Tuesday, May 26, 2020

7 Ways COVID-19 Will Transform Healthcare for the Better

From the corona crisis emerges key opportunities that health plans must not ignore.

By: Bill Phillips, Chief Content Officer

How’s this for an indefensible position: The 1918 Spanish flu was good for public health.

Yes, the pandemic hit a weak and weary global population just as World War I was ending, killing 50 million people worldwide. But it also changed healthcare forever—for the better.

The modern era of epidemiology was born, for example, as researchers raced to understand how infectious disease spreads person to person.

Governments took steps to make healthcare more available and affordable. Many European countries embraced universal healthcare, while the United States incentivized employers to provide coverage.

States began participating in a federal disease-reporting system that helped identify future outbreaks before they began to spread.

Finally, and perhaps most importantly, individuals began to understand that illness isn’t always bum luck—they have the power to keep themselves healthy. They embraced the medical advances that came fast and furious in the 1920s: vaccines for tetanus, tuberculosis, pertussis, and diphtheria; the first use of insulin to treat diabetes; the invention of penicillin.

Now, more than a century later, humanity is at a similar inflection point. Our healthcare infrastructure is being tested and it’s likely to look very different on the other side of COVID-19. How so? At Linkwell Health, the leading content marketing company for health organizations, we believe healthcare in America will fundamentally change in the following seven ways.

Change #1: Real-Time Digital Communication Is Now Essential for Health Plans

As cases of novel coronavirus began to spread in the United States in February, so did misinformation about the disease. Members turned to health plans for answers. Why? They trust them.

In fact, according to the Edelman Trust Barometer, a 10-country survey of 10,000 people, healthcare companies are the fourth-most trusted source of COVID-19 information, behind medical experts, employer communication, and government websites and ahead of traditional and social media.

This is significant. As much as Americans love to complain about health insurance, they consider their plans to be sources of credible and helpful information. In the early days of the COVID-19 crisis, it quickly became clear that members wanted and needed a direct line of communication with their health plans.

Independence Blue Cross, based in Philadelphia, is a great example of a health plan that answered the call. On March 11, it published “COVID-19 (Coronavirus): Fact vs Fiction” on its getgoodliving.com health and wellness site. The story, along with Independence’s outreach to members, drove record traffic to the site that month.

The Edelman survey also hints at opportunities for employers, who are now facing the unprecedented task of safely transitioning their employees back to their workplaces while, at the same time, dealing with fewer resources and challenging economic times.

To cut through this uncertainty, clear, consistent, and regular communications will be essential. Bonus: Employees are asking for it. In fact, 63 percent of Edelman survey respondents say they expect employer communications about the crisis at least once a day.

Lesson: Post-COVID, members will be more engaged with the details of their health plans and more aware of their health and needs. The quickest, most effective, and least expensive way to distribute information to members is through digital channels. While it’s true that some older health plan members may not have access to email or social media, seniors are increasingly embracing technology. In fact, the 65-plus audience is the fastest-growing demographic on Facebook.

Change #2: Telehealth Is Here to Stay—And Will Grow Rapidly

“We are starting to see a new world of accessible, collaborative, and connected care that we may not otherwise have reached for years.”

So said Daniel Knecht, M.D., vice president of strategy and innovation at CVS Health, in April. One of the most exciting innovations, says Dr. Knecht, is the swift adoption of telehealth—especially among older adults. The research group Forrester says telehealth visits could reach 1 billion in 2020, up from about 50 million in 2019.

In March, as cases of COVID-19 began to spread across the country, the federal Centers for Medicare & Medicaid Services (CMS) announced it was expanding Medicare coverage for telehealth services to make virtual visits more available.

This decision drove significant interest in telehealth services among the senior population. According to a SilverSneakers survey of its members, 74 percent of adults 65 and older are now using video streaming for medical appointments, socializing, and taking classes, up from 27 percent before the pandemic.

The same survey found that telehealth utilization among this specific age group is up 400 percent. Importantly, seniors aren’t just using telehealth to triage potential coronavirus cases, but also to satisfy healthcare needs separate from the pandemic, such as management of chronic conditions.

What’s more, telehealth has become an onramp for many seniors to a greater comfort level with technology and digital health—two-thirds of SilverSneakers members say they’re now more comfortable with video and live streaming.

This is a huge opportunity for health plans to improve outcomes and reduce costs, particularly for those still relying on expensive print communications to reach older members.

Lesson: Telehealth is a tremendous resource, but seniors will need specific guidance to ease their transition to a new method of receiving care. Now more than ever, health plans must deliver clear communications to members about telehealth services and its benefits.

Change #3: The Average Person’s Health Care Team Will Expand

The coronavirus pandemic has turned a sick person’s safest haven (a hospital or urgent care center) into their biggest threat. The result is tragically predictable: Those who desperately need medical care are aggressively trying to avoid it.

