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Data analytics uncovers opportunities to help members at risk for COVID-19

April 20, 2020 | Pharmacy

A woman examines a set of data on a very large and reflective computer screen.

Aetna’s clinical and customer service teams are helping to support Medicare and other members who at higher risk for contracting COVID-19 and may suffer serious illness from the virus. The enhanced outreach is thanks to a new patient risk tool developed by a cross-functional team of CVS Health clinical and data analytics colleagues.

The unique tool, which utilizes data from published clinical studies, Aetna claims data and publicly available COVID-19 tracking information, helps identify members who live in areas with high numbers of COVID-19 cases and may be at increased risk for severe infections.

“The COVID-19 pandemic does not impact our membership evenly. Medically complex members living in hotspots are at particularly high risk,” said Daniel Knecht, M.D., Vice President of Health Strategy and Innovation. “This new model, which offers a county-by-county overview, helps us direct our telemedicine, nurse case management, and other patient resources where they’re needed most.”

A number of pre-existing health conditions, including heart disease, diabetes, lung disease, and hypertension, are believed to increase the risk of serious outcomes from contracting COVID-19. By determining which Aetna members live in geographic areas with large numbers of COVID-19 cases and may have higher risk factors, clinical and customer service teams can connect with members by phone and other means to help them understand their personal risks. Case managers also discuss the importance of proper social distancing, good handwashing and other hygiene techniques, as well as potential symptoms of COVID-19.

“This model allows us to produce a daily map that lets us understand what’s happening across the country,” said Gui Woolston, Vice President, Clinical Product Analytics. “By calculating the high-, moderate- and low-risk Medicare, Medicaid and Commercial populations, we can ensure that our outreach is appropriate to the patient’s needs.”

Engagement ranges from phone calls to digital outreach or mailed postcards, all centered on sharing critical prevention strategies as well as helping to assess symptoms, where needed. Case managers and customer service representatives educate members about enhanced benefits that have been put into place during the pandemic. And they connect members with the additional social support and other services they may need to stay well during the pandemic.

“If there’s a second wave of the pandemic, it will be important that we have this infrastructure in place and ready to deploy,” Knecht said, adding that the model could be helpful in other types of public health incidents.