Cigna COVID Global Impact Study: Physical Health Indicators Globally More Resilient, Stable Than Mental Health and Other Factors

By Clive Riddle, February 5, 2021

Cigna's International Markets business has just released its fourth COVID-19 Global Impact Study. Cigna states the series, based on Cigna's annual 360 Well-being Study, “provides further insight into the global impact of the COVID-19 pandemic on people's well-being in 11 markets around the globe.”

The new 17-page report, involved Cigna engaging “more than 23,000 people across Mainland China, Hong Kong, South Korea, New Zealand, Singapore, Spain, Taiwan, Thailand, United Arab Emirates, United Kingdom and the United States between January and October 2020, to show the changes in attitudes during the pandemic.”

Cigna reports that “the latest survey data shows that after months of pandemic-related restrictions, periodic stay-at-home orders, changing restrictions on travel and social gatherings, and multiple waves of infection, people worldwide have become even more concerned about the future. According to the study, almost half of global respondents said concern for the future is their greatest cause of stress. Another common area of stress is the balance between work life and family life. More than 40% of respondents reported low well-being scores and high stress levels in both of these areas, with 14% saying their level of stress is currently unmanageable.”

Cigna noted that while perceived well-being declined worldwide, from around a mean 62.5 on their index at the start of 2000 to 61.2 in June, and then rising slightly since – “in the U.S. it was a more positive picture, with the well-being index improving by a remarkable 2.6 points. Respondents reported significant improvements in their feelings of health and well-being.”

Cigna provides these two takeaways summarizing the report:

“What is striking about the study is that the pandemic is primarily a threat to health. And yet, the  physical indicators are the ones that remain most resilient and stable. It’s other factors, such as family, work, social and finance, that are showing the heavy toll of the virus and the global response to it. This is telling in itself of the nature of human health and well-being and the interconnected role of the factors that influence it.”

“We’re entering a new phase in response to the pandemic, one where it will be important for organizations to support their workforce by offering tailored healthcare programs that cater for a wide variety of perceptions and experiences across the globe. They need to be sensitive to the fact that emotions of employees could range across a broad spectrum and they need to provide solutions that truly address that.”

Four Important Takes on the Key Healthcare Trends and Issues for 2021

By Clive Riddle, January 22, 2021

With the promise and peril of each new year, healthcare prognosticators weigh in on what are the significant trends and issues that lay in wait. With the stakes in 2021 seemingly like no year in recent memory, here is a capsule of items put forward from four important perspectives as we move forward in the calendar:

PwC’s Health Research Institute (HRI) annually publishes their report on top issues for the new year, which will be featured next week in the 2021 Future Care Web Summit. This year’s report: Top health industry issues of 2021: Will a shocked system emerge stronger? “examines how the healthcare industry is expected to face the uncertainty of 2021, building resilience for long-term survival by developing its own forecasting systems, reshaping business portfolios post-pandemic for financial stability and growth, and creating a more nimble, modern supply chain.” 

They find the key issues will include:

• Virtual health reshapes healthcare delivery
• Clinical trials are changing—for good
• Digital relationships can help improve the clinician experience
• Enhanced Healthcare forecasting for an uncertain 2021
• Health portfolios reshaped for growth: increased investment in and by healthcare companies
• A resilient and responsive supply chain built for long-term health
• Interoperability 2021: potential foundation to power forward a more consumer-centric healthcare system after the pandemic

The employer perspective, from the Business Group on Health, is offered in their new report: Key Insights: Health Care Trends in 2021, which cities these five trends:

• The Proliferation of Virtual Care—  More attention will be given to the evaluation of the quality, outcomes, effectiveness, patient experience and cost of virtual care options and innovations, as well as the appropriateness of virtual vs. in-person care for specific services.
• A Reimagining of Health Care Delivery— Even though employers and plans may have momentarily slowed the expansion of alternative payment and delivery models because of the pandemic, a redoubling of efforts in 2021 will drive improvements in quality and value.
• A Spotlight on Mental Health and Emotional Well-being—In 2021, novel approaches such virtual counseling and the integration of Employee Assistance Programs and mental health benefits, will place mental health on par with other medical conditions.
• Adapting to the Well-being Needs of a Changing Workforce— In 2021, employers will continue to demonstrate flexibility and support employee needs through leave, remote work and other benefits.
• Addressing Gaps in Health Equity—In 2021, the health care ecosystem, including providers, suppliers and payers, will boost efforts to examine and address health equity, while mitigating the harmful effects of social determinants of health.

A hospital perspective is offered by the American Hospital Association in their AHA Trustee piece: Top 10 Emerging Trends in Health Care for 2021: The New Normal

1. More Strategic and Agile Supply Chains
2. Coopetition as a Viable Strategy
3. Patient Consumerization
4. Personalization of Care
5. Workforce Diversity and Safety
6. Virtual Care
7. Artificial Intelligence and Automation
8. Revenue Diversification
9. Mergers and integration
10. Payer Shifts

And finally, with the pandemic further bringing behavioral health issues to the forefront, the American Psychological Association offers their report on Emerging trends for 2021:

• Healing the political divide
• Social media is increasing impact
• The fight against racism must continue
• Psychology research is front and center
• Mental health apps are gaining traction
• Psychologists’ skills are in great demand
• The national mental health crisis
• The great distance learning experiment continues
• There’s a new push to reach underserved communities
• Psychology’s involvement in policing
• Psychologists are moving up in academia
• Online therapy is here to stay
• Advocacy will help secure expanded telehealth coverage
• Employers are increasing support for mental health

Health Plan Companies Start New Year M&A Activity With a Bang

By Clive Riddle, January 8, 2021

The first week of the new year witnessed a flurry of merger & activity from health plan companies, highlighted by the continuing diversification trend in which many such organizations can’t really be labeled just a health plan company anymore.

UnitedHealth Group’s Optum has acquired Change Healthcare. We are told “Change Healthcare will join with OptumInsight to provide software and data analytics, technology-enabled services and research, advisory and revenue cycle management offerings.” The agreement calls for the acquisition of Change Healthcare’s common stock for $25.75 per share in cash and is expected to close in the second half of 2021.

In a statement, Andrew Witty, President of UnitedHealth Group and CEO of Optum commented “together we will help streamline and inform the vital clinical, administrative and payment processes on which health care providers and payers depend to serve patients. We’re thrilled to welcome Change Healthcare’s highly skilled team to create a better future for health care.” Neil de Crescenzo, President and CEO of Change Healthcare, who will serve as OptumInsight’s chief executive officer, added "this opportunity is about advancing connectivity and accelerating innovations and efficiencies essential to a simpler, more intelligent and adaptive health system."

Centene Corporation announced they will acquire Magellan Health for $95 per share in cash for a total enterprise value of $2.2 billion. We are told the transaction "will broaden and deepen Centene's whole health capabilities and establish a leading behavioral health platform," with the Magellan Health CEO and management to remain in leadership roles. Centene summarizes the additional benefits of the merger as including: a combined platform to deliver better health outcomes for complex populations through the integration of physical and mental health care; an important addition to Centene's Health Care Enterprises, under which Magellan Health will continue to operate independently; creation of a next generation behavioral health platform, aligned with Centene's technology strategy with additional growth opportunities in specialty care and pharmacy.

