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OCHIN: Health Care Trends & Transformation During COVID-19

  • Abby Sears, CEO, OCHIN
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Story contributed by OCHIN.

Recent EHR data show that while the rate of COVID-19 infection appears to be slowing in some parts of the country, the number of patients testing positive for the virus continues to grow. Across the OCHIN network of providers, which treats a total of 5 million complex and underserved patients nationally, 87 OCHIN Epic organizations are actively testing patients for COVID-19.

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More than 9,300 positive cases have been identified in the collaborative to date, including new cases in hot spots like Massachusetts, California, Oregon, Washington, and New Jersey, and increased cases in the Midwest (particularly in Minnesota, Ohio, and Wisconsin) and the South (Indiana and North Carolina). This follows the CDC outbreak data and is information that OCHIN Epic members continue to share via electronic case reporting with public health agencies.

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COVID-19 has magnified health disparities and the importance of safety net providers.

Among those seen in OCHIN member clinics, Black patients are 2.5 times more likely than non-Hispanic White patients to have a COVID-19 diagnosis in the EHR and Hispanic patients are twice as likely as White patients to have a COVID-19 diagnosis in the EHR. These COVID-positive patients are 1.7 times more likely to be homeless or housing insecure, which underscores the importance of screening for social determinants of health in order to effectively reduce exposure and slow the spread of the virus among at-risk communities. Additionally, patients who are 30-64 years of age are disproportionately testing positive for the virus, potentially illustrating that progress is being made to keep vulnerable elderly patients safe.

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The rapid deployment of telehealth helped providers maintain care continuity by enabling new ways for patients to access health care.

As the number of in-person patient visits fell by more than half due to the pandemic—from an average weekly volume of 21,101 encounters to 8,761 encounters in May 2020—the OCHIN network of more than 12,000 providers in 47 states increasingly turned to telehealth services to help bridge the gap. Of the more than 2.9 million OCHIN Epic encounters completed YTD, 23% (678,040 encounters) have been conducted via telehealth; including about 65% conducted via Telemedicine/Other, 29% conducted via Phone Visits, and 6% conducted via integrated MyChart Video Visits. Demand for video visit capabilities is also on the rise: 69% of OCHIN Epic members have adopted MyChart Video Visits, with a 5-fold increase in completed virtual visits across the collaborative between March and April 2020, and continued growth through May 2020.

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COVID-19 has created new financial pressures that will have a lasting impact on health care delivery.

Due to the rapid transition to telehealth, overall visit volume is around 85-90% of pre-COVID-19 levels across the OCHIN collaborative. However, even with protections for telehealth reimbursement under COVID-19 legislation, charges are down nearly 20%. Prior to COVID-19, 74% of gross charges by OCHIN members and 76% of their gross revenue was generated from primary care services. Since the U.S. outbreak, members have seen a significant drop in charges for both primary and dental care, while behavioral health charges increased somewhat in recent months. (Note that since payments lag charges due to processing, the full impact of these changes on collections will be delayed.) This is a powerful reminder of the critical need for long-term solutions that give providers the flexibility to navigate new financial uncertainties, without compromising jobs or continuity of care for their communities.

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Abby Sears is the Chief Executive Officer of OCHIN.

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