Clinical Claims Innovation Lab focus: Long COVID
Long COVID is a result of the novel coronavirus impacting our world since the start of 2020
People who experience COVID-19 symptoms for four weeks or more may be diagnosed as having long COVID. According to an article published by the CDC, “[Long COVID] symptoms can happen to anyone who has had COVID-19, even if the illness was mild, or if they had no initial symptoms.”
Sun Life’s Clinical Claims Innovation Lab focused on members who are on long-term disability for reason of long COVID.
The severity of long COVID can vary from person to person and result in some individuals being unable to work as a result of their symptoms.
The unique nature of long COVID meant that we needed to learn about the emerging symptoms and their impact on a members' ability to do their job, and adjust our case management practices to meet the needs of members who have this still-new and complex diagnosis.
Read trends and observations of our long COVID Clinical Claims Innovation Lab
The work done by Sun Life’s Clinical Claims Innovation Lab allowed us to:
- Learn about the wide-ranging complex symptoms of Long COVID and their impact on a member’s ability to return to work;
- Analyze treatments;
- Understand recovery trends;
- Train our case managers on each of these factors to help them best engage members, employers and treating providers.
The majority of members with long COVID are case managed by the Clinical Claims Innovation Lab team
This change to our disability management practice means members are partnered with case managers knowledgeable about long COVID symptoms and experienced in discussing treatment plans and clinical interventions with treating physicians.
In addition, members benefit from:
- Early clinical collaboration to understand functional ability and prognosis for improvement, which facilitates a timely benefit decision;
- More frequent telephone contact to monitor for symptoms changes that may signal a readiness for return to work;
- Holistic discussions that include both physical and mental wellness, with help obtaining neuropsychological testing as needed;
- Earlier and more frequent discussions between case managers and vocational rehabilitation counselors to identify accommodations that help members return to work.
Trends and observations of Sun Life’s Clinical Claims Innovation Lab for long COVID
- It’s a complex diagnosis. Symptoms, durations, and the overall impact to one’s ability to work can vary greatly. Common reported symptoms (in order or prevalence): shortness of breath, fatigue, cough, cognitive issues, headache, anxiety, muscle pain.
- There are no strong predictors about who will develop long COVID. It’s not limited to individuals with pre-existing conditions or to older populations. Only 31% of members we are working with report having a pre-existing condition. While the average age in our group is 52, all age ranges are represented.
- Symptoms can be severe. 63% reported a COVID-19 related hospital stay and 76% have been referred to or are being treated by a specialist. According to the CDC, “hospitalizations and severe illnesses for lung-related diseases, including COVID-19, can cause health effects like severe weakness and exhaustion during the recovery period.”
- Having long COVID can negatively impact a person’s mental wellness. We observed this through individual discussions with members and it was noted in medical records. According to an article published by Hopkins Medicine, “...after surviving COVID-19, some people are left with lingering anxiety, depression and other mental health issues.”
- Despite all of this, long COVID symptoms generally improve over time.
Data is based on claims tracked through December 2021.
How employers can help
Long COVID is a new, medically accepted diagnosis. It can be scary and it’s important for employees to feel supported. Employers can remind employees about services provided by their employee assistance program. Further, employers can help employees with long COVID by allowing transitional return to work and workplace accommodations. There are many no-cost and easy-to-implement solutions that can help an employee recovering from long COVID be more productive at work.
The content on this page is not approved for use in New Mexico.
Group insurance policies are underwritten by Sun Life Assurance Company of Canada (Wellesley Hills, MA) in all states, except New York, under Policy Form Series 93P-LH, 15-GP-01, 12-DI-C-01, 12-GPPort-P-01, 12-STDPort-C-01, 16-DI-C-01, TDBPOLICY-2006, and TDI-POLICY. In New York, group insurance policies are underwritten by Sun Life and Health Insurance Company (U.S.) (Lansing, MI) under Policy Form Series 15-GP-01, 13-GP-LH-01, 13-LTD-C-01, 13-STD-C-01, 06P-NY-DBL, 12-GPPort-01, and 12-STDPort-C-01. Product offerings may not be available in all states and may vary depending on state laws and regulations. The group insurance policies described in this advertisement provide disability income insurance only. They do NOT provide basic hospital, basic medical, or major medical insurance as defined by the New York State Department of Financial Services.
SLPC 31678 6/22 (Exp 6/24)