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Are you at risk from silent killers in the third wave?

07 June 2021 Health Squared Medical Scheme

Clinical risk lessons from the first two waves help protect lives

The clinical risk for severe Covid-19 is dramatically higher for people who are unaware that they are living with chronic conditions, such as the ‘silent killers’ of diabetes and hypertension, according to a leading South African clinical risk expert.

“The first wave was really a wake-up call about the extent to which chronic conditions can affect a person’s individual clinical risk for Covid-19,” says Dr Jacques Snyman, medical advisor to Health Squared Medical Scheme.

“During the first wave, scheme data shows that out of those admitted to hospital almost 80% had co-morbid conditions – specifically, more than half had cardiovascular co-morbidities or diabetes. International studies also suggest that people with poorly controlled chronic conditions are at particularly high risk for Covid-19.”

According to Dr Snyman, because conditions such as high blood pressure and type-2 diabetes are often largely asymptomatic until they come to the fore with a major health event, they are regarded as ‘silent killers’. “This is even more dangerous, as many South Africans have no idea that they are at increased risk for serious Covid-19 infection because they have not been screened for these common health concerns,” he says.

“The relationship between these specific conditions and more severe Covid-19 risk is not yet fully understood, but what we do know is that the receptor site for the virus on the lining of the lungs and blood vessels is the same receptor associated with blood vessel type diseases.

“Diabetes is also a risk for blood vessel diseases, as high blood glucose causes an inflammatory reaction in the blood vessels, and this process in combination with the virus using this same receptor system allows it to easily enter the person’s cells, where it multiplies to intensify the viral load and is likely to cause much more damage in the body due to the putative inflammatory storm. The latter results in significant lung damage and or clotting in blood vessels resulting in heart attacks, stroke and pulmonary embolism.

“In the second wave, however, we found that members with these types of co-morbid conditions made up a significantly lower percentage of Covid-19 hospital admissions. We saw a 10 to 15% absolute reduction in patients with diabetes or cardiovascular disease comorbidities, compared to other comorbidities,” Dr Snyman recently pointed out during Agility Health’s Quarterly Review.

“Mutation of the virus does not change the profile of the disease, so this is not likely to be a major factor. Analysis of claims data provided a probable explanation, as we found that more members were having preventative health screenings, and many were proactively managing their health better than in the first wave.”

“In terms of claim profiles, there was a drive to better compliance with chronic care. People started prioritising their health more, and this was supported through the scheme funding preventative checks at pharmacies and clinics as well as primary healthcare.

“Even though members were seeking outpatient and primary care rather than inpatient care, their diabetes and cardiovascular conditions were actually better managed, which reduced their clinical risk during the second wave.”
The advanced claims management system Health Squared uses, Agility Health’s patented Patient Driven Care™ programme, automatically ensures that each claim and interaction with the member is risk stratified. For example, a member who claims for chronic medication erratically would suggest a higher risk because they are not adhering to the treatment they need to remain well.

“Members therefore have an additional layer of protection, as our system actively seeks to prevent members suffering future major health problems by unlocking more care in their benefits now to help them better manage their condition,” Dr Snyman says.

At-risk members are assigned a case manager who reaches out to find a solution to help reduce their health risks and encourage routine screenings. The benefits of this personal health risk reduction strategy are borne out in the managed care provider’s international experience too, as Agility Risk Solutions in South East Asia reflects similar results.

If the person is not taking their prescribed medication because of a side-effect, for example, they are encouraged to consult their doctor to find an alternative that works for them. For another member, who may have difficulty collecting their medicine from a pharmacy, this is easily resolved through arranging for their chronic medicines to be delivered to them monthly. Through managing members’ clinical risks, Health Squared works to ensure they are no longer at risk.

“By caring correctly for members, and reducing individual risk, the scheme is able to reduce financial risk for all by unlocking more care and more access to the correct benefits where needed,” Dr Snyman says.

“For the third wave and beyond, it is highly advisable for members of the public to have their regular preventative screenings and closely adhere to their treatment plan. Find out if you are at risk, especially from the ‘silent killers’ and take ownership of your health because these diseases do not have obvious symptoms but can put one at much greater risk from Covid-19 as well as future serious health problems.”

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