Why now is the time to get patients back to in-person routine care [PODCAST]

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“As the next wave of the pandemic unfolds, the rise in cases is once again straining health care systems. But that’s not the only reason hospitals and health systems could experience an influx of emergency or critical care visits. Findings from the National Poll on Healthy Aging based at the University of Michigan Institute for Healthcare Policy and Innovation revealed that nearly one in three Americans between the ages of 50 and 80 put off an in-person appointment for medical care in 2020 because they were worried about potential COVID-19 exposure, and with the emergence of new variants, that trend could continue.

There is a growing concern that patients will either see a relapse in their illness or will experience new complications as a result of waiting too long to visit the doctor. Put simply, there could essentially be two health crises crowding the system: those who have tested positive for the coronavirus, and those who delayed routine preventative and ongoing care for ailments such as chronic disease or mental health.”

Matt Dickson is a health care executive.

He shares his story and discusses his KevinMD article, “Why now is the time to get patients back to in-person routine care.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Matt Dickson. He is a health care executive, and he wrote the KevinMD article “Why now is the time to get patients back to in-person routine care.” Matt, welcome to the show.

Matt Dickson: Glad to be on. Thank you for inviting me today.

Kevin Pho: We’ll get into your article in a little bit, but first off, can you share your story and journey to where you are today?

Matt Dickson: Absolutely. So I’ve been involved in health care since I graduated from college many years ago. I won’t share, I don’t want to date myself specifically, but really most of my career I’ve been focused on helping payers, the Cignas of the world, really focusing on overpayments, appropriate and proper payments.

Really, right before this, I was working on analytic models to identify motor vehicle accidents, for example, from paid claim data, and I got a wonderful opportunity to work on the other side of the equation, which to me is really the more exciting side, which is really focusing on tools and technology that help patients navigate their journey and help providers connect with those patients.

Kevin Pho: Tell us some misconceptions, because as physicians, we don’t know what goes on behind the scenes, especially when dealing with payers. So with your experience and work on the payer side, what are some misconceptions that clinicians need to know about or need cleared up?

Matt Dickson: Well, I guess there can be sometimes maybe a little bit of an adversarial relationship. I think that at the end of the day, I believe their intent is to make sure that the money being spent in the health care system is focused on the things that really matter the most, right? So in my instance, for example, in my previous experience, again focused on motor vehicle accidents, it was to ensure that the guy who ran the red light was paying your medical bills as opposed to your health insurance payer.

So I think that, again, the focus is in the right place. Whether that happens in practice all the time is a great question, but again, I think the idea there is, “Hey, let’s make sure the dollars are being used in the most impactful way.”

Kevin Pho: So you switched from working with payers, and now you work with patients and clinicians. Tell me some of the challenges that you face in making that shift.

Matt Dickson: Well, I think it’s a lot of the focus in our article. As I made that change, I thought, “This will be easy,” right? I have come from writing these predictive models that do very, very hard things. I mean, discerning an MVA from claims data is very complex, because the injuries mirror what you’d see from any number of other kinds of issues. Back pain, for example, or if somebody were to slip and fall at home, that looks very much like a motor vehicle accident.

It’s really the challenge of not only communicating but communicating in a way that creates patient activation. That’s the biggest challenge in the space, and it certainly has been something I’ve been really focused on and certainly has been a difficult part of the transition.

Kevin Pho: All right, let’s talk about that KevinMD article that you wrote. It’s titled “Why now is the time to get patients back to in-person routine care.” Now, for those who didn’t get a chance to read your article, can you just walk my audience through it and share the story of why you decided to write it?

Matt Dickson: The reason behind writing it is something we’ve been tracking for quite some time. So as the COVID pandemic started to come to fruition and really have a real impact on the way we deliver health care, we kind of looked to some of the past to say, “What are the long-term impacts going to be outside of just COVID?” right? So we looked back to the 2002 SARS epidemic and said, “How did that impact the long-term health of people who weren’t necessarily diagnosed with SARS but were impacted by the shift in the way health care was delivered during that time?”

And what we found, or saw, was particularly around diabetics. If you looked at hospital admissions for diabetics, those plummeted during the SARS epidemic and then not only rebounded to previous levels but went up and above where historically you would have seen those hospitalizations take place. So you saw this real knock-on effect with long-term chronic conditions, not only going back to where they were but being even worse, and we’re seeing that unfold kind of in real time here in America as well.

