Pivoting Care Management Programs to Mitigate the Impact on Physical and Mental Health

Care Management Programs

The COVID-19 pandemic has intensified the need for care management programs to pivot from population health management to cohort care management as a way to mitigate the effects of stress and anxiety caused by the pandemic coupled with social determinants (SDoH) issues like reduced provider access, financial instability, as well as employment and environmental safety concerns.

Why is Cohort Care Management Needed Now?

Cohort care management equips your organization to identify and focus on micro-communities within your population. These are patients with modifiable and avoidable risk who could benefit from a personalized approach to care management. Studies have shown that cohort care management can help health systems achieve a 37 percent reduction in avoidable ED visits and 30-day readmissions.

Cohort care management is accomplished via trusted relationships, where care managers engage the whole person and catalyze commitment to a set of “next best actions” that will reduce risk. Technology and analytics enable care managers to easily reach across organizations and systems, gather and use data in ways that leverage the power of the population guidance yet are personalized to the specific needs of the person in their care.

To best address the needs of cohorts, supplementary technical solutions may require rapid deployment, augmenting existing large care platforms, and achieving the prompt response and value that is warranted by the pandemic.  These micro-solutions should be flexible, nimble, and easy-to-deploy, enhancing your current care management programs and weaving together disparate systems.

Four Pandemic Populations Needing Cohort Care Management

COVID-19 presents a once-in-100-years pandemic that, according to Pew Research, causes 20 percent of people to physically react and report experiencing nervousness or anxiety during the past week. When the health effects of social determinants compound the stress and anxiety caused by the pandemic, the impact is particularly harmful to the mental and physical health of four specific populations.

Focusing on, and proactively addressing, the needs of these high-acuity populations allows providers and payers to avoid unnecessary, and risky, emergency department visits and hospitalizations while supporting better outcomes through effective cohort care management to minimize pandemic-related physical, medical, and mental health damage.

Population #1: Front Line Healthcare Workers and First Responders

Healthcare Workers

Front-line healthcare workers and first responders will need long-term resources to fully recover from the experiences they’ve amassed during COVID-19. The pandemic is adding to the emotional fatigue physicians were facing pre-COVID-19 as 50 percent of physicians were battling burnout. This population is having similar symptoms to veterans of war, supported by research from the Department of Veterans Affairs. They report five to ten percent of survivors with PTSD may have lasting relationship issues, which, at their most extreme, include psychological and physical aggression against their partners and family members.

Population #2: Patients with Chronic Conditions Like Diabetes, COPD, Hypertension

Chronic Health Condition

Stress can affect diabetes control, both directly and indirectly.  For instance, access to healthy, affordable food, heightened for underserved populations, affects glucose control, and increases stress. Adapting diabetes-focused stress management interventions can address diabetes-related stress while improving resiliency, improving health outcomes. For an individual with COPD, stress has been associated with more depressive symptoms and worse quality of life. Research on other prevalent conditions, affecting half of the U.S. population, indicates this population’s need.

Population #3: Patients at Greater Risk for Developing Chronic Conditions

Chronic Health Conditions

According to studies by the Center for Disease Control (CDC), 82 million people are currently pre-diabetic in America. Stress can also cause hypertension through repeated blood pressure elevations.  Plus, the pandemic is causing patients to delay needed treatment. When coupled with increasing SDoH issues like reduced provider access, economic and unemployment instability, and environmental safety, patients will start developing new chronic conditions.

Population #4: Patients with Exacerbated Behavioral Health Conditions

mental health

Thirty-four percent of the population is currently battling a diagnosed behavioral health condition like anxiety, depression, and addiction.  The Journal of Nervous and Mental Disease reports that amongst patients with a diagnosed behavioral health condition, there is a 25 percent comorbidity with cardiovascular disease, a 65 percent comorbidity with diabetes, and an 82 percent  comorbidity with high blood pressure. When we consider the increased stress and anxiety caused by the COVID-19 pandemic affecting provider access, economic and unemployment instability, as well as environmental safety concerns, and compound that with the daily stressor caused by their diagnosed behavioral health conditions and comorbidity (e.g., diabetes-related stress), the need to effectively obtain better health outcomes for these segments of the population become substantial.

Addressing Pandemic Populations Now

Individually, each of these cohorts represents a significant spend on a health system or health plan.  For example, the American Diabetes Association reports that the total expenditure for your organization could be 4.5 times higher for a person with comorbidity of diabetes and a behavioral health condition. Extrapolate across other diseases, and add any of the new cohorts highlighted above, and a multi-factor net effect on outcomes and cost is revealed.

The untoward effect of the pandemic will continue to emerge and mount. However, the need to pivot traditional care management efforts to address key pandemic populations is upon us. Healthcare providers and plans need support and solutions to pivot, reallocate resources, and arm care and nurse managers to mitigate the effects of stress and anxiety through proactive and focused cohort care management.

Free Tool: Cohort Care Management Value Calculator

SDLC Partners has modeled a Cohort Care Management Value Calculator to estimate the potential effects of stress and anxiety caused by the COVID-19 pandemic.

Specifically, this tool will help you visualize the cost impact of stress and anxiety on two well-established, high-acuity patient populations – diabetes and behavioral health patients.

These projections can inform decision-making about how to pivot your care management programs for better outcomes and efficiencies in the months to come.

Download Value Calculator

Additional References:

Author
Christopher Shipton
Senior Consultant/CMP, Healthcare Solutions

Christopher has over 20 years’ experience in healthcare information systems from electronic records to revenue cycle management, document management, systems integration, clinical content design, and training and support. He has worked across primary and subspecialty services with some of the largest and most respected healthcare organizations in the United States, including Highmark, Boston Medical Center, Montefiore/Einstein Weiller, Medstar Health, Health First, Baptist Health.

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