Chronic Disease Management During Covid-19
CHRONIC DISEASE MANAGEMENT DURING COVID-19WEDNESDAY, OCTOBER 7, 20202:00 PM ET / 1:00 PM CT / NOON MT / 11:00 AM PT
NATIONAL CONFERENCE OF STATE LEGISLATURES Bipartisan membership organization All 50 states and the territories 7,383 state legislators All state legislative staff (30,000 ) Mission: To improve the quality and effectiveness of state legislatures To promote policy innovation and communication amongstate legislatures To ensure states a strong, cohesive voice in the federal system
CHRONIC DISEASE MANAGEMENT DURING COVID-19: AGENDA COVID-19 Impact on Chronic Disease Susan Kansagra, MD, MBA, section chief, Chronic Disease and Injury, Division of Public Health, NorthCarolina Department of Health and Human Services Cardiovascular Disease Management Keith C. Ferdinand, MD, FACC, FAHA, FASPC, FNLA, professor of medicine, Tulane University School ofMedicine State Legislative Actions and Policy Options Jack Pitsor, research analyst, NCSL Discussion and Q&A
COVID-19 Impact onChronic DiseaseSusan Kansagra, MD, MBASection Chief, Chronic Disease and InjuryNC Division of Public HealthNC Dept of Health and Human ServicesBoard PresidentNational Association of Chronic Disease Directors
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Prevalence of Chronic Disease Condition that Impact COVID Outcomes (NC)51%of adults in North Carolinaare at higher risk for severeillness from COVID-19 basedon being 65 or older, havingat least one of theunderlying healthconditions, or both42%of people in North Carolinahave one of the healthconditions that increasesrisk for a severe illness ID-19.pdf
Impacts of COVID on Delayed Care for Chronic DiseasesOverall, 41% of US adults have avoided medical care during the pandemic because ofconcerns about COVID-19; 12% avoided urgent/emergency care and 31.5% avoided routinecare. 55% of with 2 or more underlying conditions compared avoided care42% of people without insurance compared to 25% with insurance avoided care55% Hispanic; 48% Black, non-Hispanic; 36% White, non-Hispanic avoided care49% believed to be in a group at high risk for COVID-19 compared to 39% who were notImpact of delays in care:Heart Disease Lasting damage to heart muscle fromdelayed care for heart attack Increased risk of heart failure and a4.htmCancer Tumor progression Delays early detection Lowers rate of cancer survivalDiabetes Poorer diabetes control Increase complications like kidneyand eye disease9
Prevention on Chronic Diseases – NC Resourceshttps://www.diabetesfreenc.com/10
NC Medicaid Telehealth Provisions Implemented for COVID-19NC DHHS Medicaid implemented 125 telehealth flexibilities, which spanned 482 codes, during the public healthemergency. Some of the provisions implemented were: 56 flexibilities for behavioral health, I/DD and TBI 15 flexibilities for CDSAs to bill for telehealth across multiple clinical services 6 flexibilities for pregnant and post partum services 6 flexibilities for DME prior authorizations 5 flexibilities for LEAs to bill across multiple therapies 4 flexibilities for teledentistry 4 flexibilities for outpatient specialized therapies (PT, OT, and Speech Audiology) 3 flexibilities for Well Child visits 3 flexibilities for optometry 2 flexibilities for respiratory therapy 2 flexibilities for physiological monitoring 2 flexibilities for dialysis services (ESRD and training) 2 flexibilities for consultantsThere were 15 other general telehealth flexibilities implemented11
Deaths attributable to individual risk factors (in thousands), by diseaseDanaei G, Ding EL, Mozaffarian D, Taylor B, Rehm J, et al. (2009) The Preventable Causes of Death in the United States: Comparative Risk Assessment of Dietary, Lifestyle, and Metabolic Risk Factors. PLOSMedicine 6(4): ticle?id 10.1371/journal.pmed.1000058c12
A Healthier Population Increases Resiliency Against Health ThreatsCreating a healthy, resilientpopulation requires upstreampolicy, systems, andenvironmental changesRIDOH Health Equity Framework adopted from Frieden T. A framework for public health action. AJPH. 2010.13
Other r/website-2020/covid/factsheet files/5afc0b37-6559-43e1-8664ec5ae0e13a6d/FS CDpolicymakers2020FINALv3.pdf14
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Impact of COVID-19 onCardiovascular DiseaseManagementKeith C. Ferdinand, MD, FACC, FAHA, FASPC, FNLAGerald S. Berenson Endowed Chair in Preventive CardiologyProfessor of MedicineTulane University School of MedicineLA COVID-19 Health Equity Task Force Member
COVID-19: Cardiovascular Viewpoint Cardiovascular complications of COVID-19Implications of delayed care on long term health and health caresystemsDisparities in cases and outcomesInsights from the LA COVID-19 Health Equity Task Force
usaheartfacts.org
Coronavirus means Crown in Latin
Name of this Disease for Coronavirus :COVID-19COVID-19: 'CO' stands for 'corona,’ 'VI' for 'virus,’ 'D' for disease 2019
VisualizingWhatCOVID-19Does to theBodyhttps://www.neurodiem.com/
Mechanisms of New or Worsening Heart Failure With COVID-19JACC HF online, 3 June 2020https://doi.org/10.1016/j.jchf.2020.05.006
Numerous Variables Making African AmericansMore Vulnerable to COVID-19 . “a mixture of the many difficulties faced by AfricanAmericans which may compound or even extend theburden for the coronavirus risk factors,” Ferdinand, KC April n-americans/
MMWR Early Release - Vol. 69,August 17, 2020
Numerous Variables Making African AmericansMore Vulnerable to COVID-19 Working in service industries or “essential jobs” exposingthemselves to infection;Using public transportation to get to work;Lack of access to early testing; andA historical distrust of the health-care system because ofprevious anamericans/
“ .sentinel event as an unexpected occurrenceresulting in death or serious physical or psychologicalinjury, or the risk thereof. Conventionally identifiedsentinel events, such as unintended retention of foreignobjects and fall-related events, are used to evaluatequality in hospital care ”
Keith C. Ferdinand, Samar A. NasserJ Am Coll Cardiol. 2020 Jun, 75 (21) 2746-2748.
