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In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates.

COVID-19 Discussion with Jon Cohen, MD

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On February 29, the Economist published an article succinctly titled “COVID-19 is now in 50 countries, and things will get worse.” They were very right. Exactly a month later, on March 29, the World Health Organization reported that 203 countries, areas or territories have been affected by the outbreak. Countries have been working furiously to “flatten the curve” – lower the reproductive rate of the virus -- to ease the burden on healthcare systems, buy time to find new treatments, and reduce the total number of infections throughout the course of the pandemic. With “social distancing” the key weapon in this fight, approximately 2.6 billion people, or one-third of the world’s population, are now under complete or partial lockdown. Large gatherings, day-to-day activities and business as usual have halted.  While there is no escaping the disruption this crisis is causing, there is a lot that employers can do to support their employees and employees’ families that will have a meaningful impact. Our Health on Demand research found that employees typically have a good deal of trust in their employers, and the steps you take now to help maintain their well-being -- physical, emotional, financial, and social – will echo far in the future. Here are 10 ways employers can help empower their workers to push through the uncertainty and persevere: <ul><li>Err on the side of over-communicating. Consistent communication can convey strong leadership, avoid confusion and reduce anxiety. A well-organized and supported COVID-19 communications team can take in the evolving information, distill the key implications, and distribute it effectively to the workforce. Remind employees and their managers of the support resources available through the company and in the public. </li><li>Provide testing &amp; coverage information. Employers who sponsor medical, life, disability, accident and special-risk insurance (such as business travel and expatriate coverage) should be familiar with the terms and conditions in their policies testing coverages, eligibility requirements and unique provisions for quarantine. Employers should also pay special attention to public health, law, and policy updates in their geography for further implications to testing and coverage information. Consistent messaging by managers about access to health benefits and leave is critical during a crisis. </li><li>Support mental health &amp; wellbeing. The COVID-19 pandemic is already resulting in increased stress, depression and anxiety. Employers have a role in communicating information and providing mental health support for their employees. Educating managers, making services available for those affected, and communicating the availability of Employee Assistance Programs and other support services (e.g., tele-therapy) that are in place will help to mitigate the mental health impact of the pandemic. </li><li>Encourage telemedicine. If you are an employer that provides telehealth benefits, it is imperative to communicate to employees the support that is available to them and the services available. Unnecessary exposure to infection at hospitals and care centers can be avoided through virtual care. Telemedicine or other forms of virtual care are good options for many issues. </li><li>Assist with pharmacy changes. Employers should support early refills (including for behavioral health-related prescriptions) and home delivery through a local pharmacy in order to minimize trips by employees to the pharmacy. Many employer are considering or have implemented a one-time override to allow for 90-day supplies of specialty medications. Furthermore, some employers have also extended the duration of existing authorization approvals for items such as prior authorization, step programs and quantity limit overrides to limit administrative burden, while continuing to do so for newly initiated therapies. </li><li>Leverage reliable resources. In your communications, be sure to direct employees to reliable sources of information on COVID-19, such as the WHO, Center for Disease Control (CDC), and their local public health entities. Reinforce to employees and their families that they should reference those and communications from you as their sources of truth as opposed to the 24/7 news cycle or social media. </li><li>Manage communications with local health systems &amp; public officials. A robust preparedness plan comprises governance structures, clear protocols and lines of communication. It also includes assessing supply chain viability and collaborating with public health entities. The National Association of County and City Health Officials (NACCHO) has put together a Directory of Local Health Departments by state. Be sure to monitor local, state and national legislative updates to understand what else you can do to support your employees and society to flatten the curve. </li><li>Put policies &amp; processes in place. All employers should review their existing pandemic crisis management and response plans and establish new protocols for the current environment as needed. Employers should seek legal counsel and follow the direction of local public health department officials if there are concerns about known, suspected or high-risk cases. If an employee is found to have been exposed to COVID-19, there should be protocols for transport, communication and decontamination.  </li><li>Comply with occupational health needs. To ensure employee safety, check to see if company policies are in alignment with the Occupational Safety and Health Administration (OSHA), the National Institute for Occupational Safety and Health (NIOSH), and the Environmental Protection Agency (EPA). As businesses resume operations and individuals return to work during the COVID-19 recovery phase, all employers must manage fitness for work and other occupational health practices to keep the workforce safe. </li><li>Think innovatively. Many organizations are innovating to support their workforce. We have seen employers adding hospitalization cash allowances, enhanced mental health benefits, special caregiving benefits, even allowances for creating a comfortable home-working space. Employers are also finding new ways to manage employees in the remote working culture, with innovative training and tools. Looking outside the box for solutions can help employees to thrive inside their homes. </li></ul>While it is important to ensure that employees have access to continually updated information, it is just as important to show empathy to ensure your key messages get through. In addition, as your organization works through this stressful process, remember to take notes! Lessons learned will help pinpoint and address vulnerable areas in your business and human capital strategies in preparation for the next crisis.

