Improving COVID Care Delays: How Pharma Companies Can Help Patients

The COVID pandemic indelibly altered the healthcare industry in visible, visceral ways. Not only has it extracted a nearly unimaginable human toll—with 94 million cases and more than one million deaths in the U.S. alone—but it hit pause on an industry used to providing in-person medical care, specialized surgical procedures, and routine health screenings to hundreds of millions of people annually. And even though the system seems to be returning to some semblance of normalcy, it’s going to take a village to help patients and the industry get back to full health.

Stress Cracks

The pandemic stressed the healthcare system to the point where it seemed to crack its very foundation, including who got care, what kind of care they got, and where they got it. Researchers from the Harvard T.H. Chan School of Public Health, the Robert Wood Johnson Foundation, and National Public Radio, found that roughly 20% of U.S. households were unable to get or delayed medical care for serious problems. And of those who reported delays, 57% reported negative health consequences.1

Another survey, examining the health behaviors of 1,337 adults between March and mid-July 2020 found that, among those who reported needing care during the initial months of the pandemic, more than half—52%—skipped care. This included missing scheduled preventive care (58%); not getting treatment for severe mental or physical health issues that emerged after the start of the pandemic (51%); and not picking up a prescription or missing one or more doses of a prescribed medication (15%).2

Social distancing and canceled procedures combined to make healthcare inaccessible or risky, and even two years down the line, COVID’s impact is still being felt globally. The World Health Organization reports COVID-related health service disruptions for primary care (including immunizations), rehabilitation and palliative care, emergency care, and elective surgery in the European region continued past the first stages of the pandemic and into the end of 2021. Disruptions even increased in 2021 for some services such as cancer care and nutrition.3

If there has been a positive counterpoint to COVID’s decimation of healthcare as we knew it, it’s the uptake of telehealth. The U.S. Department of Health and Human Services (HHS) showed a 63-fold increase in Medicare telehealth during the pandemic,4 and in 2021, 85% of providers said they provided care via telehealth to their patients.5

The Way We Were? Not So Much

Although many healthcare services have resumed since COVID’s earliest waves (and health services revenues have bounced back from their low in April 2020),6 healthcare is not going back to the way things were. Patients appear to have fundamentally changed how they use healthcare services, from embracing telehealth and digital tools to foregoing care.

Preventive cancer screenings are a good example. An analysis of electronic health records by Epic Health Research Network found average weekly screenings for breast and cervical cancer dropped 94%, and 86% for colon cancer during the period of January 20-April 21, 2020.6 Many months later, in January 2021, major U.S. cancer organizations such as the American Cancer Society and National Comprehensive Cancer Network; professional organizations like the American College of Physicians and American Society for Radiation Oncology; as well as dozens of cancer centers, including MD Anderson Cancer Center, Mayo Clinic, Dana-Farber Cancer Institute, and Mass General Cancer Center, put out an urgent call to action about the importance of screenings, as rates were not returning to pre-pandemic levels.7

Care delays can have serious (if not deadly) consequences for patients—and they also have significant impacts on HCPs who continue to struggle with labor shortages, supply chain issues, and revenue losses. In March of this year, for example, hospitals and health systems were reporting surgical case backlogs in the thousands or tens of thousands.8 The logistical challenges of getting patients through the system only exacerbates the potential health impacts to patients who voluntarily put off, or were forced to put off, needed care.

Who’s Affected?

The spectrum of patients affected by COVID is broad, if not comprehensive: those with chronic, respiratory, and mental health conditions; cancer patients; the elderly; the very young—but also those without health insurance, dealing with job insecurity, health responders, parents, and kids. In other words, nearly everyone.

Eric Solis, PhD of Takeda Pharmaceuticals and Mark Schulman of Veeva Crossix recently defined patient segments whose health behaviors were most affected by COVID using anonymized health and consumer data points across 300 million U.S. patients and big data sources.9 According to Solis and Schulman, 62% of patients with chronic conditions before COVID were responsible for 80% of the drop in new prescriptions. They also defined three subgroups of patients with care delays, including drops in prescriptions:

  • Middle-class suburban parents with higher rates of common conditions, who likely deprioritized their own health.
  • Mostly female, pre-Medicare-eligible patients in rural and suburban areas, with an income below $50,000 and averaging 3.5 conditions.
  • Low income, single young adults who tend to have high rates of health issues, such as obesity and depression.

How to Seize the Moment

We know that care delays matter—a lot. The longer and more widespread, the more likely to lead to serious diagnoses and higher costs. McKinsey & Company estimates the average cost of treating a patient with chronic obstructive pulmonary disease can rise as much as 7% to 11% due to increased severity in patient symptoms caused by care deferrals.10 But if getting patients to resume care is important and necessary, it also means pharma companies (and truly, most providers and companies that serve patients across the health ecosystem) have to change how they think about patients.

First, how patients want to receive care today has changed. Besides the rapid adoption of telehealth for primary care, patients have embraced (and industry has expanded options for) online mental health services; online appointment scheduling and remote registration and check-in; online pharmacies; and retail care. Pharmacy e-commerce, for example, saw massive growth during the pandemic. CVS saw online prescription orders grow 1,000%10 in the early stages of COVID, while new online pharmacies, such as Mark Cuban’s generics-focused Cost Plus Drug Company, are proliferating.

