Top At-Risk Conditions and Utilization Spikes

Top At-Risk Conditions and utilization spikes that healthcare leaders and stakeholders across the industry must prepare to proactively address in the upcoming year highlight the recently released, 2023 State of Health – In The Aftermath Report. The report also presents predictive findings and explores the top contributing factors of many utilization increases.

To access the report CLICK HERE.

“This year’s predictions reflect just how unequipped we are to handle the lingering and persistent effects of COVID-19. For the first time, we’re tracking substantial connections between SARS-CoV-2 infection and extreme comorbidities, such as acute myocarditis or cardiorenal syndrome,” said Linda Hand, CEO Prealize Health. “We are seeing the long-term effects of a system built on episodic care. These volume increases underscore the crucial need to invest our resources, energy, and focus in holistic and preventative care. Without investing in workflows and preventative care for the whole person, we cannot expect our national health to improve.”

The report forecasts conditions that are predicted to be at risk for increased utilization in 2023. Top at-risk conditions include:

• Large spikes in cardiovascular utilization across the board. Conditions including cardiorenal syndrome (29% increase), cardiomyopathy (26% increase), cardiac block (20% increase), ischemic heart disease (19% increase), chronic heart failure (13%) and cardiac dysrhythmias (8%), and valvular disorder (7%) will be increasingly common in 2023.
• Behavioral Health, intellectual & developmental disorders, substance abuse and overdoses are predicted to increase. Care utilization for pediatric substance abuse is predicted to have a 24.5% increase, while intellectual & behavioral disorders are shown to have a 13.7% increase.
• Chronic Conditions, such as COPD, Diabetes, Obesity & Asthma will significantly increase. Prealize predicts a 21% increase in COPD utilization across all age groups. Diabetes is also expected to see a substantial uptick, up 13% from the year before, while obesity is predicted to increase by 11%. Asthma’s prevalence is predicted to increase 6% year-over-year.
• A dramatic increase in obstetric emergencies for mothers that are covered by Managed Medicaid. For this population, the risk of pregnancy with complications is forecast to increase 33% in 2023. While time may reveal how limited care access will impact outcomes, generally higher levels of stress and depression, rising incidences of obesity and gestational diabetes, and a national disruption to family planning services may likely contribute.

In Prealize’s annual analysis, another telling trend also emerged. Across care types, preventive primary care physician visits and specialty care visits tended to decrease in the weeks and months following a COVID diagnosis. In turn, just as preventive office visits decreased, the utilization of care for severe conditions increased. Based on these findings, it is more important than ever for health plans to seize the opportunity and help catapult the industry into the future of care delivery.