How Coronavirus Influenced Medicare Chronic Disease Management

Medicare chronic disease management became even more challenging during the coronavirus pandemic, a recent Commonwealth Fund study confirmed.

Chronic conditions are common among Medicare beneficiaries and this has greatly influenced patient outcomes in the Medicare population during the pandemic.

After conducting a literature review, the researchers found that, among the Medicare population that was hospitalized due to the coronavirus in 2020, 80 percent suffered from hypertension and 51 percent had a chronic kidney disease.

Additionally, half of the hospitalized Medicare beneficiaries had diabetes and others had Ischemic heart disease, Alzheimer’s, dementia, heart failure, and COPD.

While many of these conditions already had strong representation in the Medicare population, the coronavirus pandemic disproportionately impacted beneficiaries with chronic conditions.

The researchers identified two major issues that the pandemic caused for chronic disease management.

First, as a result of deferred care, Medicare beneficiaries’ regular clinical checkups and disease management routines were interrupted. A third of American adults were prevented from accessing care in the first month of the outbreak because of the pandemic and that trend only grew slightly over the next couple of months.

Almost a quarter of Americans had trouble accessing their prescriptions. Around 55 percent of adults with multiple chronic conditions faced barriers in receiving their medications.

Additionally, over a third of Americans reported deferring medical care related to the coronavirus. Nearly seven in ten US adults with chronic conditions said that they were struggling with chronic disease management due to the pandemic.

Social determinants of health barriers also grew as the shutdown cut off access to cleaning supplies and groceries.

Fears around hospitalization and potential exposure to the coronavirus abounded among patients with chronic diseases. In April 2020—when many highly populated portions of the country experienced a major spike in coronavirus cases—over four in ten patients with chronic conditions reported concerns about visiting their physician’s office or the hospital.

This resulted in the second major issue: the pandemic severely disrupted Medicare beneficiaries’ emergency services. In California alone, emergency department volume was cut in half at the beginning of the outbreak and the low volume of emergency care continued for the next several weeks both in California and across the country.

At the time, CMS took action in a variety of ways, supporting access to telehealth, expanding Medicare Part D refill timeframes, and permitting reimbursement for alternate care sites. However, continuous changes are necessary in order to protect the needs of patients with chronic conditions, the Commonwealth Fund researchers argued.

The researchers suggested three policies that can address the secondary impacts of the pandemic on chronic disease management.

First, although telehealth has become a common solution to overcoming barriers to chronic disease care, policymakers have to ensure that policies related to telehealth do not aggravate existing care disparities.

For example, older patients may not know how to operate a telehealth platform, so providers could run practice visits to test patients’ skills and help troubleshoot technology issues.

Second, researchers also pointed to the CMS initiatives Hospital Without Walls and the Acute Hospital Care at Home as examples of how policymakers might reconsider regulations regarding care sites.

“In randomized trials, this model has been shown to reduce costs, health care use, and readmissions while increasing physical capacity, compared with usual hospital care for patients with complex medical conditions,” the study stated. “The outcomes of these new initiatives will likely provide critical guidance for the future.”

Lastly, CMS offered abundant flexibility to providers during the pandemic in order to ease Medicare chronic disease management. The researchers recommended that these flexibilities will continue to be key for the healthcare system as it emerges from the public health emergency and that policymakers should consider which Medicare waivers should become permanent.

“While the pandemic has had profound consequences, it also has created the opportunity to reimagine the U.S. health care system to refine value around investments in patient-centered care,” the researchers noted.

“This includes moving away from the inpatient-dominant view of medical care and expanding acute care through telemedicine, ambulatory settings, and in-home settings.”