The COVID-19 pandemic has impacted the way health care is delivered. Chronic disease management continues to drive costs and outcomes, and the rise of behavioral health is growing at a greater pace than ever. In an effort to mitigate costs and ensure patients have the access to care, payers extended coverage, health systems expanded programs, and the entire system embraced telehealth services as a means to bring solutions directly to patients.
On August 31, leadership from CIGNA and Sinai Health System joined the Health Care Council of Chicago (HC3) for a conversation around the payer’s response and perspective on trends in care, opportunities for virtual care innovation, and how the system can better address social determinants and behavioral health needs in the Chicago community.
Cathy Dimou, MD, Midwest Market Medical Executive, Cigna
Karen Janousek, Chief Population Health & Growth Officer, Sinai Health System
Doug Nemecek, MD, Chief Medical Officer of Behavioral Health, Cigna
Helen Margellos-Anast, MPH, President of Sinai Urban Health Institute
David Smith, Founder & CEO, Third Horizon Strategies and Co-Founder, HC3 (Health Care Council of Chicago)
INSURERS, PROVIDERS DISCUSSES CHALLENGES OF ACCESS TO CARE DURING COVID-19 PANDEMIC
Health News Illinois, September 3, 2020 | Link to article
Watch the Recap | Link to Video
Remarks from Brian Marsella
Cigna’s mission to improve individual health, well-being, and peace of mind has never been tested more than amid the global COVID-19 pandemic.
In response to COVID-19, Cigna has waived cost-sharing for COVID-related services, expanded payment for virtual care, tried to protect patients from surprise billing, expanded employee assistance programs, and worked closely with providers and health systems to ease any burdens such as prior authorizations and patient transfers. Cigna rolled out several new resources for consumers including symptom checking tools and 24-hour COVID-19 hotlines. The organization will also soon release some return-to-work guidelines .
Cigna has been proactively engaged in activities to address social determinants of health and behavioral health issues at the local level. A few examples include partnering with organizations to address access to food challenges, initiating community outreach with FQHCs, and directly engaging with providers and emergency departments to support addiction treatment opportunities.
Remarks Cathy Dimou, MD
Prior to COVID-19 we saw inequities. At the start of the pandemic, 70 percent of initial deaths were amongst African Americans who make up only one-third of Chicago’s population. The second wave we are seeing now is showing less morbidities but affecting more young people (18-29) than the initial wave which was predominantly affecting seniors. The Latinx community represents 44 percent of positive COVID-19 cases currently in Chicago, but they only representing 29 percent of the current population. (Note: these numbers may be misrepresented being mislabeled Caucasian/white or undefined.) These high rates of infection and morbidities highlight the massive inequities that minority communities are facing in this crisis.
Cigna’s response has been focused on ensuring the right care, at the right time, and right place. Cigna transformed how to cover virtual care almost overnight, providing a bridge for services to those that shouldn’t be exposed in an office setting. The organization made a smooth transition to virtual care and supported partners’ value-based strategies by identifying and contacting high-risk patients to ensure they understood social-distance measures and received the care they needed.
Depression, anxiety, and substance abuse disorder have all increased due to social isolation, financial troubles, and stress related to COVID-19. In Cook County alone, opioid-related deaths have doubled since last year.
We are still not seeing the full effects of delayed care and will start to see more preventable diseases going untreated due to lack of screening and treatment on the rise.
Cigna’s goals for the duration of the pandemic are make sure they meet patients where they will be once this all is over, support provider communications on how to help patient return for care, and learn how to make virtual care sustainable and effective moving forward.
Remarks from Doug Nemeck, MD
One in five adults has a mental health condition, and eight percent has a substance abuse disorder in the U.S. One of the issues that Cigna has monitored over the past few years has been loneliness and isolation. Surveys from 2018 and 2019 have found that three out of five adults surveyed were chronically lonely, and that young adults (gen-z) were particularly susceptible to these feelings.
COVID-19 has had an incredibly negative impact on behavior health needs and people’s well-being. According to a recent survey from Kaiser Family Foundation, nearly half of those who sheltered in place indicated a negative impact on their mental health. And within the first month of the pandemic there was a 34 percent increase in anti-anxiety prescriptions.
During this uncertain time, it has been challenging to support access to resources and care that people need. In order to ensure a smooth transition, Cigna has expanded their virtual care network and have strived for guaranteed appointments within five days. By adding more digital providers nation-wide they have already had over five thousand patients access these services.
Remarks from Karen Janousek
One of the first things Sinai did was to get providers on telehealth platform. However, telehealth could not be the only strategy for physical or behavioral health since not everyone has a cell phone or unlimited plans, and some are homeless. Sinai quickly addressed the need and has cultivated a blended model to meet the needs of their patients. They created care stations where patients can visit (with social distancing protocols in place) to log into a telehealth platform and receive guidance. Sinai had behavioral health professionals on the floor with clinicians in order to monitor mental health. They also utilized AI and collaborated with the Medical Home Network and other ACOs to identify, contact, and help 93 potential COVID-19 patients access resources, including social services such as food banks. Sinai has seen such a tremendous success with these solutions. In fact, many patients don’t want to go back to in-person because the telehealth platform has worked incredibly well.
Remarks from Helen Margellos-Anast
Sinai’s Urban Health Institute (SUI) was founded in 2000 with the goal of understanding inequities on hyper-focused community-based level. The impact of COVID-19 has raised the social and structural barriers that are contributing to higher exposure in vulnerable communities. In addition to what has already been addressed in the program around African American and Latinx communities being having exponentially higher rates of cases and deaths due to COVID-19 (2.2 percent higher amongst African Americans, 3.5 percent higher amongst Latinx, 3.5 percent higher death rate for both), violence and trauma has increased greatly which exacerbates these ineqities. In a recent survey of the SUI, 30 percent of Puerto Rican and 25 percent of Black respondents reported some having sort of PTSD.
In collaborative partnership with West Side United, SUI is identifying and addressing the social issues – food, housing, transportation, insurance, utilities insecurities, etc. – that impact patients who come into EDs on the West Side through a program called West Side Connect ED. Community health workers are screening the patients. Cigna is funding the program to specifically address food insecurities. The screenings at the Sinai Emergency Department have found 54 percent of patients were food insecure. In response, a new virtual platform was launched during the COVID-19 pandemic to provide more resources and access.
Panel Discussion Highlights with David Smith
Vulnerabilities have increase for all, but how has it been for the less fortunate communities?
Behavioral health issues were greatly untreated pre-COVID-19, and now people are potentially more open to understanding and addressing their own problems because most people have struggled in one way or another from behavioral health issues. Utilization is likely to change forever due to this.
What are some virtual care gaps? What has been the patient response to telehealth? Where is virtual care going? Will it stay? Telehealth will increase access all across demographics and environments, both rural and urban. Providers need to get better at addressing more complex cases because more than a check-in is needed – data-heavy solutions are necessary in complex cases.
Internet and tech needs will be upgraded in the patient populations on the south and west sides of Chicago. Increasing education and health literacy is already important and will become increasingly so.
Patients report a sense of less isolation, call durations are getting longer since the beginning of the pandemic because people are starting to engage more with providers and even talk about things other than medical care. No-show rates have gone down, because of virtual care solutions. However, the tech needs still need to be addressed in a more robust way. Some types of care delivery can be facilitated via telehealth, but blended model would best. Interoperability is not where it should be, but we are continuing to evolve.