Ten Ways for Employers to Assist Their Employees during the COVID-19 Outbreak

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General Manager

If health equity is our desired destination, then value-based care must be our vehicle. At its core, value-based care is all about improving the quality of care for patients. Rather than seeing more patients, conducting more procedures and ordering more tests, healthcare systems and providers are pivoting toward proactive, targeted care approaches that aim to identify and prevent health problems before they have a chance to worsen.  By investing in a deeper understanding of patients’ health and social risks, healthcare systems can better engage populations in upstream preventive care and social services, and providers are freed to dedicate more time and allied health services to patients with chronic conditions or comorbidities that require complex care. These actions can facilitate the identification and mitigation of the larger, more complex barriers known to directly impact patient outcomes, such as the social, behavioral and environmental determinants of health. In this way, value-based care acts as a pathway for pinpointing and addressing key barriers to equal health access, <a href="https://propellerhealth.com/press/clinical-blog/how-digital-health-can-support-underserved-populations/" target="_blank">especially among more vulnerable or underserved patient populations</a>.  With value-based care in mind, health equity can be addressed in a way that is both sustainable and scalable, delivering better outcomes to entire populations of patients who have faced unjust barriers to good health. We can accomplish this by using digital health to support patient behavior change, identify unique patient motivators and personalize approaches to chronic care management. Here’s why: Whether the stated goal is improving patient quality of life, promoting population health or reducing the cost of care, better outcomes are the foundation of the value-based care model and impact patients, providers and payers alike. Each wants patients to feel healthier and live better lives, while providers and payers also seek reduced hospitalizations and lower overall healthcare costs. Frameworks to implement value-based care typically include opportunities to intervene with each of the different stakeholders within the healthcare ecosystem, thus taking advantage of the natural alignment around improving outcomes. For digital health companies focused on promoting healthy behaviors, patients become the primary focus of intervention, reasoning that improved patient outcomes will in turn reduce care-related costs for healthcare systems and payers. So, how do we help patients achieve their healthcare goals through positive, sustainable behavior change? The answer is not simple. Every patient is unique – not only in their healthcare needs, but also in the context and environment in which they receive and manage their care. It’s difficult, for example, to expect patients to be successful with a digital health tool if the patient does not have reliable, affordable internet access or a smartphone that can support a self-management app. Consequently, understanding a patient’s unique motivations, goals, barriers, and social and economic environments in addition to their healthcare needs is essential to achieving desired behaviors and patient outcomes.   To illustrate this concept, let’s consider two hypothetical patients: Jayson, a 32-year old male with uncontrolled asthma, high symptom burden and commercial insurance, and Shirley, a 66-year old female with frequent COPD exacerbations and comorbidities, on Medicare. Jayson loves to play soccer with his friends, but recently stopped when his asthma symptoms started worsening. He felt ashamed when he became winded during games. Shirley, on the other hand, has lived with COPD for the last 9 years and following a recent layoff, she lives on a tight budget and is in constant fear of overspending on medications. Given their distinct personal and socioeconomic differences, Jayson and Shirley will likely not be encouraged to change their behaviors if we attempt to engage them with the same intervention. In these examples, a common delivery method may also not be feasible – Jason may have the latest smartphone and reliable internet access, while Shirley may be more cost-conscious. This holds true for all patients – we can’t expect that utilizing a single approach to promote patient outcomes will produce effective results for everyone. Tailored experiences are essential in motivating people to change behavior. Understanding key patient traits, current behaviors and environmental exposures can help create a more customizable experience and present opportunities to engage patients in ways not previously possible.    