Ensuring chronic disease treatments recover equitably from COVID-19 disruptions

Sree Chaguturu, MD, Senior Vice President, CVS Health and Chief Medical Officer, CVS Caremark

As the United States grappled with the enormous threat posed by the coronavirus last spring and social distancing measures took hold, we saw a significant drop in people accessing routine and preventive care. With the threat of a new, deadly and little understood virus, many chose to put off non-emergency medical care. Our analysis of prescription claims from the time shutdowns peaked through the course of the pandemic shows that this drop extended to prescription medications for common chronic conditions. While perhaps not surprising, this drop is concerning, and the patterns also reveal the impact of — and the need to address — social determinants of health.

Our analysis of medication utilization trends, which we reported in the 2020 CVS Caremark Drug Trend Report reflected a steep drop-off in the number of people beginning therapy for chronic conditions or adding additional drugs to an ongoing medication regimen.

As restrictions began to be relaxed in the third quarter, people became more comfortable seeking care again and the strain of the sudden onset of a global pandemic on the health care system lightened, the trend reversed somewhat. However, the recovery was not to pre-pandemic levels of utilization.

Perhaps of greater concern is that the drop in utilization was highest in the Medicaid population and the recovery, smallest. Medicaid patients are generally from lower-income households and often comprise more vulnerable populations including rural communities and communities of color that already face significant health disparities. And, chronic conditions like heart disease, hypertension, hyperlipidemia and diabetes are highly prevalent amongst Medicaid recipients. While the data does not show a direct correlation, it is possible — even likely — that at least some of those who stopped seeking care at the height of the pandemic and did not resume later in the year within the Medicare and commercial populations are also those who are most likely to experience health disparities linked to social determinants of health like limited access transportation and proximity to providers.

This means potentially millions of Americans are not seeking or receiving the care they need for serious chronic conditions because of disruptions from the COVID-19 pandemic. This disparity not only puts individuals at significant risk, it can also have an impact on our entire health care system because untreated and undertreated chronic diseases can lead to health complications resulting in hospital stays, and other adverse events that strain limited resources.

As a pharmacy benefit manager for one in three Americans, we have an opportunity to understand where the risks are greatest and how to create the right interventions at the right time. This includes doing the work to ensure that the challenges of the COVID-19 pandemic do not result in less or worse care in these communities:

• We are engaging with our members in vulnerable communities more often, using communications channels that they are likely to see and respond to — like text messages instead of email or phone. We tailor messages to ensure that people are both aware of their health risks and where they can get support that works for them.

• We tailor support and treatment options for members, informed by both their individual health history and by demographic patterns based on age, gender, education level, geography, income and race.

• We work within communities that face health disparities to address the things that have often driven or increased those disparities — affordability, accessibility, awareness and trust. We do this by engaging with community leaders, non-profit and faith-based organizations and other familiar and trusted local pillars to communicate health messages and improve access to health services.

We have a responsibility to ensure that the immediate health impact of the virus doesn’t exacerbate existing health challenges like the fight against chronic disease and systemic health equity gaps. By carefully monitoring utilization patterns and demographic trends, CVS Caremark is using our infrastructure and expertise to identify and address spillover effects from the pandemic ensuring that no one — especially those already impacted by health care disparities — lacks the care and support they need to manage chronic illness.

We have a responsibility to ensure that the immediate health impact of the virus doesn’t exacerbate existing health challenges like the fight against chronic disease and systemic health equity gaps. By carefully monitoring utilization patterns and demographic trends, we can identify and spillover effects from the pandemic. But we must take additional steps to address these trends and ensure that no one — especially those already impacted by health care disparities — lacks the care and support they need.

Looking ahead, data and analytics will play a key role in reducing health disparities and supporting chronic disease management. As the pharmacy benefit provider to one-in-three Americans, we use data analysis to help clients better understand the extent of health disparities — and identify ways to address them. For instance, we built a data layer that incorporates more than 400 data points from the U.S. Centers for Disease Control and Prevention, the Environmental Protection Agency, the U.S. Census Bureau and other critical sources. With this data layer, we will be able to better identify and report on health care disparities, tailor medication management and delivery, improve medication affordability, and identify increased opportunities for community partnerships.

Moving from simply understanding that care gaps exist to using data to pinpoint ways to close them will be critical in tackling the challenges of health disparities and chronic disease.

Originally published in Healthcare Dive magazine