Second, using data is the best way to tackle a challenge of this magnitude. COVID didn’t unleash one change, or one effect; it caused a universe of changes. Data—or more accurately, the right data—can help us drill into the best places to make the most impact. Healthcare is certainly known for prolifically collecting data; it’s also known for struggling how to leverage it to its best effect.

Strategies to Support Patients Who Need Care

So, how can pharma companies navigate this changed landscape to encourage and support patients to get timely care?

1. Expand consumer education. The growth of online pharmacies/pharmacy e-commerce means increased transparency in drug pricing. As patients navigate their online pharmacy options, they will be able to price compare and make decisions outside of their provider’s office. The growth of this sector contributes to and supports healthcare consumerism. As patients learn more, they gain control, and will be proactive in talking with their providers.

2. Rethink your provider audience. COVID not only changed care delivery, it changed who delivers care. To ensure access to care during COVID, state governments temporarily changed how they regulated some health professions, for example, by expanding who could deliver perinatal care or behavioral health services. These programs were so successful, some states are considering making provisional or temporary licensure changes permanent.

Similarly, as retail pharmacies became COVID vaccination destinations, pharmacists grew into more prominent and active patient advisory roles. If you are targeting only physicians with messaging, you may be missing a big part of today’s provider network—and opportunities to reach more patients.

3. Use behaviors as a lens. The digital-averse patient became an advocate during the pandemic. The never-miss-an-appointment patient became an “if I need it only” one. Customer behavior changed during the pandemic. Create customer segments based on shopping behaviors, not just demographics (e.g., the online shopper, the in-office stalwart).

4. Build digital destinations, not just websites. Consumers have shown an affinity for digital tools. While pharma has done a good job of building out e-detailing for HCPs, patient tools are more limited. Connecting patients to information and resources, and making the experience easy is in sync with the greater move to digital health.

5. Be proactive. Consumers need and want help now, especially as they face potential increased costs. The impact of inflation tends to lag in the healthcare industry because pricing is fixed for the duration of existing contracts. But as payers and providers renegotiate, consumers will start to see a hit to their wallets and many may decide to delay care for financial reasons, not just for pandemic-related ones.

We generally think about innovation as a positive force—disruptive but for the larger good. COVID has certainly disrupted healthcare, it’s up to the industry to channel that disruption into innovation, for the sake of each and every patient.

References:

1. “Delayed Care with Harmful Health Consequences – Reported Experiences from National Surveys During Coronavirus Disease 2019.” Mary G. Findling, PhD, ScM; Robert J. Blendon, ScD; John M/ Denson, MA; JAMA Health Forum, 2020; 1 (12):e201463. Doi:10.1001/jamahealthforum.20202.1463.

2. “Why 41% of Patients Have Skipped Care During COVID-19 Pandemic.” Tanya Albert Henry, AMA, Feb 15, 2021, ama-assn.org.

3. “Policy Brief 47, Addressing Backlogs and Managing Waiting Lists During and Beyond the COVID-19 Pandemic.” Ewout van Ginneken, Sarah Reed, Luigi Siciliani, Astrid Eriksen, Laura Schlepper, Florian Tille, Tomas Zapata, World Health Organization 2022.

4. “New HHS Study Shows 63-Fold Increase in Medicare Telehealth Utilization During the Pandemic.” HHS Press Office, Dec 3, 2021. Hhs.gov.

5. “2021 Telehealth Survey Report.” American Medical Association, ama-ass.org.

6. “How Have Health Spending and Utilization Changed During the Coronavirus Pandemic?” Cynthia Cox, Krutika Amin and Rabah Kamal, Peterson-KFF Health System Tracker, March 22, 2021, healthsystetracker.org.

7. “Major U.S. Cancer Centers and Organizations Endorse Goal of Resuming Cancer Screening and Treatment During the COVID-19 Pandemic.” SGO, Reengage-letter.1.12.pdf, Jan 28, 2021.

8. “How UW Medicine, Mayo Clinic + Others Are Tackling a Backlog of Surgical Cases.” Kelly Gooch and Georgina Gonzalez. Beckers Hospital Review, March 3, 2022, beckershospitalsreview.com.

9. “How Pharma and HCPs Can Support Backlogged Pandemic Patients.” Eric Solis, Takeda and Mark Shulman, Veeva Systems. Pharmaceutical Commerce, Dec. 8, 2021. Pharmaceuticalcommerce.com.

10. “Understanding the Hidden Costs of COVID-19’s Potential Impact on U.S. Healthcare.” Erica Hutchins, Kana Enomoto, Patrick Finn, John Stenson, Kyle Weber, McKinsey & Company, Sept 4, 2020, mckinsey.com.

  • Dagmara Scalise

    Dagmara Scalise is VP, Customer Strategy, Health Vertical Lead at Merkle. Dagmara is part of Merkle’s customer experience strategy team. She has nearly 20 years’ experience in healthcare strategy and brand development, customer experience, digital marketing, content development, and platform builds for a wide range of healthcare companies including UChicago Medicine, Dana Farber Cancer Institute, Scan Health, and Yale New Haven Health.

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