Digital health is an immensely powerful tool for enabling personalized care and optimizing the right intervention, at the right time. Thoughtfully-collected data may allow for a more holistic patient experience, while also providing important insights to providers and payers. With higher quality objective insights, providers will be empowered to make more informed treatment decisions with patients, and payers can effectively evaluate care outcomes and apply learnings more broadly to a variety of patient populations, from pediatric to geriatric to those historically underserved.  In fact, this is a principle already being explored in chronic respiratory condition management. Results from a study evaluating the effect of a comprehensive intervention that combined telehealth and digital technology in <a href="https://propellerhealth.com/press/clinical-blog/helping-students-with-asthma/" target="_blank">children with asthma showed improvement in controller medication adherence</a> – 8% on average, with about one-third of children experiencing greater than 20% increase in adherence. The children in this study were from minority, low-income families in inner-city areas, where traditional approaches of healthcare may not have been able to adequately address certain barriers or risk factors. Although future research needs to be done, this is a promising study that demonstrates the feasibility and need for comprehensive approaches to healthcare. Among a <a href="https://propellerhealth.com/outcomes/" target="_blank">growing body of research focused on the impact of digital health enabled clinical care</a> for underserved populations, this is one example that highlights the importance of addressing socioeconomic barriers to care, such as access to technology.  The road to health equity is a long one, but there is hope that it may not be as distant as we had initially envisioned. Value-based care is just one piece of the puzzle, and improved health outcomes will require systemic changes upstream in addition to quality care, such as safer living conditions or increased education and employment opportunities. However, as digital health adoption continues to grow among patients, providers and payers, there will be tremendous opportunity to deploy value-based approaches within patient care. If we can continue to approach chronic care management with a focus on quality outcomes and patient-centric interventions, particularly among those who have been historically left behind, we can inform healthcare stakeholders and policymakers to drive the systemic changes that will ensure health equity in access, affordability and health improvements at scale.  About Propeller Health At Propeller Health, our mission is to empower every person living with a chronic respiratory disease to take control of their health so they can live a better life. As a leader in digital health and therapeutics for asthma and COPD, we work to improve clinical outcomes, healthcare costs, and quality of life by supporting patients in managing their condition with their healthcare provider.   Propeller’s platform includes FDA-cleared medical devices, consumer apps and access to clinical data for provider monitoring throughout the care journey, to create value to all stakeholders. We enable a personalized digital experience with a human touch used by patients, caregivers, providers, payers, pharmaceutical companies and other healthcare organizations across the US, Europe and Asia. Propeller Health is a wholly owned subsidiary of ResMed. For more information, visit <a href="https://propellerhealth.com/" target="_blank">www.propellerhealth.com</a>.

