COVID-19 and Health Disparities: An Opportunity to Refocus Resources?

As public health officials grapple with the disproportionate impact of coronavirus disease 2019 (COVID-19) on the nation’s most vulnerable populations, some groups propose making the most of resources already in place or implementing new targeted interventions.

A report from The Commonwealth fund entitled “Beyond the Case Count: The Wide-Ranging Disparities of COVID-19 in the United States” highlights several methods of improving these disparities. According to authors, COVID-19 relief funds ought to target Black and Latino communities, while investments in economic security and mental health support for low-income individuals are vital. These investments can take the form of rent relief, nutrition assistance, and mental health care. Data on the pandemic’s impact by race and ethnicity also need to be publicly and consistently reported.

Importantly, researchers note that trust is integral to successful policy, writing, “Low approval ratings of government officials among Americans may speak to issues with trust. This needs to be addressed for future policies and initiatives to be successful.”

Building upon the trust already established between some Americans and medical professionals can concurrently mitigate the impact of misinformation propagated during the COVID-19 pandemic and help improve communication and drive positive outcomes in vulnerable communities (Graphic 1).

Capitalizing on this notion, Maryland’s COVID-19 task force on vulnerable populations was able to leverage data on social determinants of health to rapidly pinpoint populations most at risk of severe COVID-19 complications, while modeling how other states can carry out similar feats. Through public-private partnerships, the state of Maryland secured immediate care for hundreds of the state’s most vulnerable residents within weeks.

“We needed a data-driven approach…to determine which targeted resources were needed,” said Susan Mani, MD, the chief population health officer for LifeBridge Health, in an interview with The American Journal of Managed Care^®. “We recognized we had a really significant responsibility to our vulnerable populations in the state.”

Through the public-private coalition, Mani partnered with Trenor Williams, MD, the CEO and cofounder of Socially Determined, where the data science team developed a risk metric around COVID-19 susceptibility. Of the 2.6 million individuals for whom data was available, outreach was based on the following factors: age, disease burden, specific COVID-19 susceptibility index, economics, housing, and food.

According to Mani, risk stratification within vulnerable populations played a big role in the program’s success. “We can’t just think about risk as a sort of set bubble. We really need to be able to risk stratify so that we can then disseminate this information at a neighborhood level and then down to an individual level.”

Williams credited much of the program’s rapid success to the state’s already in place health information exchange (HIE) system, CRISP. By layering COVID-19 risk factor information on top of the data sets, experts were able to map out different areas in the state with the highest volume of at-risk populations. To ensure targeted outreach in these areas, Manage and Treat In Place teams—comprising emergency medical service (EMS) providers and social workers—proactively performed COVID-19 testing, managed urgent needs related to underlying chronic health conditions, and assessed socioeconomic needs to connect individuals with community resources.

“Because our public health officials knew, boots on the ground, a lot of the different members of these different areas, we were able to create that relationship,” Mani said. “Within about the first 25 days of doing this kind of work in those counties, we were able to see 1000 high-risk individuals.”

The pandemic provided an opportunity to think about the importance of a collective impact strategy at a large level, Mani and Williams explained.

“In times of crisis, you’re able to break down the historical barriers that existed and bring people together in a much more efficient and effective way,” Williams said.

Now, nearly 1 year into the pandemic, regulators on Friday issued an emergency use authorization for Pfizer and BioNTech’s COVID-19 vaccine in the United States, marking a major step forward in the fight against the disease that has claimed almost 300,000 American lives.

Front-line health care workers and residents of nursing homes will be the first to receive the immunization as part of the largest vaccination campaign in US history. But whether the vaccine is embraced by those most vulnerable to severe complications and the general public will largely determine its effect on the overall course of the pandemic.

Read part 1 in this series.

Read part 2 in this series.

Hear some of the interviews from this series in these Managed Care Cast episodes:

Dr Jewel Mullen Discusses NASEM's Framework for an Equitable Distribution of a COVID-19 Vaccine

How Maryland Optimized Data Analytics to Target COVID-19 Outreach to Vulnerable Populations