What Past Pandemics Can Teach Providers About Improving Financial and Clinical Outcomes Among Difficult-to-Engage Patient Populations During COVID-19

The COVID-19 crisis has drastically changed the way people interact with the healthcare system, especially the most vulnerable patients. Those who are most impacted by this change are also the most sensitive: patients with chronic conditions and older adults.

Financial reductions on the provider side combined with a fear of COVID-19 infection on the patient side creates pressure on patients to make do on their own without their usual health touchpoints. In essence, everyone has, to some degree, been introduced to the experience of being a rural patient — where care is more difficult to access.

By examining past infectious disease outbreaks, we can gain valuable insights into how these dynamics affect the financial and clinical outcomes of health systems and offer strategies for improving patient engagement in healthcare throughout pandemic conditions.

Lessons From the SARS Outbreak

One study from 2008 assessed the long-term impact of SARS on the performance of one hospital, designated an infectious disease facility during the pandemic, near the epicenter of the outbreak in Taipei.

The study’s authors reported that family medicine and psychiatry spiked for two years after the outbreak, while internal medicine and some specialties such as pulmonary medicine took years to return to prior volume. This was due, in part, to a lack of trust between patients and healthcare facilities regarding safe clinical conditions for vulnerable patient populations. The decline in utilizations during and after the SARS outbreak resulted in revenue drops that further weakened resource-strapped providers.

Another post-SARS analysis from 2012 showed that a drop in utilizations had a negative impact not only on provider revenues, but also on patient clinical outcomes. In this study, researchers observed that diabetes deaths increased by more than 8% during the SARS outbreak — and cerebrovascular deaths by more than 6%. Researchers also explained that reduced hospital utilization by diabetes patients led to poor blood pressure control, which increased their risk of stroke and heart disease mortality.

In this case, healthcare providers focused the majority of attention on high-morbidity conditions and overlooked care for patients with other chronic diseases. The impact of this shift in focus shows that when patients weren’t able to use healthcare as they normally would, their conditions worsened, deaths increased, and the long-term cost of treating patients with uncontrolled chronic conditions increased.

From these two studies, we can conclude that infectious disease outbreaks initiate a three-fold impact on healthcare systems: revenue drops, costs increase, and deaths increase. What can health systems do with these lessons to mitigate the same issues during the current COVID-19 crisis?

Recommendations for Maintaining Positive Clinical and Financial Outcomes During Pandemics

Research on the effects of past large-scale infectious outbreaks suggests that proactive outreach is a critical step toward managing noninfectious disease amid pandemic conditions. Healthcare strategies for vulnerable populations should focus on identifying opportunities to intervene and prevent worsening symptoms. Proactive patient engagement solutions can help providers identify which patients to reach out to and when, even when patients might not recognize the need for these interventions on their own.

Anecdotal evidence points to the fact that older, non-tech-savvy patients and those with high disease burden do not proactively seek out care, a situation which is further exacerbated by the gap between telehealth-based patient engagement for the masses and robust monitoring for high-risk, homebound patients. This creates a problem in which those who are at the highest risk of COVID-19 and those who can no longer safely obtain the healthcare to which they are accustomed are also the most difficult to engage.

To solve this problem, improve clinical outcomes, and remain financially sustainable during pandemic conditions, health systems must match their clinical and operational approach with patient capabilities — their level of tech savvy and their level of health literacy — and financial ROI.

For example, tech-savvy, low-risk patient populations might respond well to a digital front door such as a web-based patient portal, and high-risk populations might warrant a full monitoring suite. However, the brittle well, or those in the rising-risk category, should receive attention and investment that is cost-effective and scalable, as well as evidence-based.

Avik Som, MD, Ph.D., who is the chief medical officer and co-founder of CareSignal Deviceless RPM and a practicing physician at Massachusetts General Hospital, noted that this is precisely the kind of care CareSignal supports:

“CareSignal is designed to fill the engagement void for patients who aren’t at the highest risk but could rise into that category quickly,” said Dr. Som. “When patients are afraid to come to the hospital, providers can’t rely on patients to reach out with concerning symptoms; we have to be proactive and enable patients to raise their hands more easily. At the end of the day, our job is to provide care for all patients, not just those whose conditions have already deteriorated.”

The silver lining, as every health system in the country already knows, is that the Centers for Medicare & Medicaid Services is actively supporting this type of work. From the Federal Communications Commission’s $200 million in grants to a pragmatic, phone-only requirement for telehealth Current Procedural Terminology codes, now is the right time to guide clinical and business operations toward rising-risk patient engagement in healthcare.

Learn More:

To hear how providers from Mercy, OSF Healthcare and Esse Health are offering remote patient engagement to more patients and creating clinical and financial outcomes, check out the Becker's Hospital Review webinar.