Five Themes that Have Emerged from the Coronavirus Pandemic to Date: How will the System Respond?

Like most, I’ve been glued to coverage about the coronavirus. It dominates national news and social media voiding almost everything else including Campaign 2020.

Digesting the Covid-19 news diet is tough: thus far we’ve learned…

Public health is a global challenge that requires a coordinated global response.

• The Covid-19 outbreak started in China and spread to 184 countries. The race to find vaccines, drugs and effective testing is a global pursuit.

• Worldwide, 1.9 million have been infected and more than 115,000 have died to date: the US, Italy and Spain have been hardest hit. In the U.S., more than 560,000 are infected and more than 22,000 have died.

The public is paying attention to the coronavirus. Fear is rampant. Hope for a vaccine and drug is strong.

• Surveys show the coronavirus has captured the public’s attention: The majority is anxious and afraid. Hope about vaccines, drugs and cures is high. Polls also show the majority think the government will weather the coronavirus storm but growing fear that the recession will destroy their household finances.

Hospitals play a central role in pandemic preparedness: all have been adversely impacted by the Covid-19 virus putting the entire acute sector at risk.

• Last week, CMS released more than $50 billion in emergency funds to hospitals but it’s inadequate to keep most afloat. Up to 2 million might be hospitalized as a result of the coronavirus. Ventilators, ICU beds and supplies are in short-supply and frontline caregivers are getting infected and their ranks thinned. An analysis by the Kaiser Family Foundation released last week estimated that additional hospital costs for the uninsured could be between $14 and $42 billion. Last week, Standard and Poor’s lowered credit ratings to negative for the sector citing the pandemic as the root cause. It’s understandable.

Social distancing is key to slowing the spread of the virus but it’s implemented at great cost to the economy.

• Social distancing works to slow the spread aka “flatten the curve” but compliance is harder in certain populations: only 1 of 6 people of color in the U.S. workforce have jobs that allow work from home. Social distancing for older adults in nursing homes and assisted living is also problematic: 1 in 9 U.S. deaths is a resident and up to 20% of their staff has tested positive for the virus. Though 97% of the population is under stay-at-home orders, adherence is highly variable and in 8 states, Governors have not mandated statewide lockdowns.

• Social distancing is a blunt instrument: its use has cost the US economy 16.5 million jobs (to date) and added $4 trillion to the national debt. JPMorgan estimates the unemployment rate will reach 20%–double the peak in the 2007 recession. Goldman Sachs anticipates our GDP for 2Q 2020 will decline -34% but be up 19% in 3Q. There’s no consensus among economists about whether the recovery will be short (a V shaped quick recovery) or protracted (U shaped as in 2007-2010).

And this week, we learned that death rates are higher in the African American community.

• An analysis published Wednesday by the Centers for Disease Control and Prevention showed that the death rate is three times higher among African Americans thanwhites in the U.S. Friday, Jerome Adams, U.S. Surgeon General explained that “We do not think people of color are biologically or genetically predisposed to get COVID-19” but more susceptible because they “have a higher incidence of the very diseases that put you at risk for severe complications of coronavirus.”Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said Tuesday that African Americans “are suffering disproportionately,” adding that, “[When they do get infected, their underlying medical conditions … wind them up in the ICU.”

• The CDC finding is the latest evidence that social determinants of health, not genetics, explain why people of color in our society are less healthy, die younger and access the health system less frequently even when it’s necessary.

 
MY TAKE

No one knows for sure whether a second surge this fall will happen or where, how and when the Covid-19 virus found its way into the U.S. There’s lots of speculation and plenty of blame to be shared. But all concede that widespread testing and social distancing are necessary.

This week, epidemiologists and academics will scrub their models and signal detection methodologies to predict where the next hot spots will be. State and local officials will be watching closely. Mental health therapists and clergy will offer help and hope and frontline caregivers will go to work hoping to return home without being infected.  That’s where we are.

These five themes are not surprising to close observers of the health system. But for many outside the health system, the coronavirus and its handling has prompted fresh attention to its strengths and weaknesses.

It’s a teachable moment the industry can ill-afford to squander.

