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Five Data-Driven Strategies for Payers in a Fraught Healthcare Landscape


For payers, understanding health and disease at scale has never been more challenging – or more essential. From the rising cost of chronic disease to patient access hurdles, COVID-19 has exacerbated many of the factors that drive up costs and worsen outcomes for patients across the entire spectrum of health and disease.

At the same time, the drastic shifts associated with the pandemic have also revealed opportunities for payers to offer more effective approaches to care, improved disease awareness campaigns, and better-targeted expansion of benefit offerings. By leveraging timely insights from data, payers can better understand disease and treatment approaches on the ground and build new strategies to proactively address this new healthcare landscape. 

1. Identify What Still Works 
In some areas, there will be wisdom in sticking with what’s been effective in the past – while remaining flexible to today’s challenges. Efforts like risk assessment, outreach programs, and focusing on chronic disease will still be critical in a COVID-impacted world, but they will likely look a little different. For example, payers may face an increase in undetected disease due to deferred care, complex comorbidities associated with COVID-19, and the limits of virtual care options.

That said, payers will still need to address the same core population health challenges as always: quickly spotting health risks, identifying opportunities for intervention, optimizing the care network, and continuing the shift toward value vs volume. When properly enabled by reliable data, these initiatives will form the foundation of a modern approach to driving predictions and improving patient outcomes. 

2. Brace for the Impact of Screening Delays
As the pandemic’s ripple effects continue to come to light, real-world data can help payers understand how extensively patients have put off important screenings in an effort to avoid exposure to the virus. A research letter recently published in JAMA revealed a 46.4% drop in identification of new cancers during the pandemic as compared to pre-pandemic rates, creating a black hole in early detection. 

Here, we’ve been tracking the recovery of breast cancer care after the initial slowdown, by analyzing Komodo's Healthcare Map™ for insights into changes in mammogram volume, new breast cancer diagnoses, and breast cancer surgeries. We found that, early in the pandemic, screening volumes and diagnoses fell dramatically, but we were also able to observe a “catch-up” period during the summer months. 

Payers will need to be ready to keep up with the correction and long-term impacts of delayed diagnoses. By carefully tracking the data around screenings, payers can understand which examinations should have been taking place and when they should have happened – and leverage this data to prepare for potential surges in overdue care and delayed diagnoses.

3. Drive a Return to Prevention
Disruptions to routine preventive and nonemergency care caused childhood vaccinations to drop significantly early on in the pandemic, hitting a low point in April 2020. Though routine immunization rates have started to normalize again, the rigorous schedule for childhood vaccinations means any significant gap or delay can put a child at a greater risk to contract preventable illnesses like measles – and carry massive public health consequences. 

On the other side of the population, with higher risk for serious infection, people over the age of 65 should continue to be prioritized for COVID-19 vaccinations and resume their routine screenings to stay ahead of any potential illnesses. This counsel will be especially important for Medicare Advantage groups as they build vaccine awareness campaigns and transition their patients into the next normal. 

By understanding how COVID-19 has impacted screenings and routine immunizations, payers can build awareness campaigns to get prevention back on track. 

4. Address Social Determinants of Health 
The COVID-19 crisis has done more than create gaps in healthcare delivery; it’s also illuminated existing holes in the system and society as a whole – gaps that can be addressed using timely and comprehensive insights. 

It’s well understood that social determinants of health have a significant impact on healthcare outcomes. During this pandemic, the media has highlighted stories about the difficulties people have faced in paying for food, accessing medications, and obtaining care; growing research shows these challenges disproportionately impact people of color and those in poorer neighborhoods

For payers, these difficult and often tragic stories highlight important opportunities to extend access and address challenges ranging from food and housing insecurity, to “economic dislocation,” and unequal access to care – all of which have been heightened by the pandemic. Real-world data can help payers better understand these challenges and update programs to specifically target the needs of underserved patient communities. For example, one company was concerned that the pandemic would exacerbate existing health disparities, with key safety net clinics shuttering due to the financial impact of reduced office visits. To mitigate these circumstances, they combined Komodo’s real-world data with geocoded information to identify primary care providers operating in underserved communities who had experienced reductions in patient visit volumes.  Using this information, they were able to pinpoint those who may need support to avoid closure. 

5. Embrace Telehealth’s Emerging Role
The surge in telehealth has been a welcome change to an industry that is slow to adopt new technologies. We’ve tracked the tremendous rise in use of telehealth tools to understand what telehealth engagement looks like in the real world. While offering incredible benefits, the surge in telehealth also raises the possibility that certain signs and symptoms could be missed without in-person interactions. For payers, granular, data-driven insights can be used for early identification of gaps in care that may emerge because of the rise in telehealth use. 

If leveraged appropriately, and in complement with in-person visits, telehealth holds powerful potential to support patient care. Seeing even one third of physicians move to telehealth would improve productivity, increase access, and even help address mental health issues brought on by COVID-19: Imagine more regular check-ins on isolated elderly patients! By looking at telehealth’s impact on the entire patient journey, payers can drive smart adoption, leverage risk-based care models to reduce costs, and improve outcomes in the future. 

Finding a Path Forward

As payers look to the future, the power of data-driven insights will be crucial to better understand the wide-ranging effects of the pandemic on patient populations. As we continue to adapt, it’s more important than ever to build a comprehensive view of the patient journey supported by an understanding of:

• Diagnosis patterns and treatment milestones
• In-depth profiling of both patient and provider populations

• How patients interact with, and move between providers and visit types 

• Treatment progression and how it’s complicated by COVID-19 

All of these insights start with Komodo's Healthcare Map™ as a basis for data-enabled initiatives that meet the challenges of today. 

Learn how Komodo’s software can enrich your healthcare insights here

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