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The Patient Journey is Changing – Here’s How Health Plans Can Prepare

Changing Patient Journies-Blog

The patient journey has never been a simple thing to capture. With the industry's heavily siloed approach to data, charting a full, start-to-finish picture of how each patient interacts with the healthcare system is a massive challenge. 

The pandemic has only made this harder, rattling employment trends and insurance coverage, complicating existing health concerns, exacerbating disparities in care, and advancing telemedicine in a way that the industry has never seen before. 

To address this new landscape, health plans and payers will need to move beyond traditional approaches founded on incomplete data and arm themselves with a level of insight that matches the complexities of the future patient journey as we emerge from the pandemic. 

Employment Gaps Will Leave Messy Coverage Histories and Access Challenges

Around the country, patients have seen massive disruption in employment – weekly job loss claims exploded to 6.65 million for the week that ended on March 28, 2020; and this year, the economy has recovered one million jobs in March alone. 

In turn, the U.S. is currently facing some of the largest health insurance coverage losses in history, as well as substantial coverage changes. Even as the employment rate began to recover in the second half of the year, an Urban Institute analysis of census data found that at least three million Americans had lost job-based coverage by the end of 2020. This trend has had a  disproportionate impact on Black and Hispanic workers. More recently, over half a million Americans have signed up for coverage through healthcare.gov in 2021 alone, an indication of significant gaps and changes in coverage across the population.

But the issue extends beyond job loss. The pandemic has forced many small businesses to cut health insurance benefits, leaving even employed people without coverage. At the same time, health plan costs are rising, with large employers projecting that the cost of benefits will jump 5.3% in 2021. 

At the same time, in response to their employees’ needs, many employers are changing their benefits to offer new services like mental health support, COVID-19 testing, and expanded telehealth benefits. 

How Health Plans Can Navigate Employment Gaps

Even before COVID, the industry’s siloed approach to data made it difficult to link complete patient journeys. The disruptions to employment and insurance coverage exacerbate this increasingly complex coverage landscape for payers, who will now have a more difficult time building complete pictures of their members’ health journeys while accurately reflecting these gaps in coverage. 

Imagine a patient who lost their job and health insurance in the spring of 2020 and couldn't afford their diabetes medication. This resulted in poorly managed disease, and they ended up in the ER for multiple visits – visits that were not tracked in an insurance provider's records. Even when that patient gets a new job in 2021 and moves back onto company insurance, that essential piece of their healthcare journey and its potential impact on future health challenges is lost to health plans.

The healthcare industry will benefit from understanding how these gaps in coverage impact outcomes. Without a complete view of patient encounters – covered or otherwise – stakeholders can’t truly understand how all the pieces of the patient journey puzzle fit together. 

However, by contextualizing their membership pools against the broader insured U.S. population through tools like Komodo’s Healthcare Map™, health plans can gain a clearer picture into how the pandemic has disrupted the lives and health of the patients they serve and work to mitigate future risk.

For health plans, these trends highlight a pressing need to leverage “living” data that combines seamlessly with existing membership data. 

This is especially true with the potential pressures of “long COVID,” which will complicate care for years, and the new dimensions that telemedicine will bring to the patient journey. 

At Komodo, we believe that a comprehensive understanding of the patient journey – with visibility into every touchpoint a person has with the healthcare system, every symptom, diagnosis, and prescription – is essential to transforming the healthcare industry and reducing the burden of disease. 

To learn more about our Healthcare Map and how it builds breadth, depth, and timely insight into 325 million patient lives, start here.

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