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CHIP: A Practical Solution to Address Underlying Risks for COVID-19

Introduction

The COVID-19 pandemic has dramatically affected the usual and customary delivery of  healthcare services in the United States. One of the most significant changes has been the new  urgency and reliance on the adoption of technology, i.e., telemedicine/ telehealth, as a practical  solution to maintain delivery of necessary healthcare to patients with chronic disease.  

Here we describe how you can proactively implement and deliver the Complete Health  Improvement Program (CHIP) program via a video conferencing meeting platform. This strategy  will enhance your organization’s capacity to meet the current challenges created by COVID-19’s  requirements for social distancing, stay-at-home restrictions, and limiting group gatherings. 

Common Chronic Diseases and COVID-19

The SARS-CoV2 novel coronavirus that causes COVID-19 has created a high level of uncertainty and fear, which is having an unfortunate effect on healthcare utilization. In a recent national  survey conducted by the Alliance of Community Health Plans, only 31% of patients felt comfortable visiting their doctor’s office or hospital for care and over 40% state that they  intended to delay medical care or treatment.1 Sixty percent of respondents planned to avoid  receiving medical care during the pandemic, which can be potentially life-threatening to  individuals diagnosed with chronic diseases who require regular medical monitoring and care. 

Compounding the attitudinal problems, the most common chronic diseases in the US (heart  disease, diabetes, obesity, COPD, and hypertension) significantly increase risk for severe  complications related to COVID-19. For example, the New York State Health Department reported that 86% of the COVID-19 deaths were people inflicted with at least one chronic  disease.2 Obesity (BMI>30 kg/m2), which effects nearly half of the US population, increases the  risk of COVID-19-related deaths nearly 3-fold, especially in populations under 60 years old.3 Furthermore, obesity is present in nearly 50% of COVID-19 patients admitted to ICUs and 85%  of individuals with BMI>35 required invasive mechanical ventilation.4 These findings beg the  question of addressing the “root cause” of chronic disease, namely poor lifestyle, as a  defense to combat chronic disease and reduce COVID-19 risk.  

Lastly, COVID-19 itself appears to be associated with increased risk for chronic complications.  The American Heart Association reports that 23% of people hospitalized for COVID-19  experienced serious cardiovascular complications from the virus, with about 12% having acute  cardiac injury such as myocarditis or fatal arrhythmias.5 Scientists have discovered growing clinical evidence that COVID-19 is, in fact, an impairment of the blood circulatory system: the  virus infects the endothelial cells that line the inside of blood vessels and protect the  cardiovascular system.6,7 Damage to the endothelial cells causes inflammation in the blood  vessels throughout the body, injuring multiple organs in COVID-19 patients. This blood vessel  damage also explains why people with pre-existing chronic conditions like are at higher risk for  severe complications from COVID-19: chronic lifestyle-related diseases are associated  themselves with chronic inflammation and hampering of the immune system. 

The good news is the CHIP program offers a scientific and outcomes-based solution to address  the underlying chronic conditions that increase risk from COVID-19. The adoption of the  lifestyle medicine principles the CHIP program offers protect and stabilize endothelial cells,  reduce systemic inflammation, and strengthen the immune system. As the nationwide  “Pandemic of Chronic Disease” intersects with fear-based delays by individuals in seeking medical care and treatment, health plans and self-insured employers should anticipate a  significant escalation in future health care claims. The healthcare system and employers must  be prepared with an innovative and practical solution for patients and employees to address  this new reality. 

Virtual CHIP/CHIPHub

The Lifestyle Medicine Institute (LMI) has been fully aware for several years of the growing  interest of telemedicine/telehealth as an alternative delivery approach. To meet this increasing  market demand LMI created Virtual CHIP and the CHIPHub, LMI’s Learning Management  System, utilizing the identical clinical program content of the traditional core CHIP offering. CHIPHUB contains the CHIP intellectual property (workbooks and videos) and is accessible from  any computer or hand-held device with an internet connection.  

CHIPHUB is a fully digital on-line classroom solution that includes: 

  • All CHIP intellectual property (19 CHIP videos and four workbooks) 
  • Program and Content Management 
  • Well-Being 360 Lifestyle Health Risk Assessment 
  • Quiz Structure 
  • Facilitator/Participant Notifications and Chat 
  • Engagement Reporting 

Virtual CHIP still requires the expertise of an LMI trained and certified CHIP facilitator who uses  a video conferencing service portal to deliver and interact with CHIP participants/groups. For  the best participant experience, the technical requirements for Virtual CHIP are: 

  • A minimum of 5 Megabits per second internet connection. 
  • A computer/laptop with a camera and microphone (may be built in to laptop  already) 
  • Web browser (update to latest versions for best and safest experience):
    • Microsoft Edge 
    • Firefox 
    • Safari (for Mac computers)
    • Google Chrome

Summary

In summary, CHIP is a compelling solution that creates a triple WIN-WIN-WIN value proposition  as follows: 

  1. For the individual: CHIP is delivered safely via virtual platforms and provides the  ability to learn and adopt clinically validated lifestyle changes that will greatly  improve not only their physical health and overall wellbeing, but may provide protection against the ravages of COVID-19.  
  2. For the physician: CHIP offers a clinical treatment/care solution which addresses the  physician’s treatment plan while not necessitating in-person visits 
  3. For the Self- Insured Employer and Fully Insured Health Plan: CHIP will keep your employee or member healthier and reduce utilization of health care services  resulting in medical and pharmaceutical claims cost savings. 

References

  1. Alliance of Community Health Plans. https://achp.org/release-covid-19-shifts-consumer behavior-attitudes-toward-healthcare-services/. Accessed Oct 2020. 
  2. The Hospitalist. https://www.the-hospitalist.org/hospitalist/article/220457/coronavirus updates/comorbidities-rule-new-yorks-covid-19-deaths. Accessed Oct 2020. 
  3. Tartof SY, Qian L, Hong V, Wei R, et al. Obesity and mortality among patients diagnosed with  COVID-19: Results from an integrated care organization. Ann Intern Med 2020;M20-3742.
  4. Simonnet A, Chetboun M, Poissy J, Reverdy V< et al. High prevalence of obesity in SARS-CoV-2  requiring invasive mechanical ventilation. Obesity 2020; 28(7):1195-1199. 
  5. American Heart Association. Newsroom.heart.org/news/severe-covid-19-associated-with heart-issues-much-yet-to-discover-an-american-heart-assocation-overview. Accessed Oct 2020.
  6. Gavriilako E, Anyfanti P, Gavriilaki M, et al. Endothelial dysfunction in COVID-19: Lessons  learned from coronaviruses. Curr Hyperten Reports 2020; 22(9): 63. 
  7. Libby P, Luscher T. COVID-19 is, in the end, an endothelial disease. Eur Heart J 2020; 41(32):  3038-3044.

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