In a statement, Michael F. Neidorff, Chairman, President and Chief Executive Officer of Centene commented "This acquisition accelerates our diversification strategy and enhances our ability to build next generation capabilities in our specialty care business by leveraging our scale and investments in technology. Furthermore, we are very familiar with the range of Magellan Health's healthcare solutions as we have been one of their customers over many years.”

Molina Healthcare, Inc. announced that its acquisition of the Magellan Complete Care line of business of Magellan Health, Inc. closed on December 31, 2020. Magellan Complete Care serves approximately 200,000 members. The transaction helped clear the way for Centene's acquisition of Magellan Health.

Harvard Pilgrim Health Care and Tufts Health Plan announced their organizations have formally combined, effective January 1, 2021, having received all regulatory approvals. Tom Croswell , head of Tufts will serve as CEO for the combined organization, and Michael Carson, head of Harvard Pilgrim, will serve as President. We are told that "while Tufts Health Plan and Harvard Pilgrim Health Care are officially one organization, both heritage brands and products will remain in the market for a period of time, and the benefits, programs and services its members rely on will not change in 2021 as a result of the combination.  The new organization’s headquarters will be located in Canton, MA; move in is slated to begin in Q4 of this year.  The new organization also anticipates announcing its new name in the second quarter of 2021."

Smaller regional plans are at it as well. Physicians Health Plan of Northern Indiana  announced they acquired Core Benefits, Inc., effective December 31, 2020, to provide additional reach into the third party administration (TPA) and employee benefits market. And Bright Health announced it has signed an agreement to acquire Central Health Plan of California. Upon closing, Bright Health will serve approximately 110,000 individuals within its Medicare Advantage business.

What will the rest of January bring in the health plan M&A world, let alone the rest of 2021?

SDOH’s Cube - Compliments of Peter Kongstvedt

By Clive Riddle, September 30, 2020

Dr. Peter Kongstvedt over a decade ago, before Social Determinants of Health rose to more recent prominence, developed an illustration of how complex and intertwined the multitude of determinants are that impact a consumers' state of health, using the famous Rubik's Cube design as model.

Peter Kongstvedt, MD, FACP is a highly regarded national authority on the health care industry with particular expertise in health insurance and managed health care, and was recently emailing with me on the topic of SDoH, and shared his graphic from the past that he told me he'd "created many, many years ago in my attempts to increase awareness of the issue, though it wasn’t called SDoH then, so I grafted that on to the slide – just for you."

I was so taken with how applicable his blast from the past was for Social Determinants of Health, that I asked for his permission to share the illustration with you, so here you go - and think about applying other current determinant items as well that are being discussed in the world of SDoH, and how complex the variables are for any individual outcome - and you'll see the Rubik's challenge in front of those on the front lines of SDoH.

The Ever-Growing Body of Evidence of Racial Disparities in COVID-19 Prevalence

by Clive Riddle, September 18, 2020

Kaiser Family Foundation has released a new study: COVID-19 Racial Disparities in Testing, Infection, Hospitalization, and Death: Analysis of Epic Patient Data, which adds to the evidence of disparities in COVID prevalence.

KFF reports that "the racial disparities in illness and death are not fully explained by differences in underlying sociodemographic characteristics and health conditions, finds the study, which analyzed Epic electronic health record data for roughly 50 million patients from 53 health systems representing 399 hospitals across 21 states." They conclude that "people of color may face increased barriers to testing that contribute to delays in obtaining testing until they are in more serious condition compared to White patients. They also demonstrate that people of color are bearing a disproportionate burden of negative health outcomes related to the COVID-19 pandemic at every stage."

Although testing rates differed little by race and ethnicity, among those tested, Hispanic patients were over two-and-a-half times more likely to have a positive result comparted to White patients, while Black and Asian patients were nearly twice as likely. COVID-19 infection rates among Hispanic and Black patients were over three and two times higher, respectively, compared to the rate for White patients. Hospitalization rates for Hispanic and Black patients with COVID-19 were more than four times and over three times higher, respectively, compared to the rate for White patients. Death rates for both groups were over twice as high as the rate for White patients.

COVID19 Positive Test Results:

• Hispanic: 311 per 1,000 tests
• Black: 219 per 1,000 tests
• Asian: 220 per 1,000 tests
• White:113 per 1,000 test

COVID-19 Infection Rates

• Hispanic: 143 per 10,000 population
• Black: 107 per 10,000 population
• White: 46 per 10,000 population

COVID-19 Hospitalization rates

• Hispanic: 30.4 per 10,000 population
• Black: 24.6 per 10,000 population
• White: 7.4 per 10,000 population

COVID-19 Death Rates

• Hispanic: 5.6 per 10,000 population
• Black: 5.6 per 10,000 population
• White: 2.3 per 10,000 population

KFF reminds us that their analysis, a joint project of the Epic Health Research Network and KFF, builds upon the findings of numerous other studies. In fact, just during the past 30 days, some of these studies have included:

The Color of Coronavirus: Covid-19 Deaths By Race and Ethnicity in the U.S.

APM Research Lab, September 16, 2020

Beyond the Case Count: The Wide-Ranging Disparities of COVID-19 in the United States

The Commonwealth Fund, September 10, 2020

'Enough is enough': Gilead-Morehouse study racial, ethnic disparity in COVID-19

S&P Global Market Intelligence, September 8, 2020

Racial/Ethnic Disparities in Hospital Admissions from COVID-19 and Determining the Impact of Neighborhood Deprivation and Primary Language

medRxiv, September 2, 2020

Community-Level Factors Associated With Racial And Ethnic Disparities In COVID-19 Rates In Massachusetts

Health Affairs, August 27, 2020

Racial Disproportionality in Covid Clinical Trials

New England Journal of Medicine, August 27, 2020

Disparities in Incidence of COVID-19 Among Underrepresented Racial/Ethnic Groups in Counties Identified as Hotspots During June 5–18, 2020

CDC Morbidity and Mortality Weekly Report, August 21, 2020

Viscous Cycle: Pandemic Elevating Nation’s Blood Pressure, Which Increases COVID-19 Vulnerability

By Clive Riddle, September 3, 2020

The pandemic has increased our population’s stress levels, which has increased blood pressure levels, which creates a population more vulnerable to potential damaging effects of COVID-19. Livongo has released a paper: Tracking COVID-19’s Effect on the Nation’s High Blood Pressure, that examines their own national dataset in this regard.

Livongo refers to a August 14^th CDC Morbidity and Mortality Weekly Report article: Mental Health, Substance Use, and Suicidal Ideation During the COVID-19 Pandemic, which cites that “symptoms of anxiety disorder and depressive disorder increased considerably in the United States during April–June of 2020, compared with the same period in 2019”, and presents findings from their survey taken June 24–30, 2020 that include “40.9% of respondents reported at least one adverse mental or behavioral health condition, including symptoms of anxiety disorder or depressive disorder (30.9%), symptoms of a trauma- and stressor-related disorder (TSRD) related to the pandemic (26.3%), and having started or increased substance use to cope with stress or emotions related to COVID-19 (13.3%).

