Chronic Disease & Prevention

Declines in preventive care were well documented early in the pandemic as people took precautionary measures and avoided clinical settings, however utilization of preventive services remains low. The number of people getting childhood vaccines, mammograms and colonoscopies continues to decline, according to the Health Care Cost Institute.

Managing chronic health problems is even more important during the pandemic because certain medical conditions, including diabetes, obesity, cancer and kidney disease, place adults of all ages at an increased risk of severe illness from COVID-19 (CDC). More than three-quarters of the people who have died from COVID-19 had at least one preexisting condition.

Given the essential nature of chronic disease care, innovative measures are being taken to make care delivery safer and accessible.

• Kidney Disease: Recognizing how the pandemic has impacted health care needs and costs associated with chronic kidney disease, Premera is partnering with two nonprofit kidney centers to provide additional support and education on kidney disease.
• Diabetes: Blue Cross and Blue Shield of North Carolina is partnering with Virta Health to help address type 2 diabetes through an innovative virtual care model. 
• In-Home Testing Kits: Blue Cross and Blue Shield of Minnesota is providing in-home test kits for some preventive screenings for Medicare Advantage members.

Cancer Care During COVID-19

COVID-19 has become the third leading cause of death in the U.S., after heart disease and cancer. The pandemic has also negatively impacted cancer patients’ care and diagnoses.

• Additional Deaths: Missed screenings and disruptions to care could result in at least 10,000 additional deaths from breast and colon cancer alone over the next 10 years. 
• Advanced Cancer: 18% of newly diagnosed breast-cancer patients this year had an advanced stage of the disease, compared to 12% in all of 2019.
• Surgery Delays: Breast cancer patients’ surgeries are being delayed due to the pandemic, which could result in an additional 3,000 deaths over the next 10 years.
• Cancer Research: The pandemic has also disrupted cancer research for potentially life saving treatments. Only 20 percent of clinical trials are recruiting patients at the same rate as usual.

Patients with cancer are also navigating COVID-19’s risks. COVID-19 increased the cancer fatality rate to 13% of patients, compared to 3% in the general COVID-19 patient population.

Black patients with cancer were more than twice as likely to be hospitalized due to COVID-19 than White patients. Existing racial disparities in cancer care must also be addressed:

• Death Rate: Black Americans have had the highest overall death rate from cancer for the past four decades, due to a lack of access to screening and treatment. 
• Screening: A $75,000 grant from the Illinois Health and Hospital Association and Blue Cross Blue Shield of Illinois is funding efforts to improve breast cancer screening among minority and low-income patients.

Mental Health Challenges and Barriers 

Experts predict the eventual mental health toll of the pandemic will be higher than the medical impact of COVID-19. Stay-at-home orders and school closures are resulting in financial strain, isolation and the erosion of support networks. These factors have contributed to increases in suicide, overdoses and violence.

• Pandemic Increase: Compared to the one-fifth of Americans with a diagnosable mental illness pre-pandemic, almost 41% of Americans now report struggling with their mental health or substance use.
• Concerns: Among people living with a mental illness, 98% had at least one major concern regarding the pandemic, including disruption of services, running out of medication, and social isolation.

 
Resources and solutions:

• NIHCM’s recent webinar and infographic provide actionable, workplace strategies that both employees and employers can implement to support and improve mental health and wellness.
• Community efforts, such as BCBSIL’s Blue Door Neighborhood Centers, can have a positive impact on the mental health of residents.
• Blue Cross Blue Shield of Western New York launched free self-screening online tools for depression and anxiety, available to anyone in the community.
• NIHCM’s new infographic reviews what we know about the burdens facing young parents and produces solutions that can support them during the pandemic and beyond.

The recent death of Walter Wallace, Jr. in Philadelphia, highlights the need for a wider discussion about the appropriate response to someone having a  mental health crisis.

• Problem: People with mental illnesses are 16 times more likely to be killed during an encounter with law enforcement. However, sometimes calling 911 is the only option, when crisis hotlines and mental health response teams are not available.
• Community Responders: A recent analysis suggests Community Responders could offer a more appropriate response to 911 calls related to medical and social service concerns, including mental health needs, substance use disorders and homelessness.
• New Approach: Communities across the country are trying new approaches for responding to mental health. San Francisco is deploying fire and health department professionals to respond to psychiatric, behavioral and substance abuse crisis calls.

LGBTQ Health & Well-Being 

As mental health challenges increase during the pandemic, it is important to recognize the unique and disproportionate impact on LGBTQ youth. While nationwide LGBTQ-inclusive data is limited, The Trevor Project is filling a much needed gap in research by highlighting the mental health and suicide concerns in this community and providing resources and support.

• National LGBTQ Survey: The Trevor Project’s recently released second annual nationwide survey of LGBTQ mental health found that 40% of LGBTQ respondents — and nearly half of trans and non-binary respondents--seriously considered suicide in the past twelve months.
• Mental Health of Black LGBTQ Youth: This research brief identifies risk factors for Black LGBTQ youth mental health as well as high impact protective factors.
• Latinx LGBTQ Suicide Risk: This research brief examines factors associated with attempting suicide among Latinx LGBTQ youth.

Resources:

The Trevor Project: How LGBTQ youth can cope with anxiety and stress during COVID-19

NIHCM Webinar: Addressing Health Disparities in the LGBTQ Community

NIHCM Webinar: Communities for Change, Preventing Suicide

If you are in crisis, please call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255), or text the Crisis Text Line at 741741.

Community Health, Food & Housing Security During COVID-19 

The COVID-19 pandemic has disproportionately impacted vulnerable communities while negatively impacting many of the social determinants of health (SDOH), including food security, housing and transportation. There is a need for policies and programs in health care to address SDOH and improve health equity.
 
Community Investments: Investing in community health workers and community-based organizations would help address the social determinants that lead to poor health outcomes in low-income, minority populations both during COVID-19 and beyond.

• Independence Blue Cross is a partner in a Philadelphia community-based network that connects people to nonmedical services such as food, housing, and transportation.
• BCBSMA announced $400,000 in grants to support communities of color, address food insecurity, and aid teachers during COVID-19.
• Blue Cross and Blue Shield of Illinois launched a program to financially reward hospitals for reducing health disparities and improving health equity - supporting hospitals with the highest concentration of members who are at risk of contracting COVID-19.

Food Insecurity: The pandemic has highlighted the need to address threats to food security. As many as 1 in 6 Americans may face hunger in 2020, including 1 in 4 children.

• School meals, particularly breakfast, play a critical role in school age children’s health. Almost 20% of children do not eat breakfast.
• NIHCM’s webinar and infographic provide insights on food insecurity in the United States and how it has been exacerbated by the COVID-19 pandemic.

Homelessness: NIHCM’s recent webinar and infographic highlight the health challenges faced by the homeless community during COVID-19 and outlines solutions to improve the health and well-being of these individuals.

• A report from the Bipartisan Policy Center provides recommendations on ensuring safe, health, and affordable housing during the pandemic.