In addition to the health problems directly caused by COVID-19, the crisis has also resulted in a slew of other issues due to patients delaying and deferring care over the past year. As one recent report from Humana and the Medical Group Management Association (MGMA) put it, “The country’s health problems didn’t disappear during the COVID-19 pandemic, but for thousands of medical practices nationwide, the patients needing treatment did.”
That report, “No Time to Waste: Deferred Care and Pandemic Recovery,” was largely based on MGMA polling throughout the pandemic, and “paints a startling picture of the disruption caused by COVID-19,” according to researchers. For example, the research pointed to 97 percent of practices reporting a drop in patient volumes by early April, with safety (87 percent) ranking as the top reason patients cited for deferring care during the pandemic, followed by job/insurance loss (9 percent) and other issues (4 percent), such as elective surgery bans, visitor restrictions in clinics or noncompliance with mask/safety requirements.
The impact of these decisions—primarily delaying preventative care and falling behind on routine health maintenance— has the potential to be drastic. The Wall Street Journal reported in October that the shutdown of much of the U.S. healthcare system for non-emergent care led to hundreds of thousands of cancer screenings being deferred. “Because many cancers can advance rapidly, months without detection could mean fewer treatment options and worse outcomes, including more deaths,” the piece stated, noting a National Cancer Institute estimate from earlier in 2020 that missed screenings and other pandemic-related impacts on care could result in about 10,000 additional deaths from breast and colon cancer alone over the next 10 years.
The Primary Care Collaborative has also been tracking such trends over the last several months, and in a late November survey, reported that 37 percent of primary care clinicians said their patients with chronic conditions are in “noticeably worse health resulting from the pandemic.” This is due, in part, to visits that are not happening: 56 percent of surveyed clinicians said they have seen an increase in negative health burdens due to delayed or inaccessible care.
Of course, the health needs of patients vary greatly across a number of factors. Seniors—many of whom are particularly vulnerable to the virus—need the highest level of protection from COVID-19, but it’s important that protecting them from the virus should not inadvertently put them at greater risk for complications from other, non-COVID issues, including cancer, heart disease, and depression.
Partners in Primary Care is a Louisville, Ky.-based wholly owned subsidiary of Humana that places a strong emphasis on providing senior-focused primary care to members of Medicare Advantage health plans. The primary care medical group practice operates centers in eight U.S. states, caring for nearly 60,000 patients. Early on in the pandemic, Partners’ leaders understood the importance of being proactive and working with patients to understand what their overall health goals were, and what Partners needed to do to help and facilitate, not only with disease identification but also slowing down disease progression, says Renee Buckingham, president of Partners in Primary Care.
Like many patient care organizations, Partners focused on two areas at the pandemic’s onset last spring: shifting care delivery to virtual when appropriate, and instituting safety protocols in line with CDC guidelines. Indeed, while some hospitals and physician practices went “all-in” on telehealth, Partners—which conducted nearly 40,000 combined video and telephonic visits over the course of the year—knew that wouldn’t be enough to ensure that its seniors were not missing out on important appointments.
Recognizing that they weren’t going to be able to get every patient to physically come in, while also understanding that telehealth can’t solve all healthcare issues, Partners came up with what Buckingham calls “some creative solutions,” including in-person visits where patients remain in their car as a staff member takes an iPad out to them, with a medical assistant facilitating the visit curbside. In another scenario, Partners would send caregivers into the home with appropriate PPE to ensure safety. “There was lots of work spent focusing on remaining connected to our patients, continuously encouraging them to take care of themselves, and focusing on what they needed in order to make sure that that their care would not have a gap,” Buckingham says.
An increase in visits in 2020?
While many medical practices have had to shut down under the stress of the pandemic—thousands, according to the Physicians Foundation—Partners’ 56 care centers have remained open throughout the crisis. What’s more, seniors actually made more visits to their primary care doctor in 2020 than 2019, with 87 percent of Partners’ patients making one or more visits to their local center compared to 75 percent in 2019, based on claims data through October 2020, officials noted. And in the case of annual wellness visits (AWV), 94 percent of at-risk patients had a comprehensive AWV in 2020, up from 89 percent in 2019, they added.
Buckingham and the organization’s other senior leaders believe that operating under an integrated, comprehensive, value-based care model has enabled Partners to offer a unique patient care experience to seniors, while also avoiding financial disaster during the crisis since it mostly takes capitation or global capitation for the care they provide.
They note that all Partners in Primary Care centers are staffed by board-certified physicians and care teams who have been specially trained to treat the senior population. Further, physicians spend more time with their patients—well more than the 10 to 15 minutes in most practices—and care teams focus on creating personalized care plans designed to help patients achieve their best possible health. This includes helping patients with social, behavioral and financial needs, they state.
Specifically, says Buckingham, “We've invested in nurse care coaches, social workers, and behavioral health specialists and pharmacists, who collectively work with the primary care physician to ensure that the care plan that has been agreed to between the patient and the physician gets executed. We also commit to treating the ‘whole person,’ so we address things like food insecurity and housing disparity, because all those things have an impact on health. We have invested heavily in things that have a positive impact on outcomes for our patients that are not paid for by fee-for-service medicine. And because many primary care physicians practice fee-for-service medicine, they have not been able to afford to invest in [these areas],” she contends.
Ultimately, says Buckingham, “Despite what we hear about seniors being resistant to coming outside the home [during the pandemic], I think that our [results] demonstrate the deep relationship that we have with our patients that was established pre COVID, the trust that they've placed in us, and their willingness to engage with us—despite an unwillingness to engage with others,” she asserts.