Livongo reminds us that “while anxiety and stress do not directly cause long-term hypertension, episodes of psycho-social stress and anxiety are well known to cause dramatic spikes in blood pressure (BP).” They note there was a 136% increase in utilization of their myStrength behavioral health solution in the period from January to May.

Livongo’s dataset in this case is driven by Livongo for Hypertension Members that “regularly measure their BP with a monitor and cuff that connect wirelessly with Livongo’s smartphone app. Readings are automatically transmitted to our Applied Health Signals platform where participants can view results.”

Their analysis did indicate a pandemic BP spike, and they report “until late January of this year the percentage of our Members nationally with high BP in any given week was on average 62%. At the end of January, however, we saw a rise in high BP roughly corresponding with the announcement of the first confirmed case of COVID-19 in the US (Jan 21) and the first mass quarantine of residents in the Chinese city of Wuhan (Jan 23). From that point forward, the proportion of our Members with high BP has mostly remained at a heightened level above 62%. An initial analysis of data at the state level shows that in 30 states the percentage of Members with high BP has increased between January and August. According to the data, high BP reached another significant peak in early to mid April when 68% of our Members nationally registered high BP.”

The implications? Livongo reminds us that “while no more susceptible to COVID-19, this population is more at risk of serious illness, hospitalization, and death from the virus. As our BP data reveals, the stress and anxiety and social isolation we have all experienced has had an outsized and measurable impact on this at-risk population.”

Livongo wasn’t the first to note this pandemic spike. Back in May, St. Luke’s Kansas City released an article in which their medical director discussed the trend: Doctors seeing more patients with high blood pressure amid coronavirus pandemic.

The American Heart Association has recently updated a guidance page: Keeping a lid on blood pressure during the coronavirus crisis, noting the need to manage stress, and cautioning that “high blood pressure might raise your risk of experiencing severe complications from the coronavirus. Nearly half of U.S. adults have high blood pressure, or hypertension, which is defined as consistent readings of 130/80 or above.”

Six Takeaways from a New White Paper for Payers on Pandemic Driven Medicaid and ACA Expansion

by Clive Riddle, August 21, 2020

Change Healthcare has just released a 13-page white paper: Pandemic-Driven Medicaid and ACA Expansion: Impacts and Considerations for Payers, that "details expected changes in the composition of national Medicaid and ACA member populations, and explores the potential financial consequences of the pandemic on payers."

Here are six takeaways from their report:

1. Five states with the biggest percentage jump in Medicaid enrollment from Feb 2020 to May 2020: Florida - 9.8%, Missouri - 8.8%, Wisconsin - 8.5%, Minnesota - 8.4%, Kentucky - 8.1%
2. Of those with employer-sponsored -care that are losing coverage, nearly half are eligible for Medicaid, and an additional 31% are eligible for marketplace subsidies.
3. Expect enrollment backlogs: “Typically, a new Medicaid member is assigned to a Managed Care Organization (MCO) within 45 days after enrolling. Current processing backlogs indicate that window will likely expand significantly and it might be 60 to 90 days before members can receive care through an MCO after enrollment—and that is dependent on the availability of healthcare services.”
4. Expect utilization backlogs: ”we expect the most dramatic impact of Medicaid member utilization to hit in 2021, when care services are likely to be more widely accessible.”
5. Coverage will shift back: “As the economy rebounds, coverage will likely shift back to commercial lines of business and payers should be prepared for continual changes in coverage for the foreseeable future.”
6. Five strategies are recommended payers mitigate challenges caused by the pandemic: 

• Prepare your infrastructure by expanding provider networks to increase capacity; expect and plan for payment delays from financially unstable states.
• Collaborate with providers to ensure that members who are most at-risk receive access to necessary healthcare services.
• Accurately identify primary healthcare insurance coverage to reduce exposure and avoid costly recoveries.
• 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.
• Aggressively manage risk scores by identifying members in need of documentation and proactively facilitating care visits by the end of the calendar year.

“Buts” to Navigate in the Pandemic Acceleration of the Digital and Healthcare Experience Intersection

By Clive Riddle, August 14, 2020

Accenture has just released a new 37-page report, the Accenture Digital Health Technology Vision 2020, based on a survey of 259 payer and provider healthcare executives, which found “that the vast majority (85%) of executives believe that technology has become an inextricable part of the human experience [and] furthermore, 45% of those polled said that rapid advancements in new technologies and scientific innovations are positioned to disrupt their industry.”

In a statement, Dr. Kaveh Safavi, a senior managing director in Accenture’s Health practice says that “COVID-19 has not slowed digital technology innovation; rather, it’s amplifying it to historic levels,” and surmised that “the intersection between digital technology and healthcare experiences has certainly accelerated with the COVID-19 pandemic, and leading the future of care will demand rethinking core assumptions about the intersection of people and technology. People’s perceptions of and relationships with technology are changing, and to adapt, healthcare payers and providers need to redesign digital experiences.”

The Accenture study found 78% of the healthcare provider and payer executives believe that the stakes for innovation have never been higher, but there are a number of “buts” in their findings that present obstacles to navigate in the middle of this digital and healthcare experience intersection, including:

• 69% of healthcare payers and providers are already piloting or adopting artificial intelligence; BUT 39% said they have inclusive design or human-centric design principles in place to support human-machine collaboration.
• 71% believe that robotics will enable the next generation of services in the physical world, BUT 54% believe that their employees will be challenged to figure out how to work with robots.
• 70% of healthcare consumers polled as part of the research said they are concerned about data privacy and commercial tracking associated with their online activities, behaviors, location and interests, BUT that same number (70%) of consumers also said they expect their relationship with technology to be more prominent in their lives over the next three years.

Data Breaches – Unfortunately Healthcare Is the Leading Industry

By Clive Riddle, July 31, 2020

IBM Security has just released their 82-page 2020 Cost of a Data Breach Report, “a global study examining the financial impact of data breaches” finding that overall “these incidents cost companies studied $3.86 million per breach on average, and that compromised employee accounts were the most expensive root cause.”

Healthcare is unfortunately the leading industry in this arena. IBM tells us that “In the healthcare industry, the average cost of a data breach in 2020 was $7.13 million. Of the 17 industries surveyed, healthcare ranked first in average cost. The average time to identify and contain a breach in this industry was 329 days.”

The study was “based on in-depth interviews with more than 3,200 security professional in organizations that suffered a data breach over the past year….Based on in-depth analysis of data breaches experienced by over 500 organizations worldwide, 80% of these incidents resulted in the exposure of customers' personally identifiable information (PII). Out of all types of data exposed in these breaches, customer PII was also the costliest to businesses studied.”