Paul
 
 
 

P.S. I have been looking for tools that help hospitals, nursing home and clinicians manage through the coronavirus. Here’s one: the PIE COVID-19 response execution and tracking platform that integrates CDC guidelines and reporting accountability with a hospital’s unique protocols and procedures. Essentially, it hardwires CDC-approved processes, responsibilities, and accountability into the hospital’s COVID-19 crisis response faster and with more accuracy. It’s free. Go to  https://my.pie.me/store and check COVID-19 Pandemic.
 
 
 
 
 
CORONAVIRUS UPDATE

 
Watchlist week of April 13, 2020: Keep Your Eye On…

• Stimulus: House-Senate approval of an additional $250 billion stimulus fund to be added to the CARES Act’s appropriations targeted to small businesses, hospitals and community health clinics.

• Antibody testing: watch for announcement from the FDA about anti-body tests that have passed scientific muster and potentially available within weeks.

• Household funds: watch for the first wave of CARES Act household relief funds to hit direct deposit accounts this week.

• Results from last Tuesday’s Wisconsin Presidential Primary will be released.

Hospitalization Rates by Age

• 0 to 4 years of age: 0.3%

• 5 to 17 years of age: 0.1%

• 18 to 49 years of age: 2.5%

• 50 to 64 years of age: 7.5%

• 65 to 74 years of age: 12.2%

• 75 to 84 years of age: 15.8%

• 85 or older: 17.2%

CDC.gov https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/summary.html

HMA Forecast: Medicaid, Uninsured

A model developed by Health Management Associates (HMA) estimates Medicaid enrollment could increase by 11 to 23 million across all states and unemployment from 10 to 25% of the population. They estimate the number of people uninsured could reach 30 million in the lowest unemployment rate scenario and could climb to 40 million if the country experiences a 25% unemployment rate.

“HMA Model Provides Forecast of COVID-19 Impact on Medicaid, Marketplace, Uninsured Health” Management Associates April 3, 2020 https://www.healthmanagement.com/

Insurers Announce Temporary Policy Changes

Most insurers have announced waivers of co-payments for coronavirus testing and in some cases treatment. Most are expanding telehealth coverage, streamlining claims processing to expedite provider reimbursement, modifying pre-authorization protocols in their Medicaid, Medicare and commercial lines of business and allowing early prescription refills. United, Humana, Molina, Anthem, Centene were among plans making announcements last week.

Related:

Last week, CMS announced It will raise Medicare Advantage Plan Payment Rates by 1.66% in 2021 compared to 2.53% increase in 2020 Read More ACA Exchange Enrollment Remains Steady at 11.4 Million. And enrollment in the Exchanges as of April 1, 2020 remains steady at 11.4 million: 87% are eligible for subsidies to pay their insurance premium.

CMS https://www.cms.gov/

Study: 8.5 million Will Lose Employer Sponsored Coverage

A report published Tuesday in the Annals of Internal Medicine estimates that more than 7 million Americans could lose their employer-sponsored health insurance during the COVID-19 pandemic. More than 1.5 million Americans have already lost their health insurance and 5.7 million are projected to lose coverage by the end of June.

“Intersecting U.S. Epidemics: COVID-19 and Lack of Health Insurance” Annals of Internal Medicine April 7, 2020 https://annals.org/aim/fullarticle/2764415/intersecting-u-s-epidemics-covid-19-lack-health-insurance

AHIP Study: Insurer costs $56- $536 Billion; Enrollee Out of Pocket $10-78 billion

The Wakely Consulting study conducted for AHIP (America’s Health Insurance Plans) estimates the cost to insurers from COVID-19 will range from $56 billion to $556 billion over the next two years. The key variables to watch are the number of Americans who become infected but are asymptomatic, the impact of interventions such as social distancing, the availability of testing and costs associated with intensive care stays that are longer than estimated. Wakely’s mid-range scenario that more than 50 million Americans will become infected, 5.5 million will require hospitalization and which 1.3 million will require intensive care at average cost/patient of $30,000.

In addition to insurer cost, the report also estimates out-of-pocket costs for consumers (enrollees) will be 14-18% of annual allowed costs on average across lines of business modeled totaling between $10 billion and $78 billion.

