year-old with no underlying health conditions.

Many payers are concerned that there will be an exponential increase in healthcare use in Q3 and Q4 as patients seek to make up for the care that they have missed or neglected for months. Several states reopened once their COVID-19 case rates subsided, and other states have completely reopened despite ongoing COVID-19 surges.

CarePort offers comprehensive solutions that can help insurers prepare for this influx of patients with chronic health conditions. CarePort solutions provide increased visibility, improved post-acute care selection and authorization, and evaluation of provider performance. With these solutions in place, payers can ensure that members receive the best possible care and don’t fall through the cracks, and they can also have a better line of sight to emerging utilization trends.

To learn about CarePort’s payer solutions, click here or contact us.

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