EXECUTIVE SUMMARY

A patient-centric care coordination model is needed to help patients with COVID-19 after they are discharged from the hospital.

  • The program brings durable medical equipment, case management, and services to patients with symptoms that continue after discharge.
  • Many people become long-haulers after contracting COVID-19.
  • Many COVID-19 patients with long-term health issues were not hospitalized and experienced only mild to moderate illness.

A coordinated care approach to treating patients with COVID-19, including workers’ compensation cases, can provide patient-centric healthcare that is efficient and effective.

“Our care path program provides either a patient-centric model or an event-based model that helps bring in a care coordination aspect, following a diagnosis or tied to an event,” says Linda Colsen, vice president of customer service with One Call in Jacksonville, FL. One Call provides workers’ compensation services. “Our primary focus is in post-discharge recovery. It’s focused on coordinated care after their discharge.”

For example, a person might undergo surgery related to an injury. After surgery, the person may need durable medical equipment, home healthcare, physical therapy, and — if the person speaks a language other than English — language services.

“Coordination has to take place in a finite period,” Colsen says. “People need a lot of products and services. The goal is to bring them together in a coordinated approach.”

The care path model includes pullout pathways, such as the respiratory pathway. This originated with coal miners and people who experienced silica illnesses and deaths, she says.

“Because COVID started out as primarily a respiratory illness, we looked at the care path to see what we could do to help people recover faster and return to health,” Colsen explains. “There was so much we didn’t know about COVID. There were not specific procedures and care plans.”

The public holds some misconceptions about COVID-19 because of the invisibility of patients’ long-term debilities from the disease.

“One piece that has fed into a lot of misperceptions is what you see on the news of a person in the hospital and in the ICU and on the ventilator for six weeks, and now they’re getting discharged,” Colsen says. “There are two lines of hospital workers cheering as the person is wheeled out of the door.”

But the COVID-19 story does not stop there. “If you’re in the hospital for weeks and weeks, you have issues with your strength, the diet restrictions are different, and you need a lot of things,” Colsen explains. “People are not wheeled out of the hospital today and then back to life tomorrow.”

Instead, many people became long-haulers, people who continued to suffer physical and psychological problems for weeks or months after they were discharged.

“We believe it is important to treat the whole person so they can get back to work,” Colsen says. “There are long-haulers, and medical professionals need to know why they are still having issues with brain fog and why they can’t go back to being their fully functioning selves.”

Many people who suffered from COVID-19 had done nothing more dangerous than go to work each day and, suddenly, they lose four weeks or more of their lives in the hospital. “As we learn more about the virus and subsequent complications, things are going to change,” Colsen adds. “We’ll be able to adapt to those changes and recognize that the person is trying to get better and needs assistance.”

They devised a model that would help people recover and also provide savings to payers. “The model was based on COVID cases,” Colsen says. “But if we take the COVID diagnosis out of the picture, I believe the patient-centric care coordination approach is better for families because people get the help they need.”

This approach provides case management help in an efficient and evidence-based way. “We partnered with [a company] that does outcomes research, and they looked at Medicare data because it’s widely available for those patients with a COVID diagnosis,” Colsen says. “They started looking at their complications and other symptoms.”

For example, blood clots are a common complication for people with COVID-19. “It could be a blood clot in the lungs, or it could cause stroke,” she says. “All sorts of bad stuff could happen.”

The idea was to look at the various COVID-19 complications, collect data, and determine the frequency and duration of each. They also studied how long it took for patients to recover, and made comparisons of the care path vs. general care among a Medicare population. The research revealed a coordinated care approach could save $6 million among 1,000 patients. This was based on illness severity reporting by the Centers for Disease Control and Prevention (CDC), which showed unmanaged costs as potentially $21 million. This is based on unpublished data Colsen shared with Case Management Advisor.

“Using CDC-published severity percentages, 81% had mild to moderate illness, and 14% were severely ill and were admitted to the hospital. Five percent were in the ICU with multisystem organ failure,” Colsen says. “They had cardiac, vascular, gastrointestinal, neurological, organ, respiratory, musculoskeletal, and other complications.”

The study also showed coordinated care shortens the length of skilled nursing facility stays by an average of 9.5 days, with an additional cost savings of about $10,000 per patient. The One Call data conclude payers and employers could save between 31% and 53% when applying a coordinated approach to care with network pricing.

“We looked at illness severity among people in the ICU after severe events or being critically ill,” Colsen says. “We looked at what they needed and for how long.”

There is a larger population of COVID-19 patients who are not hospitalized, but have mild to moderate illness. “We looked at what products and services they needed, and compared how the model looked in terms of utilization,” she explains. “The coordinated clinical management approach drives clinical savings.”

One of the coordinated care techniques that helped drive significant clinical savings was monitoring patients. Physical therapy is one example.

“When patients receive physical therapy, we actively monitor their utilization and recovery plan,” she says. “Once they reach their rehabilitation goals, they don’t continue with physical therapy.”

Also, if patients are not progressing, there are triggers in the system to bring about a peer review and discussion with the physical therapist.