Medicare Beneficiaries at High Risk in COVID-19-Prevalent Counties

In the top 25 US counties with the highest prevalence of COVID-19, the majority of adults over age 65 are at high risk for severe illness if they contract the virus, according to an analysis from Avalere.

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While COVID-19 is still a new disease, research suggests that certain patient populations are more likely to develop serious complications from the virus. Although the majority of cases seem to be mild, those who develop more severe symptoms often need oxygen and prolonged ventilation.

“The CDC has identified specific populations of individuals who are at higher risk for severe illness from COVID-19, including adults aged 65 and older and people of all ages with certain underlying health conditions,” Avalere researchers stated.

According to the CDC, these underlying conditions include moderate-to-severe asthma, chronic lung disease, diabetes, obesity, chronic kidney disease, and other disorders.

To estimate the share of seniors with one of these underlying medical conditions, Avalere examined the distribution of Medicare fee-for-service (FFS) beneficiaries and associated conditions based on five disease categories: autoimmune, cancer, heart, lung, and metabolic conditions.

The team found that in counties with a high prevalence of COVID-19, most Medicare FFS beneficiaries are at high risk for severe complications from coronavirus. In fact, most Medicare FFS beneficiaries across the nation are at high risk, as sixty-one percent of beneficiaries nationwide have one or more high-risk health conditions.

These results could inform not only the current situation around coronavirus, but also healthcare spending.

“This information has implications for the COVID-19 pandemic as well as future spending in the Medicare program, benefit offerings by Medicare Advantage plans, and the federal budget,” researchers said.

Historically, Medicare beneficiaries have been significantly impacted by chronic disease, and in turn, so has healthcare spending for this population. In the midst of coronavirus, it will be more important than ever to ensure these individuals are protecting themselves from infection.

As the pandemic continues on, healthcare researchers have aimed to uncover more about COVID-19 and the populations who are most at risk of severe illness and death.

A team from NYU recently used an artificial intelligence algorithm to accurately predict which patients newly diagnosed with COVID-19 would go on to develop severe respiratory disease. Researchers found that changes in three features, including levels of the liver enzyme alanine aminotransferase (ALT) reported myalgia, and hemoglobin levels were most accurately predictive of subsequent, severe disease.

While the team noted that the model needs further refining, the results could help inform COVID-19 treatment and prevention efforts.

“Our goal was to design and deploy a decision-support tool using AI capabilities—mostly predictive analytics—to flag future clinical coronavirus severity,” said co-author Anasse Bari, PhD, a clinical assistant professor in computer science at NYU Courant Institute of Mathematical Science.

“We hope that the tool, when fully developed, will be useful to physicians as they assess which moderately ill patients really need beds, and who can safely go home, when hospital resources are stretched thin.”

The Avalere data further demonstrates the increased vulnerability of older patients and individuals with chronic conditions during the pandemic. The results of the study indicate that counties significantly impacted by COVID-19 may need to take extra precautions to support and protect Medicare FFS beneficiaries.