Alicia Cowley, MD, MBA, a hospitalist and Director of Clinical Content at Phreesia, was recently interviewed on the Becker’s Healthcare Podcast about how the COVID-19 pandemic has caused delayed care for millions of people and solutions for how to bring them back to the office to get the care they missed. This is an edited transcript of Dr. Cowley’s conversation with Becker’s Healthcare’s Brian Zimmerman. Listen to the full podcast here.
Brian Zimmerman: How has the COVID-19 pandemic led to delayed care? Were there specific patient types or services that were disproportionately affected?
Dr. Cowley: There were three main ways that care was delayed. First, when the pandemic began, a lot of ambulatory care was shut down, furloughing staff or closed entirely. This made it harder to schedule care. Second, patients were really scared to come into the office and avoided care at all costs unless it was very urgent. Phreesia saw that trend in our data—visit volumes were down by 60% at its worst. Finally, the loss of the hospital as a safety net created major gaps in care coordination for many people.
As a Latina, I worry about how this quieter crisis of missed care affects communities of color. Late last year, the CDC released data that broke my heart. In 2020, deaths from all causes nationwide were just over 20% above our usual yearly mortality rate across all races and ethnicities. More strikingly, Latinos and Black Americans were three and four times more affected than white Americans. A lot of people think it’s because people of color have higher rates of chronic health conditions. But we need to look at social determinants of health, structural racism and language barriers when we’re talking about differential outcomes.
Brian Zimmerman: What are the implications of this delayed care?
Dr. Cowley: I’ll start with the obvious clinical implication: putting care on hold allows small health problems to become large health issues. Patients and providers don’t have the chance to engage in preventive care and chronic care management that can improve health outcomes. There are financial implications, too. If people aren’t coming in, revenue goes down. In fact, Health Affairs estimated that last year almost $70,000 in revenue was lost per primary care provider.
So now we’ve got a system trapped in this vicious cycle—you’ve got revenue losses resulting in staff cuts or shuttered care sites, patients having a hard time accessing care in a timely manner, and that doesn’t even factor in the strains associated with rebound volumes trying to squeeze into a smaller number of care sites. Now, some patients are presenting with missed or later-stage diagnoses that result in increased disease burden for them and their families, worse health outcomes, and rising costs for them and the system as a whole.
Brian Zimmerman: What are some options for bringing patients back in for the care they missed during the pandemic?
Dr. Cowley: Healthcare organizations need to communicate that they’re going to offer patients the great experience that they expect as they come back in for care. In this past year, patients got used to having options that better addressed their preferences and their needs —telehealth or drive-through vaccinations, for example—and many patients are not going to want to go back to the old ways. And I like to think that clinical teams are happy about these changes too.
Start with these two strategies: Embrace the accelerated changes that the pandemic brought to your daily routines and make them work for your patients and your providers long-term, not just now. Then, proactively reach out to your patients who missed care and offer to reschedule that care either in-person or through telehealth.
Brian Zimmerman: What advice would you give to provider organizations that want to bring their patients back to the office to close their gaps in care? Where should they start?
Dr. Cowley: Here’s how to get started help patients catch up on their delayed care:
- Start with the tools you already have—your electronic medical records or population health tool—to identify who is overdue for care.
- Recall patients in whatever form works best for your community and your organization. I think digital is great; it allows for automation and staffing efficiency. Automated options can be really helpful for organizations that are running a leaner team or that want to ensure staff can take time off this summer.
- As you’re looking to recall patients, think about their conditions and needs. Which ones need to be seen in person and which could be seen through telehealth. Again, the idea here is to offer options to ease those access barriers, when appropriate.
- And finally, remember that in the last 14 months, patients have gotten used to using technology in places they hadn’t before. Don’t be scared to modernize!
The pandemic forced our healthcare industry to enter the digital age at breakneck speed. It’s created new benchmarks that are likely to set the standard for care for years to come. And I’m really excited to see where we go next.
Learn how Phreesia can help healthcare organizations like yours address gaps in care.