Managing the Care of At-Risk Populations During the COVID-19 Pandemic

Thoughtware Alert Mar 27, 2020
Long-term-care provider speaking with senior

Across the country, Medicaid managed care organizations (MCO) play an essential role in managing the health of elderly and homebound individuals, as well as other populations at a higher risk for severe illness related to COVID-19. The following operational considerations may benefit your organization as it works to support beneficiaries during the COVID-19 outbreak.

  1. Does your internal risk stratification methodology align with known risk factors for COVID-19?

According to the Centers for Disease Control and Prevention (CDC), populations at higher risk for severe illness related to COVID-19 include individuals:

  • Aged 65 years and older.
  • Who live in a nursing home or long-term care (LTC) facility.
  • Who have certain high-risk conditions, including chronic lung disease, moderate to severe asthma, serious heart conditions, severe obesity, i.e., body mass index over 40, diabetes, renal failure and liver disease.
  • Who are immunocompromised due to cancer treatment, bone marrow or organ transplant, immune deficiency, poorly controlled HIV or AIDS and/or prolonged use of corticosteroids and other immune-weakening medications.
  • Who are pregnant. People who are pregnant should be monitored since they are known to be at risk with severe viral illness, however, to date, data on COVID-19 has not shown increased risk.

Based on demographic data (including age, residence type and comorbidities) and claims data related to ongoing treatments and medications, your organization can identify beneficiaries who may be at higher risk for severe illness related to COVID-19. This can help guide organizational decisions regarding who would benefit most from frequent telephone contact.

  1. Are your resources being used efficiently?
  • Reevaluate your organization’s telephone script. Consider whether certain questions, statements and/or tasks can be removed from your script, while remaining compliant with state and federal regulations, so you can increase the number of beneficiaries contacted. You may want to add certain questions, statements or tasks to your script in the context of the COVID-19 outbreak, including:
    • Reviewing and screening for primary symptoms of COVID-19, including fever, cough and shortness of breath.
    • Reviewing and screening for emergency warning signs to seek immediate medical attention, including trouble breathing, persistent pain or pressure in the chest, new confusion or inability to arouse and bluish lips or face.
    • Reiterating the importance of prevention through social distancing.
    • Confirming a backup plan for care for beneficiaries receiving long-term services and support.
  • Repurpose staff as needed. Consider whether certain roles would benefit from cross-training in the context of the COVID-19 outbreak to increase your organization’s ability to perform essential functions.
  • Share information. Identify a location within your existing electronic health record (EHR) and/or care management system to track beneficiaries’ current status. Make all internal staff aware of this location for adding and verifying status.
  1. How can your existing relationships support ongoing efforts?

Maintain regular contact with providers that maintain regular contact with your beneficiaries, including home care agencies, nursing homes and LTC facilities. Establish primary and backup contacts for these providers. Home care agencies may use an electronic visit verification (EVV) system to automatically contact your beneficiaries. Contact your home care agency partners to discuss whether their EVV system can support your organization’s ongoing efforts.

Reach out to your BKD Trusted Advisor™ or submit the Contact Us form below if you have needs related to maintaining current operations during or addressing issues that have arisen as a result of the COVID-19 outbreak.

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