The report states that “the average cost of a data breach has fluctuated between $3.50 million and $4.00 million in recent years.” For healthcare, it averaged $8.6 million in 2015 and reached $10.0 million in 2019, before reducing to $7.1 million this year.

Their overall conclusions include:

• ·         Companies studied who had fully deployed security automation technologies (which leverage AI, analytics and automated orchestration to identify and respond to security events) experienced less than half the data breach costs compared to those who didn't have these tools deployed – $2.45 million vs. $6.03 million on average.
• ·         In incidents where attackers accessed corporate networks through the use of stolen or compromised credentials, studied businesses saw nearly $1 million higher data breach costs compared to the global average – reaching $4.77 million per data breach. Exploiting third-party vulnerabilities was the second costliest root cause of malicious breaches ($4.5 million) for this group.  
• ·         Breaches wherein over 50 million records were compromised saw costs jump to $392 million from $388 million the previous year. Breaches where 40 to 50 million records were exposed cost studied companies $364 million on average, a cost increase of $19 million compared to the 2019 report.
• ·         The Most Damaging Breaches: Data breaches believed to originate from nation state attacks were the costliest, compared to other threat actors examined in the report. State-sponsored attacks averaged $4.43 million in data breach costs, surpassing both financially motivated cybercriminals and hacktivists.

The interactive version of the report provides an industry-specific calculator that shows the average cost of a data breach associated with various factors and the average amount organizations estimated these factors either increased or decreased the cost in the selected country or industry. This analysis looks at only one variable at a time and multiple cost factors cannot be combined.

We selected the healthcare industry, and ran the calculator for the following factors, yielding industry-specific results in order of dollar magnitude:

1. Incident Response Testing - $275,136
2. Business Continuity Plan- $273,585
3. AI Platform - $232,452
4. Employee Training - $245,920
5. Extensive Encryptions - $195,376
6. Formation of IR Team - $193,720
7. Security Analytics -  $186,820
8. Board Involvement - $181,526
9. Red Team Testing - $176,730
10. Cyber Insurance - $175,091
11. Vulnerability Testing - $174,708
12. DevSecOps - $174,671
13. Threat Intel Sharing - $160,294
14. Data Loss Prevention - $133,583
15. CISO Appointed - $111,532
16. ID Theft Protection - $48,693
17. Managed Security System- $41,946

We should note that this Wednesday, August 5, 2020, at 2 PM Eastern, Alaap B. Shah, Member of the Firm, Epstein Becker Green will update health plans on cybersecurity trends and risk management response preparedness and best practices, in the complimentary HealthcareWebSummit event: Health Plan Cybersecurity Trends and Risk Management Response Preparations.

The Relationship (or lack thereof) Between a State’s Overall Health Ranking and Their COVID-19 Fatality Rate

by Clive Riddle, July 17, 2020

Given that co-morbidities have such an impact on COVID-19 fatalities, we thought it would be interesting to compare overall state health rankings that take co-morbidities into consideration, with COVID-19 fatality rates by state

We took the most recent results from America’s Health Rankings, their 30^th annual report released in December, which provides a “comprehensive assessment of the nation’s health and on a state-by-state basis. The report includes 35 core measures of health that are used to rank states.” Would states with healthier lifestyles and lower incidence of co-morbidities translate into lower COVID-19 fatality rates? For that matter, would healthier lifestyles translate to lower case rates under the assumption those practicing healthier lifestyles might also practice more social distancing, mask-wearing and hand-washing?

We exported Johns Hopkins COVID-19 data through July 17^th from the Kaiser Family Foundation State Health Facts webpage on Confirmed COVID-19 Cases and Deaths, and indicated rankings for COVID-19 fatality rates (Deaths per 1,000 / Cases per 1,000.) We also indicated the rank for Cases per 1,000 population.

The exercise unfortunately doesn’t indicate a widespread relationship. There are certain states whose rankings are similar (Utah and Hawaii in the Top 10 healthy states,) Actually, there appears to be a closer relationship in healthy state rankings and Cases/1,000 than with Fatality rates, although it is still not much of a relationship.

There are obviously more relevant factors at work here, than the overall state of a state populations’ health. But here is the state-by-state comparison of rankings:

The Relationship (or lack thereof) Between COVID-19 State Restrictions and Prevalence

By Clive Riddle, July 10, 2020

Wallet Hub earlier this week released updated rankings of States by Coronavirus Restrictions. The rankings were based on data available on July 6^th, and assigned scores based on 18 metrics including “whether the state has any penalties for non-compliance with COVID-19 legislation to whether the state has required face masks in public and health checks at restaurants.”

They found the five least restrictive states – in order – to be South Dakota, Wisconsin, Utah, Wyoming and Oklahoma. They found the five most restrictive states – in order – to be California, Colorado, Hawaii, New Jersey, and New Mexico.

We thought it would be interesting to compare their rankings to COVD-19 prevalence, using current CDC deaths and cases per 100,000 population rates by state. The question to examine, if is there is a relative relationship between the levels of restrictions and COVID-19 deaths and cases per capita. The spreadsheet we compiled is provided below.

We reversed the rankings provided by WalletHub. They ranked states by the least restrictive – South Dakota was #1, California was #51. But in comparing Death and Case Rates where #1 would be the highest rates, we decided to rank states by the most restrictive – with the hypothesis that the most restrictive states should have the greatest prevalence.

The results were very mixed – you can select certain states to make whichever case you want. To go with the above hypothesis – you can point to Atlantic states like New Jersey, New York, Delaware and Maryland – all with a close relationship between their high levels of restrictions and high COVID-19 prevalence. You can also point to Wyoming on the other end of the scale that lines up #48 in restrictions, #48 in death rates and #44 in case rates.

On the other hand, there is Hawaii ranking third in most restrictions, but lowest in the nation in death and case rates, bolstering those who want to argue that imposing restrictions up front can result in lower prevalence (or an argument to move your state to an island.) MaIne also can make such a case – ranking 6^th in restrictions but 43^rd in deaths and 45^th in cases (or perhaps a case to move your state further north than Toronto.) But on still another hand, California is less compelling, ranking first in restrictions but 30^th in deaths and 29^th in cases (California had a compelling case that deteriorated during the past month.)

And California’s deterioration of course highlights the problem that this exercise doesn’t address – the greater importance of recent change rates vs cumulative rates, and the impact of changes in restrictions. But for now, examining relationships between state approaches, and state incidence of COVID-19, is like everything else to do with the virus – quite a mess.

Five Things to Know from Humana’s 2020 Bold Goal Progress Report

By Clive Riddle, June 19, 2020

Humana in 2015 launched its Bold Goal program, their population health strategy targeting specific communities, and incorporating SDoH components with the goal of improving health of these communities in applicable measures by 20%. They have just released their 2020 Bold Goal Progress Report which details the company’s progress in meeting their goal, and their “ongoing efforts to help address the impact that social determinants of health and health-related social needs, such as food insecurity and loneliness, have on the physical and mental health of the Medicare Advantage population.”

