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Managing Risk in a Post COVID-19 World
How payers and providers can use external data to reduce risk associated with the virus in informing strategies in understanding both near and long-term cost and utilization trends.
Mar 01, 2021
In the early days of the pandemic, hospitals were struggling to figure out how to treat patients, including identifying what symptoms they would have and how to address staffing and supply chain challenges. While we’ve come a long way since the days of shared ventilators and unvetted medications, there is still so much we don’t know about this virus and the long-term implications it will have on patient care.
This has become a risk management challenge for payers and providers who are now having to project the long-term impacts of COVID-19-related care, understand the utilization across medical services and delivery settings, and what that care is likely to cost, with very little data to rely on. There are so many unknowns in these forecasts, particularly for patients with co-morbidities, whose conditions may be exacerbated by the virus, it can be close to impossible for payers and providers to properly predict these impacts.
In most cases, when payers and providers want to predict annual costs and demand among patient populations, they would rely on their own historical data sets to project volume, flow utilization, and treatment costs. But with COVID-19, internal data alone simply cannot provide the detailed insights they will need to make accurate projections. Providers and payers can gain more detailed insights by adding external data sources to their forecasting models.
Filling the gaps
While no one has the answers yet, payers and providers can use longitudinal prescription and medicals claims databases from companies like IQVIA to fill in these gaps. IQVIA’s Medical Claims Database provides detailed, all-payer information about patient-level diagnoses, procedures, and provider panel demographics from facilities across the country. The Longitudinal Prescription Database offers near real-time information about the prescriptions drugs and therapies being prescribed in different regions and the pace and consistency at which those prescriptions are being filled.
These data sets provide payers and providers with the depth and breadth of data they need to see how other experts in the field are handling COVID-19 care and to identify variations across patient populations, regions, facilities, socioeconomic factors, and other defining characteristics. These insights can help them more accurately predict future demand, anticipate COVID-related complications and costs, and help understand effective standards of care among different populations to improve outcomes and reduce risks.
Payers and providers can also leverage these data sets to determine how the pandemic will alter the patterns of when, where, and how patients will access care in the future and what impact that shift will have on costs and revenue. This includes determining whether telehealth will continue to be a popular care option in the years to come and whether it will introduce new costs, obstacles, or potential revenue streams for their business models.
The big picture
Individually, each of these healthcare data sets can add value for providers and payers who are trying to predict treatment costs and demand, and to define the best course of treatment for their patients and members. But when analyzed together, it paints a detailed picture of how COVID-19 is driving cost and demand trends across the country.
They can then compare these analyses with their own internal data to validate if the care they are providing/paying for aligns with standard practices, what they can do to improve the quality and cost of outcomes using different treatment methods, and identify what types of outreach efforts can be used to encourage more prompt interventions.
These data sets can also help providers make choices about how they will deliver care going forward and where they should make investments to support those plans.
Providers can use the data to help decide when and if they want to offer telehealth services to meet the needs of their patients, while payers can use them to determine whether telehealth is a cost-effective solution that they should be covering and to determine when and if they should encourage its use among members to meet standards of care at a lower cost.
There are many ways payers and providers can benefit from adding external healthcare data sets into their strategic planning process, but the most impactful benefits can be seen when these data are used as a tool to inform optimal decision-making and mitigate risks as they prepare for a future that is being continuously redefined by a global pandemic.
There are still many uncertainties about the cost and impact that COVID-19 will have on different patient populations in the years to come, but the stakeholders who leverage external data will be best prepared to track near real-time market changes and to deal with what that future holds.
Healthcare expertise & unparalleled data to mitigate risk
Learn how using trusted external analytics, combined with insights from your own data, can mitigate risk and support your strategic planning process.