Webinar Recap – Healthcare, Interrupted: Helping Members Navigate Their Return to Care

Categories: Employers Resources, Expert Medical Opinion, Navigation, Webinars

Our Jan. 13 webinar, “Healthcare, Interrupted: Helping Members Navigate Their Return to Care,” took a look at the ways that labor or HR/benefits leaders can successfully improve their members’ healthcare experience even in the face of COVID-19. More specifically, Charlie Hamilton, Consultant, Local 338 RWDSU/UFCW; Ben Pauley, CEBS, Director of Labor and Public Sector at Grand Rounds; and myself, Todd Thames, MD, MHA, FAAFP, Senior Regional Medical Director at Grand Rounds went over:

  • The long-lasting impacts of COVID-19 on healthcare in the U.S.
  • A return to care strategy that helps members navigate the system to get the medical, administrative and financial support they need.
  • How Local 338 partnered with Grand Rounds to drive significant value for its members.

Following are some highlights from the hour-long presentation.

 

COVID-19 Has Changed Healthcare as We Know It

Healthcare in the United States is hard to navigate, even in normal times. Then the pandemic hit, bringing more intense pressure on the system. COVID-19 created an inflection point, changing how we’ll deliver healthcare in the U.S. going forward. This inflection point triggered:

  • Increased uncertainty around coronavirus-related health insurance coverage (what is and isn’t covered) and vaccines (who can get it and when).
  • A decrease in access to care during the early part of the pandemic as doctors’ offices and hospitals canceled or delayed care, while a number were forced to shut down.
  • A spike in behavioral health needs, which can severely impact physical conditions—about 68% of behavioral health needs tend to co-exist with physical conditions.

What then is the new normal for the future of healthcare? Certainly, there’s been a massive acceleration in the use and adoption of telehealth solutions. Telemedicine utilization grew by about 8000% year on year from April 2020. Utilization levels will likely stabilize somewhere above where it was before the onset of the pandemic.

Previously, telehealth served mainly tele-urgent needs—for example, respiratory infections. The pandemic has brought about a dramatic shift in telemedicine visits for chronic conditions like blood pressure, arthritis and diabetes. Leveraging virtual care to address these types of conditions, which often require frequent visits, could really help improve access to care, making patient-centered care truly about meeting members where they are.

That said, virtual care isn’t reaching everyone equally. Adoption has lagged in lower-income areas, where access to broadband is limited. Members in these areas are about 46% less likely to receive virtual care for major chronic conditions than members living in higher-income zip codes. This is going to be a challenge that we’ll want to dedicate resources to helping solve as we look to how to best use telehealth to improve access for our members, no matter where they live.

 

Local 338 Achieves Better Outcomes and Lower Costs for the Fund and its Members

The mandate for Local 338 Health and Welfare Fund, which provides health benefits to roughly 3,300 full-time members and covers about 6,000 lives, has been to improve service to our members and keep costs under control. Local 338 partnered with Grand Rounds in June 2018 to help achieve its mandate, using expert medical opinions (EMO) to connect its members to high-quality providers who could help get them to the right diagnosis and treatment. This in turn has led to better outcomes and lower costs to both the members and the fund.

The partnership resulted in:

  • An 83% change in treatment with Grand Rounds’ EMO service.
  • A 50% change in medications also via EMO.
  • A 90% improvement in provider quality.

In addition, accurate and timely guidance to COVID-19 testing via Grand Rounds’ healthcare navigation service has proven to be invaluable for Local 338’s members, all of whom are essential workers and under extreme stress as they face the possibility of being exposed to the virus on a daily basis. Having the help of Grand Rounds has improved the odds of a positive outcome and avoided unnecessary or inappropriate care for its members.

 

How to Find a Partner That Can Improve the Member Experience

When it comes to searching for a partner who can help navigate a safe and optimal return to care, look for one that will:

  1. Provide members with options for how they want to engage via high-tech and high-touch services—whether by app-based video, phone or text.
  2. Proactively identify and reach out to members regarding their healthcare preferences and the actions they can and should take to stay healthy based on their specific needs.
  3. Stay rooted in clinical expertise with a focus on provider quality; this includes coordinating longitudinal care that delivers a smooth and seamless experience.
  4. Administer complete, patient-centered care for all of your members, one that addresses the full range of medical, mental, social, family and financial concerns.

Getting connected to high-quality providers via a matching engine or concierge referral service really matters. For example, we found that primary care providers in the top 10th percentile were:

  • 30-40% more likely to conduct appropriate cancer screenings.
  • 30-70% less likely to prescribe high-risk medications.
  • More than 90% less likely to be sanctioned in the future.

Through earlier disease detection, appropriately administered treatment protocols and reductions in unnecessary procedures, these high-quality providers can help provide significant time and costs savings to members.

That’s why it’s important to find a partner able to provide your members with tools and access to a clinical team that can help them better manage their health. This in turn will improve the overall healthcare experience while delivering better outcomes for the fund or employer.

Learn more about our expert medical opinion and health care navigation solutions

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