For targeted communities and populations, their program “uses the U.S. Centers for Disease Control and Prevention (CDC) Healthy Days assessment tool to measure the mentally and physically unhealthy days of individuals over a 30-day period, covering Humana member populations through lines of business such as Medicare Advantage, Group and Medicaid.”

Here’s five things to know from the 2020 Progress Report: 

1. In their original (2015) seven Bold Goal communities, the number of unhealthy days reduced from 13.58 in 2015 to 13.27 in 2020, which non-bold goal communities increased from 13.42 to 13.45 during that time.
2. Of the seven communities, five reduced unhealthy days from 2015-2019, while two increased: San Antonio -8.6%; Baton Rouge -4.5%; Tampa -3.7%; New Orleans -2.2%; Knoxville -2.2%; Broward +0.6% and Louisville +7.4%
3. For the first time since Humana began benchmarking, Humana Medicare Advantage members across all markets improved their Healthy Days. 
4. Humana screened more than 2.6 million Humana members for social determinants of health in 2019. Humana found that each member screened had an average of 3.5 health-related social needs (e.g. food insecurity, socially isolated or lonely)
5. Depression had the most unhealthy days of six targeted chronic conditions, members with chronic obstructive pulmonary disease (COPD) had 17.94 unhealthy days (decreased 1.2% in 2019); coronary artery disease had 14.94 unhealthy days (decreased 1.8%); depression had 22.21 unhealthy days (decreased 2.9%), congestive heart failure had 17.29 unhealthy days (decreased 3.1%) and hypertension had 13.67 unhealthy days (decreased 3.2%)

COVID-19 and the Uncertainties for 2021 Health Plan Premiums

By Clive Riddle, June 12, 2020

What will COVID-19 do to next year’s health plan premiums? The American Academy of Actuaries have just released a new issue brief, Drivers of 2021 Heatlh Insurance Premium Changes: The Effects of COVID-19. They tell us one thing for certain, is COVID-19 brings a whole lot of uncertainty to the equation.

Academy Senior Health Fellow Cori Uccello explains that “premium changes are based on how costs of care, enrollment, and other factors are expected to change relative to insurers' assumptions that were used in setting premiums for the current year, and the COVID-19 pandemic has brought new unknowns and opposing trends into the mix. The pandemic has introduced both positive and negative cost pressures within the health care system, and uncertainties to key projections such as claims that could be sensitive to possible subsequent waves of infection and illness.”

Four key points of their nine-page issue brief include:

1. For the first half of this year, increased health spending due to the direct costs of diagnosing and treating COVID-19 has been more than offset by a reduction in non-COVID-19 health services

2. We don’t know how trends will continue through the remainder of this year.

3. COVID-19 has introduced significant uncertainty regarding projecting 2021 claims levels

4. How COVID-19 will impact 2021 premiums depends on assumptions involving:

• The emergence of subsequent COVID-19 waves in 2020 or in 2021
• Whether non-COVID-19 utilization continues to be deferred or eliminated in 2021 or whether treatment deferred in 2020 is provided in 2021
• The pandemic’s economic effects on shifts in insurance coverage and risk pool composition, and
• COVID-19 testing and treatment costs, the availability of new treatments and vaccines, increases in mental health and substance treatment needs, changes to telehealth utilization and costs, and changes to provider reimbursement rates

With such an uncertain immediate future, perhaps the best place to start in considering premium rate impact, is to ask the right questions. Last month, MIlliman released a seven-page white paper on this topic: COVID-19: Considerations for commercial health insurance rates in 2021 and beyond.

Milliman tackled the topic by addressing these issues, and their related questions going forward:

1. Acute treatment and vaccination for COVID-19: How will COVID-19 infections and prevention impact 2021 costs? How will the cost of treatment evolve? When will a vaccine be ready, and what will it cost?

2. Access and demand for healthcare: How will the pandemic and aftermath affect access and types of care received? How long will utilization declines last, and what will patterns look like in the aftermath?

3. Lasting impacts on population health: How will the pandemic affect overall population health? How will carriers adjust rating philosophies to manager COVID-19 risk?

4. Economic impacts on enrollment and utilization: How will collateral economic damage affect enrollment and utilization patterns?

5. Disruptions to provider networks: How will provider systems be disrupted? How might this affect future contract negotiations and reimbursement structures? How will costs swings interact with one-sided and two-sided risk-sharing arrangements?

6. Operational impacts: How will disruptions and cash flow volatility impact reserve estimates used for pricing? How will delivery systems need to adapt, and how will that influence risks and costs? How might general and administrative expenses be impacted?

Long Term Care COVID-19 Deaths – Six Things To Know from CMS Data

By Clive Riddle, June 5, 2020

Diving into the new CMS COVID-19 Dataset on Medicare and Medicaid Long Term Care Facilities, here are six things to know from the data reported through May 31^st, 2020:

1. 0.4% of the reporting facilities - the top 50 facilities by cumulative COVID-19 deaths – represent  22.6% of the COVID-19 deaths reported.

2. The top 1% of the reporting facilities– represent 35.5% of the COVID-19 deaths reported.

3. Cumulative COVID-19 Deaths reported in the dataset represent 40.4% of total deaths at those facilities. However, there may be issues with the total deaths reported in the dataset, as the COVID-19 deaths exceeded the total deaths reported in 12 of the top 50 facilities by COVID-19 alone.

4. Here is a listing of the top 20 facilities by cumulative COVID-19 deaths:

• ·         Dellridge Health & Rehabilitation Center, Paramus, NJ (753)
• ·         Family Of Caring Healthcare At Ridgewood, Ridgewood, NJ (517)
• ·         Advanced Subacute Rehabilitation Center At Sewell, Sewell, NJ (396)
• ·         Southern Pointe Living Center, Colbert, OK (339)
• ·         Complete Care At Summit Ridge, West Orange, NJ (311)
• ·         Blaire House Of Tewksbury, Tewksbury, MA (282)
• ·         Pleasant View Nsg Home, Mount Airy, MD (253)
• ·         Durand Senior Care And Rehab Center, L L C, Durand, MI (243)
• ·         Martha T Berry Mcf, Mount Clemens, MI (214)
• ·         Advantage Living Center - Samaritan, Detroit, MI (163)
• ·         Avanti Wellness & Rehab, Niles, IL (158)
• ·         Parkhouse Rehabilitation And Nursing Center, Royersford, PA (149)
• ·         Orchard View Manor, East Providence, RI (133)
• ·         Sunset Home, Quincy, IL (123)
• ·         Bickford Health Care Center, Windsor Locks, CT (123)
• ·         Neshaminy Manor Home, Warrington, PA (119)
• ·         Park Ridge Nursing Home, Rochester, NY (119)
• ·         Crystal Rehabilitation And Healthcare Center, Greenwood, MS (118)
• ·         Saint Mary'S Villa Nursing Hom, Moscow, PA (114)
• ·         Knolls West Post Acute Llc, Victorville, CA (106)
• ·         Sunset Lake Health And Rehabilitation Center, Venice, FL (103)

5. CMS provides this map of COVID-19 Deaths by State:

6. CMS also provides this chart of Deaths per 1,000 Residents by State, with New Jersey at 178.3, followed by Massachusetts at 120.6 and Connecticut at 115.3. The national average is 30.2:

The Latest on Physician Burnout in the Time of COVID-19

By Clive Riddle, May 29, 2020

After COVID-19 fully assaulted the United States in March, an article appeared in the April 9^th Harvard Medical School’s Lean Forward: A Double Whammy: The COVID-19 Pandemic and Burnout in Medical Professionals, sharing that “leaders are advising health care workers to think of the pandemic as a marathon, not a sprint. But how long can health care workers hold up in these challenging conditions?” They cited a recent study on China’s physician COVID-19 experience: “researchers in China conducted a cross-sectional study published in JAMA Network Open Journal in March 2020. The study involved 1257 health care workers in China during the coronavirus pandemic and reported troubling results; 50.4% had symptoms of depression, 34.0% reported insomnia, 44.6% reported symptoms of anxiety and 71.5% reported distress.”