So the National Cancer Institute just came out and said that they anticipate 10,000 more deaths over the next decade due to cancer than what historical trends suggest. A Lancet study just came out that is estimating anywhere between an 8 and a 9 percent increase in deaths due to breast cancer up to year five after diagnosis. It’s even worse for colorectal. They’re anticipating anywhere between a 15 to 16 percent increase.

So we’re seeing these knock-on effects already starting to happen or being anticipated, and really that’s been the genesis of the article, to say, “Hey, there’s an opportunity now to aggressively intervene to get people back in for these diagnostics on their yearly visits, so that we can hopefully unravel some of the damage that was done by people delaying care during the pandemic.”

Kevin Pho: Now, cancer screening, routine diabetic screening, they’ve gone down, certainly, but do you have any data in terms of how much they’ve gone down during the pandemic?

Matt Dickson: Yeah, absolutely. So we actually saw some of this data coming out. The CDC, in conjunction with Medicare, Medicaid, runs their early prevention program, and they just came out and said that in April 2020 it was down 90 percent over the five-year average. So certainly some of that has rebounded quite a bit, but there was a time where we were seeing up to 90 percent reductions.

I don’t know if you’re an NFL fan or not. If you are, at least in my area, you can’t avoid the commercials where you’re actually seeing them talk about this quite a bit, where you’re having ex-NFL stars and coaches saying, “Look, cancer screenings, especially for at-risk communities, really took a nosedive during the pandemic,” and how important it is for people to, again, kind of get over that fear of, “Well, if I go to the doctor’s office, I might catch COVID,” and really address the much bigger issue or problem, which is if you don’t, you may have cancer that isn’t detected early. We all know the importance of early detection, and that may have an even more serious long-term impact on your health.

Kevin Pho: So I know the COVID pandemic is a once-in-a-century phenomenon, but I was wondering, can you extrapolate some data from the SARS pandemic that you had mentioned earlier? You did mention delayed diagnosis in diabetes leading to increased hospitalizations later on, but extrapolating from that data, what can you expect in terms of numbers of delayed diagnoses of cancer due to these missed screenings?

Matt Dickson: Well, I think some of those we just touched on. So certainly I’m not in a position to extrapolate that, but we did talk about the National Cancer Institute study, that’s 10,000 additional deaths over the next decade. Lancet is telling you that you’re looking at roughly a 10 to 15 percent increase for some types of cancers. So if you look at the Lancet study, you’re talking about hundreds of thousands of cases when you talk about anywhere between a 10 and 15 percent increase, with the National Cancer Institute being a little more cautious and calling, and I hate to say this, just 10,000 additional deaths.

But certainly, and I think the good news there is, it hasn’t happened yet, right? So this is why that article and the timing of that article for us was so important, because I do believe there’s still a real opportunity for clinicians to intervene and help stem some of that tide.

Kevin Pho: So let’s talk about some of those opportunities. You did mention some NFL players on commercials bringing patients in for cancer screenings, but let’s talk specifically. What are some of the opportunities clinicians can use to bring people into the clinic for cancer screening and other health screenings?

Matt Dickson: Yeah, I think first and foremost, communication is the core of all of it. So first and foremost, I think that what you’re seeing is that there’s still fear for individuals out there around catching COVID, right? So this is preventing them from coming in to get those screenings. So certainly there’s a lot of importance that needs to be placed around communicating what you’re doing to keep those patients safe, the protocols you’re using. For example, some clinicians maybe having people use separate entrances and exits, right? All the things you’re doing to keep them safe, I think communicating that is critically important.

I think the other thing that’s important when we talk about opportunities to really intervene is we’ve seen a very uneven response, right? After the pandemic has gone through its ebbs and flows, in some areas, I’m sure that your audience is completely overwhelmed and has so many people coming in that they don’t have enough diagnostic tools available to them to complete those screenings. In other areas, I think what you’re seeing is a lot of idle equipment used as part of those diagnostic screenings, and it requires two different responses.

The first, where you’re overwhelmed, the question is, what are you doing to ensure that the right people are coming in? Because really what’s happening in some of those areas is the people that are most at risk sometimes are the ones that are most challenged to come in and complete those screenings, and now we’re creating an access problem. So these high-risk individuals are calling up or trying to get those appointments, and they’re finding they’re months and months out, because those spots have been taken by people who maybe are a little lower risk but don’t have as many challenges coming in to receive that care or that diagnostic test.