Health equity through value-based care: wishful thinking or digital health future?

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CEO/ Founder

In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates. Hear that silence? It&#39;s the sound of a planet that&#39;s been brought to a screeching halt by a tiny pathogen. Who would have believed only a few months ago the surreality of record reduction in global GDP, oil prices nosediving to below zero for the first time in history, or 22 million Americans filing for unemployment benefits in the space of a few weeks*. We’re living in a moment that’s going beyond anything seen in most people’s lifetimes. The world as we know it is being changed by COVID-19, both on an institutional and personal level. Take for example the biggest institution of them all - the government. If the prime role of any government is the protection of the security of its nation, then the very definition of that security has just been challenged. The U.S. has lost more people to COVID-19 than to the wars in Vietnam, Iraq and Afghanistan, and to all terrorist attacks on its soil including 9/11, combined. No government will be able to ignore the warnings that our real security challenge is not just ‘a war but a virus’ and not just ‘missiles but microbes’. While our institutions will change, each of us individually has already changed in so many ways. My experience of COVID-19 has been punctuated by the loss of my father. He survived partisan wars, radical movements, political internment and revolutions, and yet lost the battle against this unseen tiny organism. A fit, healthy man in his early 90s, he was a humanitarian, an entrepreneur, an engineer and my best friend. Just before he went into the ICU, he asked to speak to my children, his grandchildren. He told them this crisis would pass, like every other. But he also told them we should never forget it, and they must emerge wiser. Our people individually, and our society collectively has paid too high a price to return to business as usual.  So, where do we go from here in healthcare? The pandemic has exposed our ‘unhealthy’ shortcomings Even before COVID-19, we faced supply shortages in healthcare, that meant our industry only served a minority of the world’s population. Half of humanity, according to the World Health Organization, does not have access to basic healthcare, and 5 billion people cannot even dream of getting access to any kind of surgery.  In 2016, the WHO reported that we were 5 million healthcare professionals short, and things are getting worse. By 2030, the world would have a deficit of 18 million healthcare professionals. And here we are. COVID-19 has exposed it all. Einstein used to say “the definition of insanity is doing the same thing over and over again and expecting a different result”. I am going to be controversial here. The old methods of healthcare, with all its best intentions, have failed us and we cannot go back. The good news is that many governments, medical professionals, health systems and innovative businesses across the world have already acknowledged this and are working together to uncover new solutions. New technology is the new normal It’s been remarkable to see how we’ve all adapted to the current situation. Healthcare has adapted faster than most thought possible to meet our needs. Only a few months ago, something as mundane as telemedicine was considered ‘a radical new technology’. Now, it’s commonplace. But this crisis has also exposed its shortcomings. A doctor behind a phone is as expensive, and as much in short supply as one sitting in a clinic. The same is true with many other promising solutions. So how can we use technology to safeguard our health? The answer is to forget about the means and focus on the needs. This is the moment we discovered that it’s not about the technology but its application in solving the root cause of a problem. Some healthcare systems are already learning from this, and proactively thinking of new ways of harnessing innovation to solve their foundational problems of scarcity of clinical resources and unpredictability of disease behaviour.   How need-driven innovation can protect our health systems For Babylon, this pandemic has shown us what we can do. At the time of significant surge in demand and shortage of clinical resources, we built a COVID-19 Care Assistant solution to give every person the most appropriate care by the most appropriate resource, while safeguarding our clinicians for the patients who need them most.  We created a disciplined digital funnel that gives information and reassurance to large numbers of patients who are seeking it. An AI tool to allow people to find their most probable causes of any symptoms and help them decide to self-isolate if necessary. Care plans based on the latest information, digital monitoring throughout recovery, the option to chat with a trained professional if more help is needed, 24/7 remote consultations with a doctor when required. And it speedily refers patients into hospital, only when necessary.  This system allows the same number of frontline staff to help a much greater number of people, all whilst making sure that people get the care they need. Our service now covers 8% of England’s population and is being launched to millions of members in the US and Brazil. Already we’re seeing that around 80% of people who use it don’t actually need to speak to a clinician – that’s a huge release valve for any clinical resource. The simple rethinking of solutions like this will result in meaningful change, making healthcare more affordable and accessible to people everywhere, including the billions who were previously being left behind. It is time these solutions are applied to assist with significant challenges, such as management of chronic conditions, from diabetes to mental health. Now that we have seen what can be done in meeting one crisis, there is no excuse to ignore the chronic crisis that we have been struggling with before this one.  Changing attitudes can help change healthcare Accelerating advancements in technology and biology is about to melt into air all that we know in healthcare. A perfect storm is brewing that will merge the new discoveries in quantum computing, AI, mixed reality, robotics, organ reconstruction, genetic engineering and synthetic biology, to help us shape new possibilities hitherto unimaginable. For the first time in history, it is possible to dream of making quality healthcare accessible and affordable for every person on Earth. But science and technology by itself won’t transform healthcare. What is required is a change in attitude. Each and every one of us is responsible for that change. These are dark and difficult times. We cannot let it go to waste, and must learn from these challenges where we can. People all around the world have paid far too heavy a price for us to go back to the way it was before. It is our obligation to those who have suffered not to return to our old ways, but to reshape for the better all that we do. References *<a href="https://hub.jhu.edu/2020/04/16/coronavirus-impact-on-european-american-economies/" target="_blank">The Hub at John Hopkins, 16 April 2020</a>

How the Pandemic Will Change Healthcare

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