The long-term economic impacts of the COVID-19 s pandemic is anybody’s best guess, as are its long-term health impacts.
Emerging evidence shows that, even after recovering from infection, longer-term symptoms such as exhaustion headaches and muscle aches in some patients can last for weeks. In more severe cases, resulting in hospitalization, longer-term consequences can include lung scarring, arrhythmias and compromised liver and kidney function.
There are fears that severe cases could also be correlated to an increased risk in blood clotting given the profound anti-inflammatory reactions the body has in some cases to infection. This could lead to a substantial increase in strokes, heart attacks and deep vein thrombosis, for example.
Moving past actual coronavirus infection, other health concerns related to the pandemic have been well documented. The most notable are mental-health concerns given the sudden impact on people’s lives and livelihoods, isolation and concerns about the uncertainties of the world until such time as a reliable vaccine is commercially available. On top of that, add the impact of delayed surgeries and the public’s general lack of willingness to seek medical attention during the height of the pandemic to the complex equation with respect to long-term impacts on health.
Finally, challenges loom for employers with respect to return to work. Will employees who’ve enjoyed the opportunity to work remotely — by avoiding aspects of working life such as commuting, balancing work and home obligations and personal interactions with supervisors and/or colleagues — have issues starting to deal with increasing anxiety and declining mental health over the prospect of a return to work? What about frontline health-care workers and related essential employees who have been working relentlessly in recent months while the rest of the world was isolated? And at what point will physical and mental exhaustion reach a breaking point?
All this to say, managing both short- and long-term disability claims is about to become significantly more challenging because our industry has no playbook for what happens after a pandemic. The same way that COVID-19 forced the adoption of remote work and resulted in the widespread uptake of innovations like virtual care, I hope it will also change the way disability claims are managed and, more importantly, prevented.
Today, disability management and prevention efforts are significantly hampered by a lack of information. While a plan sponsor may have all of its benefits lines with the same carrier, that doesn’t mean the necessary information is available. The process today is much more manual and subjective than it should be as a result of the lack of better information.
The management and prevention of disability claims post-pandemic can be positively impacted by enriching and integrating claims data at a transactional level. Benefits data needs to be considered like a pyramid where each layer builds on top of its foundation.
Drug claims data is at the base of the pyramid for the following reasons:
- It has the greatest volume of claims;
- It has the most robust claims data standard;
- Every acute and chronic disease state at a claimant level can be reversed engineered from this data set with the right clinical algorithms (to account for the multitude of drugs that treat multiple disease states);
- It can reverse engineer disease severity and chronology; and
- It can be used to measure adherence to therapy and appropriateness of therapy.
Once the data is properly enriched — which also requires the use of a common classification language that can span all benefits lines, it can be integrated with extended health claims data, which is the next level of the pyramid.
From here, the extended health claims data can be enriched with insights from drug experience and claimant level to provide greater history into a member’s health journey and/or to help identify members at high risk for absence/disability to enable a proactive intervention.
The next layers of the pyramid can be enriched absence, short- and/or long-term disability claims data that take advantage of all of the insights from drug and extended health claims to add more context and information to the absence or disability claim.
A wealth of information can be mined by enriching and integrating claims data at a claimant level — with appropriate privacy safeguards — and can be used to help prioritize, optimize and even prevent disability claims.
To make this an industry standard — in the same way that virtual care will soon be a standard — it will take a commitment to using data in a responsible way, developing the tools and algorithms to enrich the data, build/use common classification systems to link disparate data sets together in a consistent and meaningful way and share encryption keys.
The tools are available. The only thing lacking is will. Perhaps the unparalleled complexity that will face the industry later in 2020 and into 2021 will accelerate required innovation to ensure both plan sponsors and their members are looked after.