A May 17^th Forbes article,  Doctor, Heal Thyself: Physician Burnout In The Wake Of Covid-19 quotes Nisha Mehta, MD, radiologist, physician advocate and keynote speaker: “For many physicians, Covid-19 may be the proverbial straw that breaks the camel’s back as they isolate themselves physically from their family and friends while encountering a surge of sickness and death.” They cite that “physician burnout was an epidemic BEFORE the Covid-19 pandemic. According to a 2018 study, 400 physicians die by suicide each year – double that of the general population. In addition, doctors have the highest suicide rate of any profession in the U.S including combat veterans. From an economic standpoint, studies estimate that physician burnout is costing the health care system approximately $4.6 billion per year.”

An example of a growing trend, at the start of this month Charlotte, N.C.-based Novant Health established a new task force that will screen front-line healthcare workers for burnout.

Without focusing on just COVID-19, The May issue of The Journal of the American Board of Family Medicine featured are series of studies on physician burnout. In Joy in Work for Clinicians and Staff: Identifying Remedial Predictors of Burnout from the Mini Z Survey, Niharika Khanna, Russ Montgomery and Elena Klyushnenkova remind us that “Joy in medical practice is an important marker of clinician satisfaction related to structural and cultural aspects of the practice.”

Their study involved the CMS Transforming Clinical Practice Initiative (TCPI), which provided coaching and learning support to practices during transition to new models of value-based care. Specifically, Maryland practices participated in the Garden Practice Transformation Network (GPTN) as a part of the TCPI. During practices assessment, the authors measured prevalence of burnout and identified its remediable predictors among GPTN-Maryland practices.

 They found “prevalence of burnout symptoms was 22%, with 35% enjoying their work. A 100-point Time Constraints/Teamwork (T/T) score was constructed using factors significantly associated with burnout symptoms. T/T score increase by 1 unit was associated with 10% increase in the odds of moving from the group experiencing burnout or stress to the group who found ‘joy in work’.”

In Indicators of Workplace Burnout Among Physicians, Advanced Practice Clinicians, and Staff in Small to Medium-Sized Primary Care Practices, Debora Goetz Goldberg, Tulay G. Soylu, Victoria M. Grady, Panagiota Kitsantas, James D. Grady and Len M. Nichols remind us that “burnout is defined as a ‘syndrome of emotional exhaustion, depersonalization, and a sense of low personal accomplishment that results in decreased effectiveness at work.’ Numerous studies have concluded that burnout is a serious problem for physicians, advanced practice clinicians, nurses, and other health care professionals. Recent research indicates that primary care physicians experience a higher rate of burnout than most other physician specialties.”

Their study analyzed survey responses from 1273 healthcare professionals from 154 small to medium-sized primary care practices participating in the EvidenceNOW initiative in Virginia. They found “workplace burnout was reported by 31.6% of the physicians, 17.2% of advanced practice clinicians, 18.9% of clinical support staff, and 17.5% of administrative staff. Regardless of burnout status, results show all healthcare professional groups had high levels of anxiety. Providers had significantly higher scores for anxiety than all other healthcare professionals. Providers who experienced higher levels of anxiety and withdrawal were more than three times as likely to report burnout compared to those who experienced low levels in these domains.”

They recommend that “programs should focus on strengthening the work environment of small to medium-sized practices to improve organizational capacity for change and address high levels of anxiety experienced by physicians, advanced practice clinicians and staff.”

Here’s hoping our healthcare heroes can somehow find joy in work, and a strengthened work environment in these COVID-19 times.

Surveying COVID-19 Financial Impact on Providers

By Clive Riddle, May 15, 2020

NEPC’s Healthcare Practice Group has just released survey results from a diverse set of healthcare organizations around the country on financial steps they are taking during the pandemic. Here's what NEPC found:

• ·         78% have or will access lines of credit
• ·         96% anticipate additional government assistance
• ·         61% have already, or plan on, furloughing staff
• ·         43% have already, or plan to, suspend or postpone retirement plan contributions (28% of with organizations $2B in assets did so,  compared to 63% with a credit rating of BBB or lower)
• ·         56% said their daily burn rates increased by up to 25%, while 23% of respondents indicated a daily burn increase of more than 25%
• ·         28% of East Coast organizations had 25%+ burn increases, vs 8% of West Coast organizations

In late April, Merritt Hawkins and The Physicians Foundation released national physician survey results that found

• ·         48% are treating patients through telemedicine, up from 18% in 2018
• ·         21% of physicians have been furloughed or experienced a pay cut
• ·         14% plan to change practice settings as a result of COVID-19
• ·         18% plan to retire, temporarily close their practices, or opt out of patient care

Also, the California Medical Association in late April released the results of its COVID-19 Physician Financial Health Survey, which found that "95% of physician practices are worried about their financial health due to the COVID-19 public health emergency. Practice revenue has declined by 64% since March 1, 2020, with 75% of practices experiencing a revenue decline of 50% or greater."

The Brave New Healthcare Strategic Venture World

By Clive Riddle, May 8, 2020

Strategic investing has escalated as a “thing” with health systems and health plans, and you’ll find the fingerprints of their various venture funds on an increasing number of important healthcare startup and acquisition transactions. Given our new COVID CoronaWorld will is leaving many providers and startups undercapitalized, the potential is there for stakeholders that manage to maintain a healthy venture fund to have an even greater strategic impact in the coming years.

BDC Advisors' Steve Weylandt, Dudley E. Morris, and Alan Trimakas published this April 27th article with HFMA:  8 hallmarks of a successful healthcare venture capital program that begins with "Developing innovative venture capital projects is rapidly becoming an essential element of the U.S. health system’s strategy to ensure long-term financial viability. In the past five years, healthcare venture capital programs and innovation labs have become essential tools for health systems."

