Just the Facts: Managed Care Evaluates the Evidence on COVID-19

Much has been written about disparities in distribution of COVID-19 vaccine doses, actual vaccination of the general population (150 million doses given by early April), and care for patients with active COVID-19 infections. What is the role of a managed care organization during a public health emergency, such as during the COVID-19 pandemic?

At AMCP 2021, G. Caleb Alexander, MD, MS, professor of epidemiology and Medicine, Johns Hopkins Bloomberg School of Public Health, and Dan Kent, PharmD, CDE, specialty quality clinical coordinator at Kaiser Permanente of Washington, indicated that health plans and insurers can be a vital link in information regarding therapeutics, supply chain, shortages, and use of resources during the pandemic.

Dr. Alexander briefly reviewed a small group of medications (including controversial drugs) developed or repurposed to treat and prevent COVID, as well as their mechanisms of action. He also touched on the Infectious Disease Society of American’s COVID treatment guidelines, which were published in April 2020 and updated this past February. He noted that the IDSA and National Institutes of Health guidelines are the most authoritative, stratifying patients by disease severity. And they grade the evidence as to its credibility.

When considering management approaches in a shifting, rapidly progressing environment such as during a pandemic, Dr. Alexander offered several guiding principles:

  • Gain knowledge about the know the evidence base and understand the limits of the evidence.
  • Stratify treatments based on the characteristics and severity of the patient (different treatments may be more or less effective depending on when administered).
  • Recognize the role of variants.
  • Assess the opportunities and challenges posed by the various vaccines, such as vaccine type, storage requirements, differences in time before antibodies are detected).
  • Emphasize the primary need for prevention through simple measures like hand washing and mask wearing.
  • Optimize delivery systems to help reduce racial, ethnic, and socioeconomic disparities in hospitalization and death.

“The evidence base continues to evolve dynamically,” second presenter Dr. Kent added, “Staying up to date with treatment is a must. The overarching principles of effective treatment can help to ensure the right drug is given to the right patient at the right time.”

There are still some important gaps in the evidence to date regarding COVID-19 management. First is “long-haulers syndrome,” which appears inconsistently. Some patients who appear to recover from an initial COVID-19 infection continue to experience a range of persistent symptoms and disability. The presenters said several studies are underway to help provide additional information about this phenomenon.

A second issue for which the data are still being analyzed relates to immunity. The data are more limited for patients who have received vaccines because of the short time frame since their initial testing. However, recent study results do indicate that the Pfizer and Moderna vaccines provide at least six months of COVID-19 antibody production. 

Drs. Alexander and Kent predicted that COVID-19 vaccinations will continue for years.

“It will be necessary to expand vaccine capacity and address staffing challenges for vaccines,” they said.

Alexander GC, Kent D. Managed Care Approaches to Manage COVID-19. Presentation B7. Presented at AMCP 2021; April 12-16, 2021.