If you know a hospital worker, you’ve likely heard them ponder this question: Where have all the heart attacks and strokes gone? Cardio patients aren’t less sick; they’re staying home. In fact, a Journal of the American College of Cardiology study found that 38 percent fewer people were treated for life-threatening heart-artery blockages during March, even though the inflammation caused by COVID-19 should have actually increased their prevalence.

Fear isn’t the only deterrent. An AccessOne survey of 1,004 people, conducted in April, found that 64 percent of Americans are very or somewhat concerned about paying their medical bills this year. Those earning more than $100,000 a year are the most worried—63 say they’d delay a nonemergency surgery and 59 percent a diagnostic procedure, such as a colonoscopy.

Distrust, combined with financial concerns, will lead to an expansion of how Americans choose to receive information and care. Self-protection will become priority one for everyone, which not only means greater adoption of home diagnosis and monitoring (more on that later) but also a broader definition of “healthcare provider.”

What do I mean? Pharmacists, physical therapists, dentists, optometrists, and other practitioners will assume a greater role in protecting the health of the American public. For this reason, expect an acceleration of the long-anticipated transformation of retail establishments into one-stop health and wellness destinations, as we’ve seen at Walmart, CVS, and Walgreens.

For example, CVS Health, parent to Aetna, recently announced it’s opening 600 new HealthHubs by the end of the year and aims to have 1,500 operating by the end of 2021. Staffed by healthcare professionals such as nurse practitioners and physician assistants, these clinics cater to those with common illnesses and chronic conditions, such as high blood pressure, sleep apnea, and diabetes.

These one-stop destinations aren’t just a new way to treat patients—they’re a chance to empower people to take control of their health. For example, while consulting with Walmart on its Care Clinic user experience, Linkwell Health identified hundreds of moments during each patient visit that were good opportunities to inform and educate.

Lesson: The COVID-19 pandemic has made Americans acutely aware that good healthcare is as fragile as good health. As a result, people will increasingly consider non-traditional sources of education and care. It’s a huge opportunity for health plans to provide members with information that empowers them to take better care of their health, which will lead to a healthier population and reduced claims costs. It’s truly a win-win.

Change #4: Mental Health Impact Will Infuse Everything

Consider where we were in February: Social isolation was already a near-epidemic among seniors, and Generation Z was already the loneliest generation. In addition, the suicide rate in America had risen for 15 straight years.

Throw a pandemic into the mix where 90 percent of the country is asked to stay at home, add 40 million unemployment claims in ten weeks, and the results are disturbing if unsurprising:

  • 45 percent of people say their mental health has taken a turn for the worse because of COVID-19, according to a Kaiser Family Foundation survey
  • 19 percent say it’s had a major negative impact
  • Prescriptions for anti-anxiety and anti-depressant meds rose 34 and 19 percent respectively in February and March

A 2014 study published in the journal Social Science & Medicine looked at the mental health impact of the recession that hit the United States in late 2007. It found that for every percentage point increase in the nation’s unemployment rate, the suicide rate jumped 1.6 percent.

“Mitigating and treating the threat of this virus was the right immediate public health focus, and now we must prepare for a second wave of the pandemic involving ‘diseases of despair,’ especially depression and addiction,” said Andy Keller, Ph.D., president and CEO of the Meadows Mental Health Policy Institute, in April.

The institute’s research suggests that a five percentage point increase in the unemployment rate, similar to the recession of 2007 to 2009, would result in 4,000 more suicides and 4,800 more overdoses each year in America. An economic meltdown akin to the Great Depression would lead to 18,000 and 22,000 more deaths, respectively.

What’s different this time is that healthcare providers may be at the highest risk. A study of doctors and nurses in China, published in JAMA Network Open, found that half reported depression, 45 percent anxiety, and 34 percent insomnia.

CVS Health is again on the frontlines here, offering free outpatient mental health counseling to hospital employees in the hardest-hit states.

Lesson: Mental health awareness is becoming increasingly important to everyone, but particularly for high-risk groups. For health plans, it’s an opportunity to educate and empower members to seek treatment and, where it persists, erase any stigma surrounding seeking help. In addition, those with chronic illness need to take extra precautions, so mental health will become an essential component to disease management programs.

Change #5: Open Enrollment Campaigns Will Require Year-Round Messaging

This year’s enrollment period will be unlike any previous, particularly in the Medicare space. Gone are in-person meetups and educational seminars, replaced by highly targeted digital marketing and sophisticated engagement techniques.

This is especially important as plans adapt to the new normal and roll out benefits like telehealth, mail order pharmacy, and meal delivery.

For health plans without a strong existing digital foundation, this an uncertain and maybe even scary time. But it’s also a massive opportunity to future-proof your organization by deepening your relationships with members, expanding your digital capabilities, and making your marketing operation far more efficient.

