Friday, Jun 30, 2023

Sicker Patients: The Next Healthcare Surprise

Navesh Kandiyil MD, MBA,FACHEHealthcare Industry Consulting Director, NTT DATA

John Frownfelter, MD, FACPHealthcare Industry Consulting Director/ Chief Strategist, Data Driven Health, NTT DATA


The COVID emergency, which no one anticipated, may be over, with surges of infections no longer interfering with the delivery of other medical services. But the next “surprise” is approaching. Fewer appointment slots, inflationary pressures, loss of Medicaid coverage, and high deductibles amount to interference of another kind. Delayed care will result in the arrival of more patients with higher acuity. 

Sicker patients are on the way. The question is, what can you do? In this article we’ll review those underlying causes for delayed care, consider the consequences, and offer a few suggestions on how to mitigate the impact of this next shock to your system.

Reasons for Delayed Care

Patients are delaying care for several reasons. First, there is the shortage of doctors and nurses, which was unfolding before COVID and has only widened since then. Shortages lead to fewer appointment slots, which translate into reduced access to care. For many patients, that means having to wait longer to see a doctor, if not giving up. These constraints especially bear upon the 100 million Americans who live in Health Professional Shortage Areas (HPSAs), where there is a current need for more than 17,000 primary care practitioners.  

Inflation and changes in Medicaid are two other factors. The percentage of Americans who reported postponing medical treatment in 2022 due to costs rose 12 points year-over-year, to 38 percent, according to Gallup’s Health and Healthcare annual poll. This was the sharpest annual increase to date and the highest percentage in the poll’s 22-year trend. In addition, pandemic-related emergency provisions that paused the yearly reapplication process for Medicaid have ended. As a result, millions of Americans who failed to reapply or are no longer eligible are likely to lack coverage. 

A final driver of delays – or avoidance – is the disincentive posed by high-deductible health plans (HDHPs). According to a Kaiser Family Foundation (KFF) survey from 2022, 44 percent of insured Americans worry about affording their deductible before health insurance kicks in. The trend is clear. Drawing from KFF and other data, Value Penguin researchers reported that 55.7% of American private-sector workers were enrolled in HDHPs in 2021, the highest percentage on record and eighth straight yearly increase.  

Greater Delay = Higher Acuity (higher costs) and Mortality

The negative impact of postponed care is no mystery. Failing to identify a disease in an early stage means any subsequent medical engagement must play catch up. Without intervention, disease develops on a predictable course, typically becoming more severe and harder to treat. In either case – failing to screen or intervene – the consequences can be deadly, as studies have shown. 

A Mayo Clinic report in 2020 stated that a delay in colon cancer surgery of more than four months could lead to 10,000 excess deaths in the U.S. over five years. Physicians at the Icahn School of Medicine at Mount Sinai reported that three months after elective procedures were halted due to COVID, more than 30 percent of aortic stenosis patients who deferred care required emergency surgery or died. An NIH report noted that the estimated 9.4 million screenings for cancer that did not occur in 2020 could lead to more advanced-stage diagnoses and, ultimately, to higher mortalities. 

How to Mitigate the Crisis 

Reversing this downward spiral requires both analysis and a proactive stance. It is crucial to understand key indicators and see how they look from the perspective of patient, clinician, clinical executive and CFO. But you also need to act. For starters, consider just one of the drivers mentioned above: the end of Medicaid emergency provisions. To take the initiative, you could have identified at-risk patients, supported their Medicaid renewals if possible, and maximized the chances for positive outcomes, while minimizing bad debt and leakage. 

To mitigate the impact of sicker patients across the board going forward, focus on these three areas: 

  1. Monitoring and analysis. Do you have enough visibility into patient behavior? Are patients continuing to defer care or are they migrating to simpler alternatives? Stratify your at-risk patients and populations, taking into account not only their current risk but also their changing circumstances, such as financial stability. Data analytics is the primary antidote to the new crisis of delayed care-driven morbidity.
  2. Patient engagement. Service delivery models changed during the COVID-era, but it is not enough to maintain the digital front door to your office and facilities. You also need to build genuine connections with patients through remote monitoring and management. Patient participation is critical to bending this curve. New technologies, such as digital augmentation of the home setting and patient engagement through conversational AI capabilities, also can help you navigate these challenges. 
  3. Automation. Data and process automation can help put patients on optimum care pathways and reduce the time it takes to connect with specialists and undergo procedures. Automation can also lighten the heavy (and burnout-inducing) load of routine care and enable medical teams to focus on tougher and more complex cases. Of course, little of this can happen with siloed data. A good place to start is to examine your own organization’s data interoperability capabilities. 

Bad News, Good News

The unexpected pandemic led to deferred care, which increased patient acuity, as the American Hospital Association has well documented. Unfortunately, while the pandemic has abated, other factors are in play, promising similar results. The good news is that the drivers of this follow-on wave of sickness are hiding in plain sight. With strategic applications of monitoring and analysis, patient engagement, and automation, you can begin preempting the next, new “surprise” today.

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