The other part of the equation is areas or regions where they just can’t get the people to come in right now. You’re talking about a much different type of communication, and again, I think the underpinning of that is assuring people that they’re safe and then also reiterating to them, and you saw this in these NFL commercials, that while, yes, there is always a risk of catching COVID, there’s things you can do to mitigate that risk as you engage in the health care system. But more importantly, the bigger risk to you at this time, especially for high-risk groups, is that you will have undiagnosed cancer, for example.

I don’t want to just talk about cancer. Certainly anybody who has chronic conditions like high blood pressure, for example, and diabetes, as we talked about with the SARS epidemic, certainly they’re at risk as well and really need to recreate that connection with their physician and really reconnect in a way that ensures compliance with their care plans.

Kevin Pho: Now, can you share a case study or a story of a specific clinic or hospital that implemented some of the ideas that you’re talking about to bring patients back and get them back on the screening horse, so to speak?

Matt Dickson: Yeah, absolutely. So one of our clients started a very aggressive colorectal campaign, and what they did here, and I think they were smart about this, is they used that risk assessment, right? So they really focused on the people that were at high risk, and the approach they took was getting outside of this blanket approach. I think this is one of the challenges we’re seeing out there. People are just sending mass or blanket communication via email that just goes out to everybody who fits very broad criteria.

They really focused in on the individuals that were at high risk, and what they did was they actually used live voice agents to make outbound calls, right? So at the end of the day, we’re trying to, A, create a human connection and, B, more than anything, answer people’s questions about their safety, right? It’s very hard to do that, I think, in an email. It becomes so long and cumbersome if you try to have it via email, and you’re typically going to get people hitting the delete button or catching spam filters.

So having that ability for those agents to assuage those fears, right, where, “Well, I would come in, but,” right, or, “I’m really worried about this.” “Well, let us tell you what we’re doing and why some of those fears may be unfounded, or the ways we’re mitigating those.”

So they were able to see, and many of those people, unfortunately, I guess fortunately, had gotten their screenings but had done them maybe elsewhere, outside of that health system, but they were seeing 20, 30 percent of the people that were being connected with were actually scheduling those screenings in real time. So certainly we’ve seen some good results by using a really human-based approach to this.

And that may not make sense financially to do for everybody you have that has high blood pressure, right? That’s such a large number, and it’s very difficult to do those kinds of approaches. But certainly in specific areas where people are at high risk, it may make sense to use a more assertive, aggressive approach to ensuring they get in and get those screenings done.

Kevin Pho: We’re talking to Matt Dickson. He is a health care executive, and he wrote the KevinMD article “Why now is the time to get patients back to in-person routine care.” Matt, what are some of your take-home messages that you want to leave with the KevinMD audience?

Matt Dickson: Well, I think that really, at the end of the day, all effective patient communication, and that’s really what we have to focus on, right? You see a lot of focus on how to communicate with patients, using technology to do so, but really the question is how to make that communication effective, right? So that creates patient activation and adherence. And I think the grounding part of all of that is all effective communication is humanized communication. People want to feel like that communication was specific to them and just not part of a very broad outreach effort.

So again, things like risk scoring, so that you use different content based on the amount of risk that a particular individual may have for a certain condition. Certainly understanding that you need to do some A/B testing of communication. So we see often people will send an email, for example, and then if they don’t get a response, they send the exact same email again. Different people are motivated by different things, right? And understanding that you may have to change the content of that message to activate people who are motivated in different ways.

I will say the thing, though, at the end of the day, that I think is really an important take-home message for your audience is really all good communication, like I said, is human-focused. We did a survey recently. In 2020, 54 percent of patients said they felt rushed during a doctor’s appointment over the last 12 months. That number has come down in 2021 to 41 percent. But for you to be patient, caring, compassionate, understanding in your communication certainly requires you to take care of yourself.

And the other thing that I think we’re seeing that is concerning to me when we look at the data is that physicians are reporting burnout. Really, the numbers have been quite alarming. Matter of fact, the survey just went out from the Physicians Foundation. They surveyed roughly 2,500 U.S. physicians, and 61 percent reported experiencing burnout often, a 53 percent increase since 2018. So I would encourage your audience of clinicians certainly to take care of yourself first, because I believe that really truly is the foundation of effective communication.

Kevin Pho: Matt, thank you so much for sharing your time and insight, and thanks again for being on the show.

Matt Dickson: All right, thank you for having me.

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