From the beginning of the COVID-19 pandemic, we have been told that the highest-risk populations are those with one or more pre-existing chronic conditions such as chronic obstructive pulmonary disease (COPD), chronic heart failure (CHF), cancer, and diabetes. Given the effect the coronavirus has on the lungs, and the evidence we have gathered so far, it certainly makes sense to offer extra attention to isolating and protecting these populations – both to keep them safe and to prevent the spread to others.

Yet there is another cohort that is just as much at risk yet has received scant attention. Namely, those for whom social determinants of health (SDOH) are part of their everyday lives. These factors can take many forms: lack of access to the healthcare system (other than the emergency department), food scarcity (or lack of healthy foods), housing instability, lack of reliable transportation, undiagnosed depression, loneliness, and other issues that form the foundation of Maslow’s Hierarchy of Needs.

Whatever form they take, over the last few years we have come to understand how much SDOH affects both short- and long-term health. Simply put, it is difficult to get a patient/member to exercise more and take their medications as prescribed, when they don’t know where their next meal is coming from or where they will lay their heads to rest that night. This means the strategies that work for those who are not facing SDOH impacts are not as likely to work for those who are facing issues.

With that in mind, EXL Health has developed a heat map infographic that shows county-by-county where future COVID-19 hot spots are likely to erupt. A key aspect of the approach is to provide risk-bearing entities the ability to leverage data to make informed operational decisions. The infographic is based on two factors.

The first is counties where the COVID-19 coronavirus is already present, based on publicly available data from the Centers for Disease Control and Prevention (CDC) and other sources. This data is changing rapidly day-by-day, sometimes hour-by-hour, so it forms a snapshot in time.

The second is a combination of EXL’s own proprietary Commercial Internal Benchmark database which is representative of the U.S. population that tracks risk factors based on pre-existing conditions, state-reported County Health Rankings, and publicly available demographic and sociographic data. EXL used its advanced clinical analytics and actuarial expertise, along with its long history of driving insights based on rich data assets, to assess the effect these combined factors could have in contributing to a COVID-19 outbreak.

The resulting heat maps, which are shown in the infographic, highlight the U.S. counties that are most prone to becoming the next hot spots for COVID-19. The goal of this type of analytics is to help health payers and providers work together, along with community resources, to prepare for a potential surge in patients in the future.

With this data in-hand, payers and providers in high-risk counties will be able to make better decisions and put intervention planning in place, including obtaining necessary resources and developing multi-tier strategies for deploying physicians, nurses, physician assistants and other clinicians to prepare for a potential sudden influx of patients.

More importantly, they can get ahead of the current pandemic (as well as prepare for a potential next wave) and work with those high-risk populations facing SDOH factors to mitigate the effects before the issue becomes critical.

As more data becomes available, these models can be refined even further. For example, down the road the CDC will acquire and release additional mortality data as a result of COVID-19. That data can be fed into the models to develop more precise personas and profiles that will help payers and providers direct their resources where they are most needed.

It will also show which levers that have already been pulled – social distancing, closing businesses, delivery of care in alternate settings, etc. – were most effective in slowing the spread so we will know what to do if a second surge hits. The data will indicate how effective it has been, which could have a significant impact on how healthcare is delivered – and paid for – in the future.

Once the immediate crisis has passed, the resilient US healthcare system will begin to focus on its own recovery. Even greater emphasis will likely be placed on gaining a more thorough understanding of SDOH risk factors and how they contribute to emerging clinical risk within the general health of the U.S. population.

By taking lessons we have learned under the current duress, analyzing the outcomes and using predictive analytics to apply them more precisely moving forward, we can do a better job of treating patients/members with chronic conditions and/or SDOH challenges. All of which will help reduce the factors that made the current situation so deadly as well as create a healthier country overall.

The infographic is an important first step to achieving that better future, because it gives us the ability to understand where the risks are emerging. As stated previously, the situation is constantly evolving. EXL Health will continue to update the analysis with new insights as they become available.


Victor Collymore, Senior Vice President and Chief Medical Officer

Victor A. Collymore, MD, FACP is the Vice President and Chief Medical Officer at EXL Service, a multi-national company, where he oversees utilization management, coordinates disease and care management, and liaisons with pharmacy, sales and marketing, data and predictive modeling departments, and life sciences. In addition, he has overseen quality and run several medical groups. He understands the key mechanisms by which medical groups and health plans can augment quality of care, quality of service, and be responsible stewards of resources. His knowledge also includes an understanding of appropriate coding and documentation, medical necessity determinations, accreditation processes, and provider/hospital contract negotiations.

His professional business experience includes being the Chief Medical Officer of Community Health Plan of Washington for more than four years, Medical Director at Evercare/United Health Group, Chief Executive Officer of Providence Physician Group, Vice President of the PeaceHealth Medical Group, Medical Director of Care Coordination at Group Health Cooperative, Associate Medical Director and Hospitalist Chief at Kaiser Permanente in Colorado, Assistant Chief/Program Director of the Internal Medicine Residency at Kaiser Permanente in Los Angeles, and Associate Clinical Professor of Medicine at UCLA.

Board certified in Internal Medicine and a Fellow of the American College of Physicians, he received his medical degree at Columbia’s College of Physicians and Surgeons in New York and completed his internship and residency in Internal Medicine at Mount Sinai Hospital in New York.

David Hom, Chief Evangelist

David Hom is an internationally-recognized expert in the field of consumer engagement through programs such as Value Based Benefits and Employee Wellness. He joined SCIO Health Analytics® in 2009 after more than 25 years with Pitney-Bowes Corporation, where he was responsible for introducing their leading-edge programs in value-based wellness and responsible for reducing medical trend by 50% of the industry average each year for 15 years.

Dave has been a visionary at EXL, and has built EXL’s leading products on behavioral economics applications for many health plans and a technology-enabled solution to engage members based on the gap value and it’s impact on avoidable hospital events.

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