Posted by Jason Bae ● November 16, 2020

We Must Invest in Proactive Patient Outreach in COVID-19

Recently, Prealize advisory board member Dr. Alan Glaseroff and I wrote an article on on America’s need for investment in proactive patient outreach. This is now more important than ever. 


The COVID-19 pandemic has taken more than 235,000 American lives. Racial reckoning and economic devastation alongside the pandemic have led to a tripling of emotional distress.


Essential preventive services such as cancer screeningschildhood vaccinationsmaintenance visits for chronic illnesses have not recovered fully after plummeting in April; this will likely result in a surge of preventable illnesses and death.


We recommend immediate investment in proactive patient outreach in order to prevent these immediate and downstream effects of the pandemic. Payers and providers should focus on the following investment strategies to reduce preventable harm. 


  1. Identify patients with new vulnerabilities during COVID-19
    Reactive approaches to identify high-risk patients based on historical utilization patterns miss many patients facing new vulnerabilities posed by the pandemic. During the COVID-19 epidemic, these newly vulnerable “unseen sufferers” include patients adversely affected by the pandemic due to racism, essential work, or age, or those overdue for cancer screenings, for example. Payors and providers must incorporate these new risk factors in their outreach prioritization. Healthcare leaders can leverage AI-powered predictive analytics solutions like Prealize to analyze clinical, demographic, and social determinants of health data, and proactively and accurately identify such at-risk patients that are often overlooked by the human eye.
  2. Focus on behavior change and social needs for impact
    Helping patients minimize COVID-19 risk and socialize safely is of paramount importance, especially with pervasive misinformation and confusion on this issue. The first step is to assess for their correct understanding and current social practice patterns, such as physical distancing, hand washing, and mask use. Then, healthcare organizations should engage these newly vulnerable patients to increase safe behaviors via text, phone calls, or in-person, and reinforce recommended behaviors through trust-building, evidenced-based behavior change. Trust-building, evidence-based behavior change techniques such as motivational interviewing that link recommended behaviors should be utilized for maximal effectiveness. Outreach programs should also encourage and enable patients to receive non-urgent but essential care, such as cancer screening and chronic care management. This may include helping with safe transportation and assisting with a virtual setup plan. Lastly, more patients are facing significant social challenges with health implications, such as unemployment, food or energy insecurities, or social isolation. Health care organizations should connect them to appropriate social agencies or help obtain necessary services for living a healthy life, such as free meal service for isolated seniors. 
  3. Leverage non-clinical staff to build trust and maximize return on investment
    Outreach programs should hire and train non-clinical people, often referred to as patient advocates, health promoters, and community health workers. These health workers are generally from similar demographic and socioeconomic backgrounds as their patients and develop longitudinal relationships built on with mutual trust and shared lived experience. Studies show that these workers can effect desirable health outcomes and provide a positive return on investment. Many recently unemployed people or currently furloughed frontline staff could serve in this role for the benefit of patients.

Investment in proactive care can avert many ill effects of this COVID-19 pandemic on patients and our fragile health care system. Read the full article here, and stay safe.

Topics: COVID-19