Key to success: Serve, don’t sell. To effectively acquire and retain members, health plans should be thinking in terms of the conversations they can have, not the products they can push. Regular digital communication all year long—via blog, email, social media, and SMS—builds trust, credibility, and loyalty for when it matters most (read: AEP).

To that end, Linkwell Health has created a free downloadable assessment toolkit to help plans understand the benefits of a year-round messaging strategy, assess the strengths and weaknesses of their digital infrastructure, and help them establish a content strategy that supports their acquisition and retention goals.

Important note: This strategy will likely be essential on the commercial side too, as turmoil in employment and coverage could mean additional special enrollment periods and demand a continuous acquisition cycle and hyper-targeted messaging to support it.

Lesson: A brand is a mirror. Your members should be able to look at yours and see themselves staring back. If they see you as a trustworthy, credible, empathetic, and knowledgeable partner on their health journey, they will develop deep affection (dare I say love?) for their health plan. They’ll also buy more stuff and follow your guidance.

Change #6: Condition Management Will Be Reinvented

Chronic conditions pause for nothing, not even a global pandemic. And yet, many of those who suffer from them have delayed their regular appointments.

According to a Modern Healthcare report, 31 percent of Americans have put off trips to their doctor because of the COVID-19 crisis. For seniors, the number is closer to 50 percent, according to an NPR survey.

Eventually, people will begin visiting doctor’s offices again. But perhaps not in the same numbers. Enter the exploding field of home diagnosis and monitoring.

Livongo, for example, helps diabetes patients by collecting data from blood glucose meters in real time. Patients are alerted when their blood sugar goes out of range, so they can respond immediately. The technology helps them spot patterns too. The company has similar monitoring for weight management, hypertension, and mental health.

“The ability to provide care at the right moment is why remote monitoring will become the new standard of care,” wrote Glen Tullman, Livongo’s founder and executive chairman, on the company blog in April. “If you like telehealth, you will love remote monitoring.”

Another example is Audicus, which ships low-cost, high-quality hearing aids directly to a patient’s home after they take an online hearing assessment. Patients also receive unlimited consultation by phone, email, or chat with the company’s audiologists and other experts—no doctors’ appointments necessary.

Lesson: The COVID-19 crisis will usher in a host of new technologies that will empower health plan members to actively participate in the real-time management of chronic diseases. Plans that join the conversation have a real opportunity to improve things like medication adherence, ER avoidance, and overall quality metrics.

Change #7: We All Must Urgently Address Social Determinants of Health

Here comes the rub. Yes, the first six changes present huge opportunities for health plans of all sizes. But because they’re largely driven by technology, there’s a risk they’ll further exacerbate equity of care between those with financial means and those without.

Fact is, a third of households in the United States are headed by an adult aged 65 or older. Of those, a third don’t have a computer and half don’t have a smartphone, according to the U.S. census. And in many lower-income communities, 30 percent of children don’t have computer or Internet access. As we enter what will likely be the worst economic downturn in our lifetimes, these numbers will only get more dire.

As healthcare marches toward its digital future, the mantra must be no patient left behind. After all, 50 percent of health outcomes—from risk of disease to overall life expectancy—are determined by the six social determinants of health: nutrition, physical environment, community, healthcare, financial stability, and education. Consider:

  • The average life expectancy of Americans living below the federal poverty line ($25,750 a year) is 8 years fewer than those earning four times more than the federal poverty line, according to the Institute for Research on Poverty at the University of Wisconsin.
  • Half of American adults have at least one chronic disease that could have been prevented by better nutrition, says the Federal Office of Disease Prevention and Health Promotion.
  • Adults over 60 who feel lonely have a 45 percent higher risk of premature death, according to the 2018 Cigna Loneliness Study.
  • According to JAMA Internal Medicine, every 10 additional primary care physicians within a 100,000-person population is associated with a 51.5-day increase in life expectancy per person and a 1.4% decline in deaths from common causes like cancer and heart disease.

Cigna has been a leader in addressing health equity. In 2008, it created the Health Equity Council, an internal group charged with raising awareness, exchanging ideas, and promoting health equity across the entire enterprise. In 2018, it added social determinants of health as a key pillar.

There’s no silver bullet here. Bridging the health-equity gap requires close coordination among plans, providers, and the community. For example, Cigna organizes free screenings, counseling, and complimentary transportation to those in need, along with home-based care through its CareAllies subsidiary.

Lesson: Technology can and will transform healthcare forever, but for the neediest patients, the right care at the right time at the right place will always require a human touch.

To be sure, the COVID-19 crisis is far from over. In fact, the worst may be yet to come—at least in terms of public health and economic impacts. But now is not the time to sit and watch. Now is the time to envision your future—and step toward it.

Bill Phillips is the Chief Content Officer at Linkwell Health, the leading digital content marketing company serving health plans and wellness organizations.