“New Study: COVID-19 Health Care Costs Could Reach $556 Billion Over Two Years” AHIP April 8, 2020 https://www.ahip.org/new-study-covid-19-health-care-costs-could-reach-556-billion-over-two-years/

OIG Survey: Hospital CEOs Concerned about Supplies, Frontline Caregivers and Facilities

The HHS’ Inspector General survey of 323 hospital CEO’s identified their four major concerns: 1-lack of adequate supplies (PPE, masks, ventilators) and testing, 2-the health and safety of their frontline caregivers 3-the adequacy of their physical facilities to handle surge and infection controls and 4-the need for federal support and guidance. All believe the coronavirus will erode revenues and margins not easily recovered.

“Hospital Experiences Responding to the COVID-19 Pandemic:  Results of a National Pulse Survey March 23–27, 2020” Office of the Inspector General, US Department of Health and Human Services https://oig.hhs.gov/oei/reports/oei-06-20-00300.asp

Public Opinion: Anxious, Uninformed, Optimistic

Sage Growth Partners April 6 Survey of 744 Adults:

• The March 23 survey found 47% of respondents reported anxiety levels of 7 (out of 10) or higher, vs. 60% in April 6 survey—a 28% increase.

• Those reporting the highest anxiety scores (10) have increased 78% in two weeks, from 9% to 16%.

• Feelings of social isolation have increased by 18%; 52% reported feeling very isolated (7 or higher) in the first survey, compared to 62% in the second survey.

Public Opinion Strategies Poll of 2410 Voters Conducted March 24-26:

• Americans are deeply concerned about the effects on the economy. Economic confidence has plummeted and 4 in 10 Americans have lost income from a job or business, been laid off or had hours reduced without pay.

• 45% of Americans say the worry/stress related to the coronavirus has had a negative impact on their mental health.

• 9 in 10 Americans express confidence in our ability to get through the outbreak.

• 7 in 10 Americans are willing to share their mobile location data in exchange for alerts about high risk areas, while 6 in 10 support government officials having access to anonymous mobile location data to monitor whether communities are practicing social distancing.

ACP Survey of 630 Adults 23-88 Years of Age:

• 24.6% were “very worried” about getting the coronavirus.

• 28.3% could not correctly identify symptoms or ways to prevent infection 30.2%.

• 24.6% believed that they were “not at all likely” to get the virus

• 21.9% reported that COVID-19 had little or no effect on their daily routine.

“Evolving U.S. Healthcare Needs and Attitudes During COVID-19” Sage Growth Black Book Research April 9 http://go.sage-growth.com/covid-19-market-report

“National Public Opinion Data:  The Coronavirus” Public Opinion Strategies April 7 https://pos.org/wp-content/uploads/2020/04/Coronavirus-Public-Opinion-Data_April-7.pdf

Wolf et al “Awareness, Attitudes, and Actions Related to COVID-19 Among Adults with Chronic Conditions at the Onset of the U.S. Outbreak: A Cross-sectional Survey” Annals of Internal Medicine April 9, 2020 https://annals.org/aim/fullarticle/2764612/awareness-attitudes-actions-related-covid-19-among-adults-chronic-conditions
 
 
 

RESOURCES

“Telehealth Index: 2019 Physician Survey” American Well https://business.amwell.com/resources/telehealth-index-2019-physician-survey

Barnett et al “Trends in Telemedicine Use in a Large Commercially Insured Population, 2005-2017” JAMA. 2018;320(20):2147-2149. doi:10.1001/jama.2018.12354 https://jamanetwork.com/journals/jama/article-abstract/2716547

“Not-For-Profit Acute Care Sector Outlook Revised to Negative Reflecting Possible Prolonged COVID-19 Impact” Standard and Poor’s Global Ratings March 25, 2020 https://www.spglobal.com/ratings/en/research/articles/200325-not-for-profit-acute-care-sector-outlook-revised-to-negative-reflecting-possible-prolonged-covid-19-impact-11404986

“Fast Facts on U.S. Hospitals: 2020” American Hospital Association https://www.aha.org/statistics/fast-facts-us-hospitals

Galea S, et al “The mental health consequences of COVID-19 and physical distancing” JAMA Intern Med https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2764404
 
Mathews, Kamp “Coronavirus Strikes at Least 2,100 Senior Facilities Across U.S., Killing 2,300 People” Wall Street Journal April 10, 2020 https://www.wsj.com/articles/coronavirus-strikes-at-least-2-100-nursing-homes-across-u-s-killing-2-000-residents-11586554096?mod=itp_wsj&mod=&mod=djemITP_h