Remote Monitoring for Cardiovascular Risk Reduction:The Impact of COVID-19https://www.keckmedicine.org/
Telehealth Improved Healthcare?Flexibilities allow providers to: Conduct telehealth with patients in their homes and ruralareasDeliver care to both established and (new?) patientsBill for telehealth services (both video and audio-only) as ifprovided in personEducate patients in face-to-face visitLoan (automated blood pressure cuff)
Thank You!
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TELEHEALTH STATE ACTIONS DURING COVID-19JACK PITSOR, RESEARCH ANALYST
OVERVIEW OF STATE ACTIONS All 50 states, D.C. and PuertoRico modified their telehealthpolicies due to COVID-19. 35 states, D.C. and Puerto Ricoenacted over 72 bills sinceMarch.
ENHANCING PRIVATE INSURANCE AND MEDICAID COVERAGEPrivate Insurance Twenty states now maintain paymentparity requirements for private insurers(either permanently or temporarily). Fifteen states and D.C. enacted otherprivate insurance requirements during thepandemic.Medicaid Ten states enacted legislation extendingMedicaid coverage for telehealth. MD HB 1208—Chronic conditions casemanagement via telehealth
INCREASING PROVIDER AND PATIENT ACCESS TO TELEHEALTHOut-of-State Providers & Provider-PatientRelationship KY SB 150—Authorizes health practitioners licensedin another state or territory to deliver services viatelehealth and waives in-person visit requirementsOriginating Site Requirements MN SF 4334—Expands the definition of originatingsite to include a patient’s homeBroadband Connectivity MS SB 3046—Establishes the COVID-19 BroadbandProvider Grant Program Fund
TEMPORARY VS. PERMANENT CHANGESExtend beyond the declared emergency: CT HB 6001—Extends COVID-19telehealth coverage requirements untilMarch 2021Enact permanent changes: NH HB 1623—Codifies the governor’stelehealth emergency order into statelaw
ADDITIONAL RESOURCES—AND THANK YOU! COVID-19 Resources State Action on Coronavirus (COVID-19) COVID-19: State Health Actions Rural Health Care and COVID-19 The Health Workforce and COVID-19 Other Resources Health Innovations State Law DatabaseJack Pitsor, Research AnalystJack.Pitsor@ncsl.org 303.856.1343
DISCUSSION AND Q&APlease type your questions into the chatbox in the lower left-hand corner of yourscreen.
Thank you!Questions?Contactkate.bradford@ncsl.org
COVID-19 Impact on Chronic Disease Susan Kansagra, MD, MBA, section chief, Chronic Disease and Injury, Division of Public Health, North Carolina Department of Health and Human Services Cardiovascular Disease Management Keith C. Ferdinand, MD, FACC, FAHA, FASPC, FNLA, professor of medicine, Tulane University School of Medicine
chronic liver disease, chronic lung disease, documented proteinuria, and prior hospitalizations. † This group served as the reference group. Staging of chronic kidney disease Stage 1 disease is defined by a normal GFR (greater than 90 mL/min per 1.73 m2) and persistent albuminuria Stage 2
has followed the general trends for obesity and chronic disease. About one-fourth of adults and 13.2% of high school students are obese. According to data from the Department's Chronic Disease Disparities Report 2011: Social Determinants, 82% of adults have at least one chronic disease and over half (53%) have two or more chronic diseases.
The Cost of Chronic Disease in Canada iii EXECUTIVE SUMMARY Four types of chronic disease – cardiovascular disease, cancers, chronic obstructive pulmonary disease, and diabetes – kill an estimated 153,000 Canadians every year, account for nearly three-
Bury Chronic Obstructive Pulmonary Disease (COPD) Team What Is COPD Chronic Obstructive Pulmonary Disease (COPD) is the name for a Collection of lung diseases including Chronic Bronchitis, Emphysema and Chronic Asthma. People with COPD have trouble breathing in and out. This is referred to as airflow obstruction.
Diagnosis of Cirrhosis and Chronic Liver Failure History: Patient presents with signs and symptoms of chronic liver disease or has risk factors for chronic liver disease (e.g., alcohol abuse, risk of viral hepatitis, obesity). Physical examination: Patient has hallmark findings consistent with chronic liver disease (see Table 2).
Chronic Disease Chronic diseases are illnesses that persist for a long time or last at least three months. Chronic diseases are rarely cured and often are progressive, resulting in disability later in life. Chronic diseases, such as heart disease, stroke, cancer, diabetes, asthma and arthritis, are among the most common and costly of
Chronic obstructive pulmonary disease: national clinical guideline on management of chronic obstructive pulmonary disease in adults in primary and secondary care. Thorax 2004; 59 (Suppl 1): 1-232 Agusti AG, Noguera A, Sauleda J, Sala E, Pous J, Busquet X . Systemic effects of chronic obstructive pulmonary disease. European Respiratory
Artificial Intelligence Artificial Intelligence defined . 08 Learning enables the Cognitive System to improve over time in two major ways. Firstly, by interacting with humans, and obtaining feedback from the conversation partner or by observing two interacting humans. Secondly, from all the data in the knowledge base, new knowledge can be obtained using inference. Another important aspect of .
