Grand Rounds Blog

Many months into the COVID-19 pandemic, the healthcare system and economy as a whole continue to experience significant disruptions. These disruptions have created major gaps in care for us as well as our families, friends and colleagues. And it has made it even harder for members to make their way across the most challenging healthcare landscape in our lifetime.

We see three major problems that are hampering members’ ability to access and navigate the healthcare system:

  1. Increase in demand for healthcare from 97% of members whose care was canceled due to COVID-19.
  2. Reduced access to care, especially specialty care, as practices experience financial and staffing challenges and traditional telehealth does not offer access to specialist care.
  3. Increased confusion among members about their healthcare options, associated costs and how to handle complex/chronic conditions.


Demand for Healthcare Will Increase Amidst a Decrease in Provider Availability

Due to COVID-19, one out of three members have canceled in-person procedures and appointments. And, this will cause a spike in demand later this year and into next year, as an estimated 97% of these members try to reschedule their appointments.

¹“Helping US healthcare stakeholders understand the human side of the COVID-19 crisis: McKinsey Consumer Healthcare Insights.” April 2020.

The problem with this is that there simply will not be enough primary, and more importantly, specialty providers. 

Primary care physicians are under extreme pressure. Less than 50% of practices report having enough cash on hand to stay open, while over one-third have laid off or furloughed staff in the last month. Now that patients are trying to reschedule appointments with a primary care physician (PCP), they’re having a hard time finding available PCPs. What we’re seeing is a significant reduction in access to preventive care and an increase in poorer, more expensive health interventions.

Additionally, in-person specialty care has decreased by over 60% nationwide. With offices and hospitals only just starting to reopen, high-risk patients with cancers, heart problems and chronic conditions find themselves playing a dangerous waiting game as they try to reschedule long-overdue appointments and treatments. 

Though traditional telehealth can address typical urgent care needs – like providing a new inhaler or treating an infection or sprained ankle – it does not offer access to specialist care like cardiology or oncology. As a result, traditional telehealth will not prevent the gaps in care from widening.

With diminished access to primary and specialty care, members with comorbid conditions are becoming increasingly more vulnerable. These are individuals who require complex and consistent care. But they’re the least likely to seek it out, because they don’t want to risk getting exposed to the novel coronavirus. After all, COVID-19 patients with an underlying condition are six times as likely to be hospitalized and 12 times as likely to die when compared to individuals with no such condition, as reported by the Centers for Disease Control and Prevention. In addition, 86% of COVID-19 deaths have involved at least one comorbidity.


Confusion Has Increased Around Healthcare Choices and Costs

For the majority of members, healthcare was complex and confusing even before the pandemic. Now, with severe reductions in access coupled with ever-changing and unclear regulations, members are even more confused about how to navigate the system and get the care they need.

When it comes to COVID-19, members may not know where to get tested or how much it will cost them. The federal government mandated that insurance companies cover medical costs for COVID-19 patients, including those who are presumptive positive for the virus. However, many presumptive patients who don’t receive the test but do receive treatment have subsequently been surprised with balance bills totaling thousands of dollars.

To avoid the headache and confusion around costs, some patients have chosen to opt out of the healthcare system entirely, thereby putting their health at risk. For example, doctors report that patients are “not showing up until they can barely breathe from heart failure.” As a result, members are realizing that now more than ever, it’s important to get the kind of support and expertise that will empower themselves and other members to seek appropriate care.


COVID-19’s Impact on Business Continuity Is Making it Harder to Navigate the Healthcare System

Oftentimes, it’s the administrators that members lean on to help them navigate the healthcare system and get them to the lowest-risk, most cost-effective care—whether for COVID-19 testing or to address a chronic condition. With the pandemic, members’ dependence on benefits administrators for all things healthcare has grown. And while they’re doing their best to meet members’ individual needs, they’re finding members’ needs competing with—and potentially taking a backseat to—the monumental task of developing long-ranging, comprehensive plans to sustain ongoing operations so that their funds can weather the storm brought on by the pandemic.

With GDP forecasted to drop by an annualized rate of 38% in the second quarter of 2020, funds are finding that, in order to maintain business continuity as well as meet their financial goals, they must do everything they can to keep their members healthy and safe—and get members who’ve fallen ill back on their feet again. The future of work very much depends on these funds finding optimal ways to continuously support their members in getting the care they need.

Check in later for the next blog post, which will present a solution comprising a model for healthcare navigation, including a holistic approach to telemedicine.

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