There is a lot we don’t know about coronavirus disease 2019 (COVID-19). The death rates, the incidence in the population, and the effect of antibodies are still big questions. But there are conclusions about one issue that seem to be emerging in almost every study—hospitalization and death rates are being driven by underlying chronic medical conditions.
Among people diagnosed with COVID-19 (see COVID-19 Hospitalization & Death Most Common With Cardiovascular Disease, Diabetes & Lung Disease), the most common underlying health conditions linked to hospitalization and death were cardiovascular disease (32%), diabetes (30%), and chronic lung disease (18%). And last week, the Centers for Disease Control and Prevention (CDC) expanded its list of populations at highest risk, including those with chronic kidney disease, chronic lung diseases, weak immune systems from transplants, obesity, heart conditions, sickle cell disease, and diabetes (see CDC Names Seven Conditions Most At Risk For Coronavirus; Age No Longer Considered A Risk Factor)
This data is consistent with earlier findings in China and Italy. The March Italian epidemiological study (see 99% Of Italian COVID-19 Deaths Due To Hypertension, Diabetes & Heart Disease; Half Had Three Chronic Conditions) found that more than 99% of Italians who died of COVID-19 had a chronic illness, including hypertension, diabetes, heart disease, cancer, dementia, or history of stroke. Of that group, 48.5% had three or more chronic illnesses, 25.6% had two chronic illnesses, and 25.1% had one chronic illness. Another study from Wuhan found that 48% of consumers who were hospitalized had a comorbidity, including hypertension (30%), diabetes (19%), and coronary heart disease (8%) (see Clinical Course And Risk Factors For Mortality Of Adult Inpatients With COVID-19 In Wuhan, China: A Retrospective Cohort Study).
Unfortunately, almost half (45%, or 133 million) of all Americans suffer from at least one of these conditions (see An Empirical Study of Chronic Diseases in the United States: A Visual Analytics Approach to Public Health). We also know that approximately 75% of individuals with a serious mental illness have at least one chronic health problem and half have a diagnosis of two or more chronic health problems. Chronic pulmonary illness was the most prevalent at 31% (see Prevalence, Severity, And Co-Occurrence Of Chronic Physical Health Problems Of Persons With Serious Mental Illness). Among consumers with an intellectual and developmental disability (I/DD), 45% have three or more chronic conditions (see Health Care Coverage For Consumers With An I/DD – The Trends & The Future); and among people in prison, this percentage rises to 50% (see States Test New Approaches For Justice-Involved Populations).
For provider organizations serving these populations, there is an opportunity to both “do the right thing” and gain market differentiation needed for building a sustainable market position. These vulnerable populations need care management approaches that fully embrace chronic disease management and the “whole person” care approach—and that is exactly what health plan managers have been saying they want as well.
Many times, when this idea is raised, the common push back is that we are too far into the pandemic crisis for wellness and prevention programs to make a difference. But some interesting researchers have dissuaded me of that. David Katz, M.D., founding director of the Yale-Griffin Prevention Research Center, makes a great case for creating a national health promotion campaign for those at highest risk (see Why Two Pandemics Are Better Than One: The COVID19 Opportunity). His point is that the pandemic has turned America’s chronic health liabilities into an acute threat. As he says, “The very things we tell people to do to improve their long-term health actually do fortify your immunity. Those healthy practices can affect how your immune system functions in hours, certainly in days, and a whole lot in a span of weeks….” (see S18 Ep 12 – Dr. David Katz). In his article, he continues this train of thought, “This…is what we in Preventive Medicine call a ‘teachable moment’… The immunologic responses of generally healthy bodies are an obviously high-potency defense against the ravages of SARS-CoV-2. Why race for the extrinsic salvation of a vaccine while neglecting the rarefied, intrinsic defenses of our native immune system….?”
For provider organization executive teams looking to the future, this wellness-oriented support for our most vulnerable and high-risk consumers is also exactly what health plans are looking for. Over the past year, in our OPEN MINDS web briefings, summit, and executive institutes, numerous health plan managers have put the ability to manage consumer care holistically and keep them healthy (and not using unnecessary acute care services) at the top of their “wish list” for provider organizations (see The Future Of Medicaid Managed Care: Building A Comprehensive Care Solution For The Complex Consumer Population, Open Forum On Health Plan Measures Of Treatment Efficacy, and Integration, The End Of The Carve-Out & The Importance Of Financing – The Health Plan Role In Facilitating “Whole Person” Care). This is one of those moments in time when organizations can do well by doing good.
For more on whole person approaches to care management, see these resources in The OPEN MINDS Industry Library:
- Poor Physical Health Due To Chronic Conditions Presents Barrier For Job Seekers With Serious Mental Illness
- Multiple Chronic Conditions Can Hasten Cognitive Decline
- What Are The Spending Stats On Chronic Conditions?
- ‘Best Practice’ For Reducing Readmissions For Consumers With Chronic Conditions
- How Can We Fix The Way We Manage Chronic Conditions?
- Expanding Your Integration Reach With Chronic Disease Mgmt & SDOH
- The Big Target For Specialty Provider Organizations—The Cost Of Comorbid Chronic Disease
- Thinking About Cancer As A Chronic Condition
- Community Health Worker-Based Chronic Care Management Can Cut Costs
- Managing Chronic Illness & Social Determinants Of Health (SDoH) In A Community-Based Behavioral Health Setting
For more on adjusting service lines and business models, join us for our upcoming web briefings offered as part of The OPEN MINDS Executive Blueprint For Crisis Recovery program: