Most physician practices in the United States have put their COVID-19- financial woes behind them. A recent survey notes that roughly 90 percent of practices are conducting chronic care follow-up and screening patients for depression or anxiety, while about 80 percent are performing routine cancer screenings.

Although the results of this survey point to a return to normal for the healthcare industry, the effects of the COVID-19 pandemic have contributed to potentially troubling gaps in care. According to the Centers for Disease Control and Prevention (CDC), an estimated 41 percent of adults in the U.S. either delayed or avoided medical care.

In a similar study, this one of roughly 1,000 patients with a chronic condition, 57 percent of respondents reported that they delayed receiving healthcare due to the pandemic. Women are more likely to have gone without healthcare services during the pandemic compared to men, and cervical cancer screenings declined by 94 percent in 2020. Colorectal cancer screenings were down 86 percent.

The delays in receiving care did not only apply to physical health. Among young people with major depression, 60 percent did not receive treatment during the height of the COVID-19 outbreak.

The Consequences of Delayed Care on Health Outcomes

The gaps in care resulting from these delays in scheduling of healthcare screening and services have the potential to challenge both providers and payers, especially those responsible for managing high-risk populations. These entities not only face uncertain revenue levels but underutilization of healthcare, resulting in undertreatment of chronic disease and a negative impact on long-term mental health outcomes.

Delayed or avoided medical care might increase morbidity and mortality associated with both chronic and acute health conditions and cause the need for more invasive treatment down the line. Add these obstacles to the challenges many healthcare entities faced pre-COVID-19 in implementing effective ways to address gaps in care, thereby negatively affecting quality, outcomes and reimbursements.

Payers have seen an overall reduction in claim volume, including drops in emergency department, inpatient and office visit claims across all plan types. They have an urgency to prompt patients to schedule appointments for various screenings and annual visits. Therefore, they’re working frantically with their provider and service partners to identify strategies for bringing patients back for routine care to address any complications caused by delays and deferments.

Easy-to-Implement Solutions for Healthcare Organizations to Eliminate Gaps in Care

Advantages of closing gaps in care drive essential patient loyalty, improve access to follow up care and achieve better population health outcomes. For providers, addressing these gaps impacts them financially because patient outcomes and performance are increasingly tied to financial incentives by private payers and the Centers for Medicare & Medicaid Services (CMS).

In this blog, we offer three key strategies healthcare providers and payers can utilize to close gaps in care within their patient populations. To achieve success through these strategies, healthcare entities must focus on patient preferences and engage individuals with a targeted plan in place.

Risk Stratification and Population Health Management

Employing an array of technology solutions doesn’t do much to close gaps in care if providers and payers don’t first perform risk stratification using analysis of ample real-time data. Claims data and other tools that help stratify risk can show healthcare providers which patients should be prioritized along with those who might need special attention when resuming in-office visits.

An optimal point-of-care solution effectively identifies open care gaps for proactive closure and provides payer-agnostic data to inform clinical, quality and risk adjustment programs for improvements in quality, risk adjustment scores and patient outcomes. Such a solution also can be utilized to focus on social determinants of health (SDoH) and identify health plan members with rising social risk, meaning they’re likely to need high-cost healthcare if their social needs aren’t met.

Also, population health solutions that emphasize value-based care can be beneficial for providers and payers. Specifically, outreach campaigns for population health management from health systems, hospitals and physician practices should be personalized with the goal of increasing adherence to appointments and preventive care.

Member Engagement

Member engagement has been shown to reduce overall costs. Initiatives promoting member engagement, if done correctly, help ensure members receive the care they need, thereby improving quality of care and bettering the chance for positive health outcomes.

Encouraging members to take a more active role in their healthcare also has the potential to improve member satisfaction, increase member loyalty and retention, maximize reimbursement, promote more efficient use of healthcare resources and boost Healthcare Effectiveness Data and Information Set (HEDIS) scores and CMS Star ratings.

HEDIS measures are used by 90 percent of health plans in the country for healthcare performance measurement and are vital for the overall healthcare system because they ensure that payers are collecting and analyzing data related to performance. For healthcare payers and providers in value-based care arrangements, documenting Hierarchical Condition Categories (HCC) and HEDIS quality data is crucial because a large portion of their revenue is reliant on whether or not providers meet these quality measures and document patient risk factors.

Prime examples of ways to achieve member engagement and the associated satisfaction include regular, streamlined and targeted communication, comprehensive education and quality customer service. Research has concluded that a higher level of member satisfaction is linked to digital engagement.

Another thing to consider in member engagement strategies is the theory of behavioral economics, which assumes that people are boundedly rational actors with a limited ability to process information. Don’t forget to check back next week to view our infographic explaining more about this theory and how it can be applied by healthcare providers and health plans.

Personalized Patient Outreach

After identifying at-risk populations, providers and payers should conduct patient outreach to assist in closing any gaps in care. This type of outreach was noticeably absent according to a national consumer survey conducted in May 2020. Of the survey’s respondents, only 37 percent said their health plan reached out to them with information regarding COVID-19, and even fewer (29 percent) reported that their personal physician contacted them about it.

Payers and providers should offer more value by delivering customized or personalized messages that contain patient education and health information that empowers patients to make a healthcare decision. A streamlined method for achieving this is through a HIPAA-compliant, two-way texting solution, as data suggests that patients would rather be contacted via text message or email.

AHIP Recommendations

Once these initiatives are established, we recommend developing a process to track care gaps closure. This will enable you to evaluate your combined strategies and alter your messaging if necessary.

America’s Health Insurance Plans (AHIP) published its own actionable strategies to help payers mitigate challenges caused by the pandemic:

  1. Prepare your infrastructure by expanding provider networks to increase capacity; expect and plan for payment delays from financially unstable states.
  2. Accurately identify primary healthcare insurance coverage to reduce exposure and avoid costly recoveries.
  3. Identify and capture missing risk-adjusting diagnostic codes for members by year’s end, using technology to close risk gaps and validate claims before submission.
  4. Aggressively manage risk scores by identifying members in need of documentation and proactively facilitating care visits by the end of the calendar year.

Let Providertech help your practice or health plan expand its population health outreach. We’ll help you ensure your patients and members receive necessary care through our HIPAA-compliant texting solution found in CareCommunity.