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Clinicians at health tech startups who treat patients with chronic conditions are raising a looming concern: Will their patients — many of whom have had their routine care disrupted during the Covid-19 pandemic — see a relapse in their illnesses or new complications once the crisis subsides?

Chronic conditions are as broad as they are diverse, ranging from diabetes and hypertension to Crohn’s disease and depression. As the pandemic has overwhelmed the health care system, people with chronic illnesses have been forced to postpone much of their care, which can be critical to keeping their most troublesome symptoms at bay. Now, digital health companies focused on the chronically ill are preparing for the ripple effects of those delays — and trying to get ahead of them by doubling down on patient outreach.

“This country’s health care system is in for a second wave of crisis and that’s going to be what happens when people come out of this and all these urgencies, is what I’ll call them, all of a sudden become emergencies because care has been put off,” said Sarah Hallberg, medical director at diabetes-focused digital health company Virta Health.

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There’s some evidence to suggest the pandemic is a cause for concern: A study published by researchers at two universities in Taiwan and the Johns Hopkins Bloomberg School of Public Health following the 2002-2004 SARS outbreak, for example, suggested that chronic-care hospitalizations for diabetes plummeted during the crisis but skyrocketed afterwards. Health experts are worried that similar problems could crop up as a result of the Covid-19 pandemic.

“Even if you don’t get Covid-19, your chronic diseases are probably not being managed right now because of the scourge on the health system,” said Andrew Toy, president and chief technology officer of health insurance startup Clover.

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In some ways, health tech startups are well-equipped to help head off that crisis. Their patients still visit in-person clinics, but also interact virtually with clinicians, nutritionists, and other members of so-called “care teams.” Those teams can keep seeing patients even as in-person appointments are being postponed.

Still, several of the companies’ clinicians say they are doubling down on outreach to patients to help them navigate their conditions during the pandemic. Comcast health tech spinout Quil recently unveiled a tool that helps elective surgery patients stay on track until their operations are rescheduled. Virta and another diabetes-focused digital health company, Omada, have started hosting webinars and creating special patient groups to keep people informed about how the pandemic might impact their illness. Omada, for example, is paying closer attention to data from some users’ continuous glucose monitors, which track blood sugar levels at regular intervals throughout the day, as one way of keeping an eye on how people are faring amid the pandemic.

For people with multiple chronic conditions, or those who’ve had past issues managing an aspect of their condition, hospital or lab closures could prove particularly problematic, especially if they’ve been relying on regular check-ins with practitioners or regular lab tests to keep their conditions in check. That’s an area clinicians are still trying to determine the best ways to address.

“No one has experience delivering health care during something like this,” said Toy.

Startups are also pushing to educate people with chronic conditions about Covid-19, given that people with certain diseases are at far higher risk of developing severe illness. Clover is using an algorithm to pinpoint the patients most at risk of infection. Clover’s clinicians are using that to reach out to certain patients and check in, provide basic Covid-19 information, and in some cases, suggest that patients avoid places where they’d be likely to be exposed, such as at the grocery store or pharmacy.

Clinicians at Virta, meanwhile, are identifying patients that might be at high risk of infection or diabetes-related complications during the pandemic based on their medical history.

“Do they have multiple chronic conditions? Was there a struggle that this patient was going through previously with their blood sugar? Or was there something not associated with [the pandemic] where their blood sugar was not ideal and I needed to reach out?” said Hallberg, Virta’s medical director.

When a Virta clinician reaches out, they also share Covid-19 information, check in on the patient’s general well-being, and make sure they have what they need to do things like work from home, grocery shop safely, and cook healthy meals. Mental well-being and a healthy diet are important components of diabetes management — but both can be difficult to grapple with during the pandemic, given guidelines around physical distancing and limited grocery store trips.

Clinicians at startups say their work is aimed at helping people manage certain aspects of their health — but also acknowledge the pandemic has forced some parts of a patient’s regular medical care outside of their control.

“As humans, we don’t like to be out of control, and the control has definitely been taken away from us. But we self-soothe by taking control of what we can. And our patients can do that when they feel like they have a plan and they have support,” Hallberg said.

For some startups, that support also includes keeping a close eye on the mental health of the patients they care for. Depression and anxiety, which themselves can be chronic conditions, also tend to crop up at higher rates among people with other chronic conditions such as diabetes and hypertension.

Diabetes startup Omada, which has an existing mental health coaching platform that uses cognitive behavioral therapy and mindfulness tools to help treat conditions like depression and anxiety, recently expanded access to the tool amid unprecedented demand for mental health support.

Virta and Clover, meanwhile, are sending out emails that emphasize self-care and having clinicians bring up mental health during their check-in calls with patients. For example, Virta clinicians are asking people about their social support system, such as whether they have close friends or family they can reach out to while they’re sheltering in place.

“One of the first questions after I ask a patient, ‘Are you safe?’ is, ‘Who is your support system? Who are you reaching out to, and how often?’” said Hallberg. Virta makes staff available for patients to text or call every day of the week. If a patient is having issues with something like working from home, Virta clinicians may help take action, such as writing a letter to an employer. Quil, the Comcast health tech startup, is sharing stress-reduction techniques in its coronavirus tool, including mindfulness exercises, yoga, and other activities users can do at home.

Quil, which is focused on helping people prepare for elective surgeries like hip replacements, is also working to keep patients on track for when their appointments and procedures are eventually rescheduled. That includes having patients continue with the same at-home exercises they’d been doing before their original surgery date, which could give them even more time to get ready for the operation.

“We’re keeping them engaged,” said Quil CEO Carina Edwards.

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