In January 2020, a Public Health Emergency (PHE) for the United States was declared due to the 2019 novel coronavirus. Every 90 days since, the Health and Human Services Secretary has renewed the PHE status which means our nation has been under this declaration for 12 continuous months. The numbers of coronavirus cases and deaths change so quickly that by the time this Spotlight and most articles on the subject are published, the numbers are outdated. However, as of the end of January, the United States reported more than 26 million diagnosed cases, and nearly 440,000 deaths. Recent reports predict that the nation may be positioned to soon begin its worst phase yet of cases and deaths. The availability of two vaccines is increasing as our nation’s most vulnerable and at-risk have begun to receive the two-dose immunization.
The coronavirus has had a particularly harsh impact on rural communities. Rural America has a significant population that is at high risk for severe illness if they contract COVID-19. Age is a risk factor for severe illness with COVID-19 and 80% of COVID-19-related deaths have been reported among adults aged 65 years or greater. It is notable that rural communities have a higher proportion of older Americans compared with urban communities. Nearly one quarter (23%) of all Americans aged 65 years or greater live in rural communities.
To further challenge rural communities, on a national level 80% of their population are designated as medically underserved. Rural communities have higher disability rates and higher rates of residents without health care insurance or broadband service which limits their access to virtual care. Rural health care systems were already facing extraordinary challenges, when the COVID-19 pandemic hit and many of these systems struggled to keep their doors open. With fewer physicians and specialists and fewer intensive care beds per capita – rural providers were stretched thin. CMS has noted that throughout the COVID-19 pandemic, providers in accountable care organizations delivering value-based care managed the new challenges better than those who served patients with fee-for-service models of care.
Confluence Health | Wenatchee Valley Hospital and Clinics (Confluence) have been members of the Stratum ACO since 2019 – long enough to have established value-based models of care. Confluence serves an expansive rural area in the state of Washington, an area hit hard by COVID-19.
Confluence quickly recognized that with many in-person services being shut down that their patients, and specifically their vulnerable populations, had the potential to be very isolated during the quarantine and social distancing mandates. As they transitioned to virtual care, they also noted that their Medicare population was not as technologically savvy and therefore less likely to access telehealth. With this knowledge, the case management staff placed a high emphasis on personal outreach in hopes to help patients feel supported and connect them with the care, services, or resources when indicated.
In one example, an outpatient had been diagnosed with COVID-19 and lived alone. The case manager called each day and deployed COVID-19 case management workflows overnight. As the case manager continued to call, she noted that the patient had become extremely sick and unable to get out of bed and was no longer returning calls. The Confluence team stepped in and had the patient admitted to the hospital. As the patient slowly began to improve, she thanked the case manager for her persistent outreach. When asked about her case manager the patient commented, “I would have died in bed had she not left multiple messages that day checking in – the case manager saved my life.”
“The organization as a whole recognized how specifically case management services and staff have the capacity and skill sets to connect with individuals in the community to engage them in this type of support. We as case managers, have a very specific niche for reaching out and collaborating with patients in the community setting, which is unlike any other service our clinic provides. Due to this, patients are very welcoming and grateful to receive this outreach and feel that we care for them as an individual, making them eager to enroll in this service.”
Tabitha Miller, RN