Will Delayed Care Ramp Up Demand for Specialists? Key Trends to Watch

Two out of three Americans have missed getting recommended cancer screenings during the pandemic, and more than half omitted or delayed routine care, a Prevent Cancer Foundation survey recently found. These gaps in care likely will increase individuals’ risk for serious health issues—a scenario that could put intense pressure on specialty care access, especially in areas that were underserved prior to the pandemic.

Warnings about the impact of gaps in essential care began not long after COVID-19 emerged in the United States, when it was clear that Americans were postponing needed care out of fear of contracting the coronavirus. By June 2020, four out of 10 adults had avoided care due to COVID-19 concerns, according to a CDC survey. These numbers were even higher among unpaid caregivers, people with underlying medical conditions, Black adults, Hispanic adults, young adults, and persons with disabilities.

Now, recent data are beginning to reveal the health impact of gaps in essential care for people with chronic and complex conditions:

• An MGMA survey found diabetes and hypertension outcomes have worsened among adults in the Salt Lake City area—particularly older adults—even as options for accessing telehealth have expanded.

Last year, more people than expected died from causes unrelated to COVID-19, and some of these deaths are likely due to disruptions in access to care or utilization, according to the CDC.

Rates of anxiety and depression are climbing, and experts fear this could have a profound impact on chronic care management.

In specialties like pulmonology, otolaryngology and cardiology, patient visits still lag far below pre-pandemic baselines.

Unless healthcare providers prepare for an eventual onslaught of patients with complex conditions and advanced illness, they could struggle to manage a sudden surge in demand. Such a scenario would put patient access, engagement and outcomes at risk.

Bold Steps to Stay Ahead of the Curve

How can healthcare leaders prepare for heightened demand while also engaging hard-to-reach populations that most need help? In the months ahead, efforts to increase access and build trust among those most vulnerable will be crucial. Here are three action steps to consider.

Partner with employers to close gaps in essential care. Three in four employers say they will ramp up the move toward value-based care models over the next three years. In this environment, healthcare providers will be distinguished in part by their ability to:

1. Match members with the expert best suited to review their case—not just locally
2. Perform behind-the-scenes work ahead of the appointment—from collecting medical records to coordinating lab samples, imaging and more—to optimally support medical decision making
3. Engage patients directly in a thorough review of their diagnosis and treatment plan

During the pandemic, four out of 10 Black and Hispanic adults in every age group are likely to have missed or canceled health appointments, and women in these demographics are most likely to have missed a mammogram, pap smear or HPV test. Working with employers to determine which employees and dependents missed needed care and screenings during the pandemic and encourage them to come back for care is a vital step toward closing gaps in care that could put members’ lives at risk. It’s an effort that could improve health outcomes by pairing members with the right care—including specialty care—at the right time. It also helps distribute demand for specialty care more evenly and strengthens providers’ bottom line.

Teach populations most at risk how to navigate digital paths to care. The key to a return to pre-pandemic specialty volumes is gaining patients’ trust. An MGMA survey found that while 57% of respondents had a medical condition that required immediate attention in July 2020, 60% had not tried a virtual visit, in part because they were concerned about the quality of care or the privacy of an online visit. They also stated that they did not know enough about virtual visits and believed telehealth visits were too impersonal.

Meanwhile, while more specialty providers are engaging in telehealth visits, connecting to telehealth is still hardest for those who need it most. Some consumers face challenges with broadband connectivity or availability of devices that support video interactions. Others aren’t sure how to set up a virtual visit with their physician or whether they have the tools to engage in a virtual encounter.

That’s why reaching out to populations most at risk and providing the tools and support needed to access virtual care—including specialty care—is so critical. One way to do so is by partnering with health plans and employers to determine which members could most benefit from virtual care to close essential gaps in care. From there, leaders should identify options for pairing members with the technology to access virtual care and providing one-to-one education on how to use it. Community service organizations—including those that meet social determinants of heath needs, from meal services to transportation—also could be a vital link in reaching individuals who could most benefit from telehealth.

Focus on speed to insight. If individuals most in need of care are hesitant to seek it due to lack of trust, ensuring that they have fast access to experts who can answer their questions and provide appropriate guidance is crucial. In 2021 and beyond, the ability to close essential gaps in care demands that providers have the tools and workflows to make it easy to speed access to care—including specialty care—for those who most need it. They must also be willing to honor patients’ desire for a second opinion when life-altering diagnoses are made—a scenario that could increase in the months ahead, given the tendency to delay needed care and recommended screenings.

The chances of being misdiagnosed are especially high for people with complex medical conditions: 20% of people with serious illnesses are misdiagnosed, a 2017 study found. When patients who have questions about their diagnosis are connected with a provider who specializes in their condition, the level of precision increases and is essential to providing reliable care. It is also key to ensuring speed to insight and gaining patients’ trust.

Research by The Clinic by Cleveland Clinic indicates that when patients receive a second opinion for life-altering diagnoses, such as cancer, 28% of patients who seek a second opinion receive a change in diagnosis. When treatment plans are reviewed by an expert, 72% of treatment plans are modified after analysis.

Reaching Those Most at Risk

As the MGMA survey indicates, securing the trust of people most at risk for developing complex conditions during the pandemic is vital to providing the care individuals need. It also is an important step toward mitigating sudden surges in demand that could compromise timely access to care. Efforts to meet individuals where they are, educate them on the most efficient ways to seek care and provide fast access to the medical insight they need are three great places to start.

About the Author

Frank McGillin is CEO, The Clinic by Cleveland Clinic.