Here are the "eight core principles and lessons learned from organizations that have achieved success with value-added venture capital management" that they elaborate on in the article:

1. Make venture capital a health system strategic priority

2. Clearly align corporate and venture capital investment goals

3. Make collaboration and coinvesting key parts of the strategy

4. Separate venture investing from operations

5. Build a culture that is reasonably tolerant of failure

6. Make sure to groom 'venture champions'

7. Focus on scale and implementation from the start

8. Engage health system leadership

A couple of weeks ago, Becker’s Health IT published an article on 15 digital health, telehealth startups that raised millions in the past 3 months that in addition to mentioning typical high-profile VC firms involved in the transactions, also noted involvement of Cigna Ventures and MemorialCare Innovation Fund funding a new round for AristaMD, the e-consult company; and MemorialCare Innovation Fund, LRVHealth, OSF Ventures and UnityPoint Health Ventures funding a new round for SilverCloud Health, a digital mental health platform.

Cigna Ventures in January announced strategic investment with two digital health innovation companies - Buoy Health and RecoveryOne. Buoy Health "brings an unparalleled depth and breadth of experience in leveraging artificial intelligence to facilitate real-time, high-quality and personalized care recommendations based on an individual's symptoms. RecoveryOne "combines the power of digital with the human touch by connecting individuals to one of 180 evidence-based care programs for musculoskeletal conditions ..With this approach, RecoveryOne addresses the significant gap between actual and desired outcomes achieved through traditional care."

Blue Shield of California funded the launch of Altais in August last year, at that time stating “The company, named after a star, has been in discussions with potential partners to launch services and tools to help physicians and their practices reduce administrative burden and spend more time with patients. Altais is also in discussions to eventually provide primary and specialty care services.” Given the strategic objective of many health plans to expand clinical integration, it should come as no surprise that last month Altais and Brown & Toland Physicians announced they have signed a definitive agreement that paves the way for Brown & Toland and its network of more than 2,700 physicians to join Altais Clinical Services, a subsidiary of Altais.

And Commonwealth Care Alliance this week announced their “Winter Street Ventures investment arm has led a $5 million funding round in LifePod® Solutions, Inc. (LifePod). CCA will also distribute approximately 10,000 of LifePod proactive voice units to its members across Massachusetts as part of a broader virtual care program the organization is deploying during the COVID-19 crisis. LifePod’s unique proactive voice capability enables providers and caregivers to check in with and create reminders for individuals with significant health issues, including older adults aging in place and chronically ill patients. Through this expanded relationship with LifePod, CCA will greatly enhance its ability to stay in contact with its members, and to check in on their medical, behavioral health and social needs at a time when home visits are severely reduced to protect public health and safety.”

What changes in healthcare due to COVID-19 will remain after the pandemic is finally in the rear view mirror?

By Clive Riddle, May 1, 2020

The new issue of MCOL ThoughtLeaders asks the question: “What changes in the business of healthcare are taking place during this pandemic that will most likely continue when the pandemic is behind us?” Here’s some highlights of what experts see on the road ahead:

Here are some of the lasting changes Lindsay Resnick, EVP, Wunderman Thompson Health, predicts:

1. Virtual care and telehealth education, acceptance and uptake – from scalability to care management to customer experience, plan for it.
2. Surge in uninsured and COVID-19 as a pre-existing condition will revitalize the push for healthcare reform, and keep healthcare a central 2020 election issue.
3. Changes in consumer spending combined with healthcare’s growing ‘out-of-pocket culture’ will exacerbate delays in care: treatments, prescriptions, elective procedures.
4. New, more prominent roles for nurse practitioners and physician assistants throughout the care continuum are here to stay.
5. Economic downturn and unemployment will be big influencers in insurance product selection
6. Sites of care will continue to move away from hospitals and physician offices to an array of retail clinic options and at-home care alternatives.

Ewa Kisilewicz , Principal, BDC Advisors, Among other things says “COVID-19 has deepened consumer desire to stay away from hospitals. Consumer-centric providers will respond by adding non-hospital ambulatory capacity. Since mid-March, CMS and states released a set of waivers to address anticipated staff shortages caused by COVID-19. While waivers will expire post-COVID, it will be difficult to go back to the ‘pre-COVID norm’ on the changes that improve patient access and expand scope of practice in medically underserved areas – in so far as they do not create patient safety concerns. Once these regulatory barriers are knocked down, there will be little justification to build them back up again.” She also says “physician practice acquisition by non-traditional competitors will also be “fast forwarded” and cause health systems to rethink physician engagement.”

Patrick Horine, CEO, DNV GL Healthcare, noted that “big data, artificial intelligence, and integrated information systems have been evolving for some time in healthcare, but the pandemic has brought about the importance of more timely information being available, connecting providers, tracking & reporting capabilities and the ability to use the data and apply artificial intelligence to it.” He also counsels that a “critical importance to hospitals as well as the government moving forward, is the emergency preparedness, business continuity and contingency planning that will enable a more effective response for any future pandemic,” and that “it will be essential not only within healthcare, but also in companies, and in life, that we have more diligent infection prevention practices in place as well as modification of behaviors to stay healthy.”

Mark Lutes, Chairman, Epstein Becker & Green, PC cautions that “the Public Health Emergency (“PHE”) will leave many health care providers (hospitals, SNFs, hospices, physician groups) seriously weakened…Those providers that are not strongly capitalized will seek new sources of capital and debt relief. In many cases, they will align with better capitalized competitors or new entrants willing to recapitalize the assets. The credit worthiness of patients/consumers has also been impacted by the PHE. The cohort of patients with commercial coverage will shrink lowering providers’ margins. These consumers may find themselves in managed Medicaid or Marketplace options affording less patient choice. Providers will need to be organized in such a way to successfully contract with the organizers of the networks serving these options.

Hank Osowski, Managing Partner, Strategic Health Group  reminds us that the Telemedicine paradigm shift in how care is delivered “will likely impact staffing and real estate models.” He also laments that “what is disturbing however is how reactionary the response has been for many sectors of the healthcare industry.”

And finally, Terri Welter, Principal, ECG Management Consultants, discusses in more detail the following:

• Financial positions are compromised, prompting market repositioning.
• Strategy One: Aggressively renegotiate health plan contracts
• Strategy Two: Reshape service lines to bolster margins.
• Outpatient growth will accelerate.
• Strategy Three: Invest in building the ambulatory network.
• Strategy Four: Revisit capital investment plans.
• Strategy Five: Change the economic and service relationship between physicians and consumers
• Health plan networks will become bigger competitors for health systems and their physician networks.
• Strategy Six: Partner with independent medical groups.
• Strategy Seven: Restructure health system physician enterprise organizations

Deploying SDoH Factors in the COVID Battle

By Clive Riddle, April 3, 2020

PWC’s Health Research Institute recent released: COVID-19: Six things health organizations should be considering (but might not be) offering six strategies that could be deployed in the fight against the pandemic. Number five on that list was SDoH:

“Strategies on social determinants of health can be an advantage in pandemic response. Trust-based relationships are important when people and communities are scared and unsure of what to do. Coalitions developed for pandemic response, much like social determinants of health interventions, should include trusted community organizations and providers that have access to hard-to-serve or underserved communities that may not be able to get information and support from traditional sources such as their employer or local government.”

