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Managing Chronic Disease: 3 Steps Payers Are Taking

Due to the COVID-19 pandemic, routine cancer screenings in the United States fell by 86-94 percent. And the US isn’t alone. Bloomberg reports that survival rates could fall 5-10 percent due to screenings, hospital referrals, and treatment for cancer decreasing across the world.

Additionally, 36 percent of surveyed patients with chronic illness reported disruptions in care with seven percent struggling to obtain prescription medications. How can payers and providers ensure that chronic disease, including cancer, doesn’t suffer from pandemic delays? Here are three ways payers are taking charge.

1. In-Home Screening Kits

An ounce of prevention is worth a pound of cure. Payers like Humana and Blue Cross Blue Shield are stepping up preventative care by finding innovative ways to provide access without putting members at risk for coronavirus.

In May, Blue Cross Blue Shield of Minnesota announced that it was expanding access to in-home wellness care and home test kits for preventative screenings. These kits included diabetic A1C and microalbumin tests and screening kits for colorectal cancer.

Similarly, Humana announced that it will mail more than 1 million in-home preventative care screening kits during the remainder of the year. Dr. William Shrank, Chief Medical Officer stated: 

“Because of the pandemic, many of our members—who are primarily seniors—have not been comfortable leaving their homes for routine health care. Now more than ever, proactive, preventive care can be lifesaving and life-changing for our members.”

2. Improving Quality Measures

A study by CitiusTech found that 74 percent of NCQA HEDIS quality measures may be negatively impacted by COVID-19. The report specifically noted concerns for those with chronic conditions, such as diabetes or cardiovascular disease, due to fewer new prescriptions, treatments, and doctor’s visits.

The report suggested five strategies payers can use to strengthen quality measures:

  • Narrow provider network integration
  • Work to ensure correct coding and record of virtual healthcare
  • Leverage FHIR interoperability to share gaps in care alerts
  • Enable data science for outreach optimization
  • Engage NLP analytics for margin optimization

3. Leveraging Technology

A CVS Health study found that 48 percent of respondents said they would be more likely to communicate with healthcare providers if they could do so via digital messaging, telehealth, and virtual office visits.

With telehealth, members get the care they need to manage chronic diseases without unnecessary exposure to COVID-19. Telehealth visits are being widely accepted as well. For example, Blue Cross Blue Shield of Massachusetts reported 1 million telehealth claims in just nine weeks.

Beyond telehealth, there are ways to leverage the power of technology. Level2, part of UnitedHealth Group research and development, set out to address remote monitoring for one of the costliest chronic diseases—diabetes. Using a continuous glucose monitor to gather hundreds of readings every day and compile them into an individual health record. The continuous nature of the monitor means that it’s passive for the member while being proactive for payers. It also means that payers can safely monitor member’s health remotely.

For CareOregon, technology has meant better care coordination and decreased utilization. CareOregon started using a care collaboration platform to better provide transitional care for dual-eligibility members transitioning from hospital to skilled nursing facilities or home.

With automated reports, case managers can easily track member movement and provide additional outreach and support–leading to reduced 30-day hospital readmissions. Fewer readmissions means less cost for payers, saved resources for hospitals fighting the pandemic, and better quality care for members.

Brittany Eastman
Content Marketing Specialist