Sanjay Basu is a primary care physician and epidemiologist. He is the director of research at the Harvard Medical School Center for Primary Care as well as the VP of research and population health at Collective Health, a healthcare plan administrator.
When COVID-19 cases began rising in the U.S. in early 2020, healthcare providers mobilized quickly to develop guidance and care for people who had contracted the virus. Due to shelter-in-place orders, providers devised virtual solutions and low-contact options for virus screening and wraparound services like mental and behavioral health support. Though the healthcare system was stretched thin and health professionals were overworked, major cities like San Francisco managed to maintain infection rates below levels of hospital capacity in conjunction with strong public health mandates in the community.
But COVID-19 cases are skyrocketing once again all over the country, putting hospitals near or over capacity, and the decision to decentralize the coordination, phasing and scheduling of vaccine distribution has led to frustrating delays in rollout. What's more, people who have otherwise recovered from COVID-19 are reporting complications including blood clots, shortness of breath, joint and chest pain, and neurologic and mental health issues. A recent study in Boston hospitals found that many survivors still require supplemental oxygen (15%), tube feeding (9%), or treatment with medications including antipsychotics and prescription painkillers (16%).
These long-term health complications occur at a time when many people have delayed or deferred their usual care for chronic diseases. In addition to preventing new cases and treating existing cases, we now need to quickly come up with a way to prevent and mitigate enduring health issues for COVID-19 survivors, as well as catch up on deferred care for conditions like heart failure and diabetes.
This challenge is further complicated by the fact that communities of color are at higher risk of contracting COVID-19 and face deep-rooted disparities and inequities in healthcare access and quality. Many COVID-19 survivors are people of color and/or low-income individuals who face substantial barriers navigating a healthcare system that is biased against them.
Though healthcare is slowly becoming more person-centered and prevention-focused, the pandemic has highlighted the urgent need for a national health insurance revamp. In the U.S., navigating healthcare and health insurance is a notoriously difficult and complicated process.
Patients often need to self-advocate to ensure they get treated promptly and correctly, but language barriers, complicated benefit options and unresponsive or unhelpful patient support teams keep countless people from getting the care they need. And that's especially true for those most at risk of health issues — slipping through the cracks can, and does, mean tragedy.
In this broken system, many organizations involved in healthcare capitalize on patients' misunderstandings and lack of insider knowledge. Insurers are one of the most visible offenders. We know patients are receiving devastatingly expensive, surprise bills for COVID-19 tests and treatments they thought were covered by insurance, but these stories are unfortunately becoming routine.
Massive, unexpected bills, out-of-network challenges and denied care or claims are common experiences for anyone who's dealt with U.S. healthcare. Responding to COVID-19 and its long-term healthcare implications will push our existing healthcare system to its breaking point, and providers simply cannot manage this crisis alone.
To meet current healthcare needs and improve health, all parts of our system must adapt and align to meet this crisis. Payers must align incentives and benefits to ensure every American accesses the care they need during and after the pandemic, and providers must work to proactively recommend and administer preventive care and chronic care management through a robust primary care system.
Preventive care and chronic care management delivered through comprehensive primary care works to improve people's health and can drive down costs when implemented holistically — in our experience, Collective Health's Care Navigation program, which helps people make-up missed cancer screenings, convert their medications to mail order delivery, and navigate the healthcare system to high-quality providers, among other interventions — resulted in $10.38 in healthcare savings per employee per month.
Care Navigation relies on machine learning using data on social determinants of health and teams of health professionals well-versed in the dynamic psychosocial, pharmaceutical and medical issues of at-risk communities to reach people in need of comprehensive care coordination.
One of our key studies in this field showed that social determinants of health were major drivers of cost-producing health risk factors like uncontrolled high blood pressure. Improving social determinants of health — such as arranging transportation to medical visits, providing food bank and food voucher resources for those with food insecurity and diabetes, and helping to address bills and other expenses that people often have to pay instead of medication copayments or office visit costs — can critically improve health outcomes, according to our research.
Most existing preventive care efforts are inadequate because they make patients take the first step to enroll or navigate the system. That's not truly proactive. Patients, who cannot be expected to navigate the dizzying complexity of claims adjudication and benefit denials, bear the brunt of navigation work and are often forced to hound their insurers and care providers to schedule care and get it covered.
While healthcare organizations such as Collective Health are doing whatever they can to reduce the navigation burden for patients, payers must now step in to better serve those at risk of the dangerous, lingering effects of COVID-19, both with coordinated value-based care that incentivizes hospitals and clinics to improve actual health outcomes, not necessarily do more tests or procedures or make most of their money late into a person's illness when their care is most complex and expensive. Our research has shown that transitioning to value-based care will take major reforms to healthcare payment standards, but many payers are starting this work proactively during COVID-19.
Our work to collectively heal after COVID-19 doesn't end with prioritization of navigable and proactive care, or even vaccine availability and distribution. The consequences of this virus will live with us for years to come, but by making smart decisions on transforming healthcare now, we can achieve a healthier future.