Ready or not health plans and physicians, consumers want to access your digital front door. And the Centers for Disease Control and Prevention (CDC) has strongly recommended that people call before they seek medical care for COVID-19. Call volumes, and the need to appropriately triage those calls, have never been greater.
As you might expect, primary care practices are very much feeling the strain of the COVID-19 pandemic. Weekly surveys by the Primary Care Collaborative found:
- Nearly eight in 10 clinicians (79.4 percent) report their practice is under “severe” or “close to severe” strain due to COVID-19.
- The #1 stressor is patient questions with nearly 75% saying they are overwhelmed by virtual inquiries.
- In week 3 of the survey, March 27-30, 2020, 39 percent report their practice has no video visits, down from 60 percent in week 2.
- Close to half (49 percent) say their practice has no e-visits, down from 70 percent the week before.
- More than half (55 percent) of primary care practices say their practice is conducting 50 percent or more of patient visits by telephone.
COVID-19 and Co-Morbidities
Early research conducted by the CDC suggests that patients in the United States with underlying health conditions “appear to be at a higher risk for more severe COVID-19, consistent with findings from other countries.” The percentage of COVID-19 patients with at least one underlying health condition or risk factor – diabetes mellitus, hypertension, COPD, coronary artery disease, cerebrovascular disease, chronic renal disease, and smoking – “was higher among those requiring intensive care unit (ICU) admission (78 percent) and those requiring hospitalization without ICU admission (71 percent) than that among those who were note hospitalized (27 percent.)”
Given the research connecting COVID-19 impacts and co-morbidities, health plans and physician offices need ready access to this information when patients are seeking guidance. Hence the importance of the digital front door.
Imagine Lucy. She’s concerned she has been exposed to COVID-19. She lives with two teenagers and is the part-time caregiver for her 73-year-old father, Joseph.
First, she calls her primary care physician’s office. Jess, a patient intake specialist, answers her call. When Lucy tells Jess she wants to know if she should get a COVID-19 test, Jess first accesses her patient record. Jess can readily see Lucy has diabetes, which puts her at higher risk for COVID-19 impacts.
Jess asks Lucy a series of questions that are embedded in the care management platform the physician practice uses, including:
- Do you have confirmed or possible exposure to COVID-19?
- Do you have recent travel from a high-risk area or community with known spread?
- Do you have symptoms?
Given Lucy’s symptoms, her diabetes diagnosis and her possible exposure from her son who was exposed to COVID-19 during spring break, Jess refers Lucy to the nurse care manager for clinical assessment. The nurse care manager uses the clinical questions embedded in the care coordination platform to assess her level of exposure to the virus, such as:
- Do you have a fever?
- Is your fever greater than 100.4 degrees?
- Do you have a cough?
- Do you have shortness of breath?
The nurse care manager refers Lucy for testing and, as a follow up, emails her educational information, What to Do If You’re Sick with COVID-19, and testing information. Lucy’s clinical assessment and the email with follow up information are saved within the care management platform.
Her doctor’s use of a care management platform is a key component in the practice’s digital front door strategy. For Lucy, this means her doctor’s office immediately understood she was at higher risk of COVID-19 impacts due to her diabetic condition, and given her symptoms, was able to quickly route her to testing.
Next, Lucy called her health plan to determine if the COVID-19 testing would be paid for by the insurer. Emily, a member services advocate at the health plan, answers Lucy’s call. Her health plan implemented a digital front door strategy last year, allowing Emily to see holistic member information and direct access to care management resources.
As Emily answers the call, detailed information about Lucy is presented on her screen. In addition to seeing eligibility, demographic and claims information, data that is commonly available to health plan service agents, Emily can also see a broad range of member alerts and important contextual information. In Lucy’s case, she sees her diabetes diagnosis.
Lucy asks Emily if COVID-19 testing will be paid for by the health plan. Emily assures Lucy that her health plan, like many payers, is waiving member cost-sharing for testing and treatment of COVID-19. Emily helps Lucy find a testing site near her home, and lets her know the site is open now.
For hospitals and physician organizations seeking a free, lightweight care management solution for COVID-19 patients, visit: https://content.geneia.com/2020/covid-19-care-management-for-healthcare-professionals/index.html.