A companion graphic noted "Less than 50% of primary care physicians said their practices coordinate with the right social service agencies.”

Health plans have come to embrace the SDoH component of removing economic barriers in treatment of COVID-19. While initially announcing waiver of any out-of-pocket costs for testing, more recently many health plans have issued announcements of waiving all treatment costs to consumers, including Aetna’s announcement on March 25^th,   Humana’s announcement and Cigna’s announcement on March 30^th, followed by UnitedHealthcare on March 31^st and Anthem on April 1^st.

Also, numerous health plans are making sizeable donations to COVID-19 relief efforts in their markets, including these:

Harvard Pilgrim Health Care Foundation Gives More Than $3 Million for Covid-19 Relief Efforts

Medica Donates $1 Million to Minnesota Non-Profits to Meet Emergency Needs from the Coronavirus

21 Organizations to Receive First $500K of $1M Committed by the Tufts Health Plan Foundation

Health Net Rolls Out $5.9 Million in COVID-19 Assistance for Those Serving Medi-Cal Members

But a more proactive approach in leveraging SDoH in the COVID-19 battle is being offered by analytics technology companies. Two such approaches were profiled in the April Care Technology Edition of Care Analytics News, discussing Jvion’s new COVID Community Vulnerability Map and Clarify’s COVID-19 Elderly Vulnerability Population Index (EVI) and the Clarify COVID-19 Patient Risk Profile

Jvion’s  COVID Community Vulnerability Map is built on Microsoft Azure maps, and enables healthcare providers and communities to identify the social determinants of health (SDoH) that put populations at greater risk during the COVID pandemic. Jvion states the map’s purpose is to inform “community planning and resource allocation to proactively mitigate the risk to vulnerable populations.” The Jvion COVID Community Vulnerability Map is available at https://covid19.jvion.com,

The interactive map identifies populations down to the census block level that are at risk for severe outcomes upon contracting a virus like COVID. Severe outcomes include hospitalization, organ failure and mortality. Additionally, the map surfaces the socioeconomic and environmental factors, such as lack of access to transportation or nutritious food, that put patients at greater risk. The map is also overlaid with points of interest, such as hospitals, food sources and transportation, in relation to the at-risk communities. These insights can help inform providers, public health organizations and community support agencies as they look to deploy interventions, outreach and other services to keep individuals from contracting the virus and, once infected, manage their care towards a positive outcome.

The map can quickly help local health departments prioritize their limited resources for response planning and adapt their tactics to the needs of neighborhoods and communities. By understanding the differentiated needs within their population, health systems can more adequately plan for healthcare utilization, deploy preventive or mitigating care resources, and anticipate the short-, mid- and long-term impacts of public health decisions, such as school and business closures.

Clarify Health announced that it launched two new critical applications in response to the needs of customers at the forefront of providing care to the communities impacted by COVID-19. The company is deploying the Clarify COVID-19 Elderly Vulnerability Population Index (EVI) and the Clarify COVID-19 Patient Risk Profile to healthcare organizations across the US to equip them with the patient risk insights that are needed to inform resource planning, interventions, and community initiatives.

The two applications leverage Clarify’s patient dataset, covering over 300 million lives, and AI capabilities. The solutions will reduce blind spots in patient risk by giving healthcare organizations access to an actionable COVID-19 vulnerability score for their elderly patients and a drill-down view into individual risk profiles and comorbidities at the point of care. Clarify’s COVID-19 EVI measures ZIP codes on relative vulnerability of seniors to severe coronavirus infection and delivers insights into their comorbidities, such as, cardiac diseases, respiratory diseases (including COPD), and cancer. The EVI provides hospitals, emergency services, health plans, and government agencies with the ability to identify neighborhoods which could benefit from greater testing or support services and prepare to take action quickly in high risk areas.

Clarify’s COVID-19 Patient Risk Profile is a web-based interface that highlights known risk factors for severe illness related to COVID-19. This capability is critical as frontline care providers struggle to proactively manage capacity and care for COVID-19 suspicious patients.

Seven Indirect COVID-19 Healthcare Business Implications, and Nostalgia for a 2020 Top Ten Healthcare Issues Infographic

By Clive Riddle, March 20, 2020

The HealthCare Executive Group (HCEG) recently released their 2020 HCEG Top 10 Infographic​ with summary data and insights garnered from the 10​th​ Annual  Industry Pulse Research Survey, which is shared below.

Of course, HCEG prepared the infographic based on their survey conducted well before COVID-19 sucked all the current oxygen out of the room in which most other healthcare issues are being discussed. Their survey results would undoubtedly look much different today, and almost feels nostalgic in a way.

Which poses the question – so how is COVID-19 impacting other key aspects of the business of healthcare.  Boundless information and discussion from true experts is coming forth daily on the public health implications and matters related directly to the pandemic. But what about the indirect implications, that will emerge as the year progresses?

Here’s a short list of seven items that come to mind, beyond the oft-stated concerns that the available healthcare clinician and support labor pool is at risk of being diminished from applicable quarantines, lack of personal protective equipment, and sickness within the healthcare workforce; as well as major concerns about hospital bed capacity:

1. RePrioritization: The strain on healthcare organizations while addressing COVID-19 issues, both as a provider and as an employer, will continue to cause other aspects of delivery of services to suffer as resources and attention are re-prioritized.
2. Deferral Cost: This will cause mounting deferral of non COVID-19 related care. Initially non COVID-19 healthcare costs and utilization will be lower than average, but after COVID-19 hopefully runs its course, these costs will escalate well above benchmark levels both due to pent-up demand plus increased services and costs with applicable worsening conditions resulting from deferral of care.
3. Uninsured: The uninsured population will increase significantly due to the economic slowdown driven by the pandemic and required response. Various past legislative and administrative measures to chop away at the ACA during the past three years will result in a weakened safety net.
4. Uncertainty: Uncertainty will reign in the short term for the general, and healthcare business environment, causing longer range business strategic initiatives to be paused.
5. Recession: Healthcare capital spending, M&A activity, and long-range initiative funding such as SDOH investments will thus slow down as this new Recessions escalates.
6. Policy: Healthcare election year policy reform issues will morph, both addressing public health policy issues, as well as coverage issues as the uninsured population increases.
7. Permanent Changes: Some required changes to clinical and business practices during this pandemic will evolve into longer range changes in clinical practices and how healthcare organizations do business.

Successful healthcare organizations in 2020 will somehow juggle and balance navigating the COVID-19 landscape while still keeping an eye on the ball of all the other issues that remain or result after COVID-19 hopefully subsides.

Speaking of keeping an eye on the other balls being juggled, and thus getting back to the HCEG infographic, here’s a reminder of their top ten items 2020 listed in the infographic, which we someday, somehow need to find our way back to, when we’re ready to move forward:

1. Cost& Transparency
2. Consumer Experience
3. Delivery System Transformation
4. Data & Analytics
5. Interoperability / Consumer Data Access
6. Holistic Individual Health
7. Next Generation Payment Models
8. Accessible Points of Care
9. Healthcare Policy
10. Privacy / Security