In the Texas Community
Natural disasters can pose public health problems long after the initial crisis ends. On the one-year anniversary of Hurricane Harvey, we use our data to determine how the storm impacted the health of Southeast Texas. The panel for this discussion includes Bob Morrow, MD, Southeast Texas Market President, Leanne Metcalfe, PhD, Executive Director of Planning and Research, and co-host Ross Blackstone, Director of Strategic Influence. You can listen to the complete discussion in podcast form on Apple Podcasts and SoundCloud.
Blue Promise is an online video blog that aims to address complicated health issues with candid conversations from subject matter experts. New editions are published regularly and are hosted by Dr. Dan McCoy, President of Blue Cross and Blue Shield of Texas.
Dan McCoy, MD; President, BCBSTX
Leanne Metcalfe, PhD; Exec. Dir. of Planning and Research, BCBSTX
Bob Morrow, MD, MBA, Southeast Texas Market President, BCBSTX
Ross Blackstone; Director, Strategic Influence, BCBSTX
It’s been a year since Hurricane Harvey made landfall as a category 4 storm right here in Texas.
Harvey ravaged the economy as well as the health of our Southeast region. In this edition of Blue Promise, we'll use our data to look into the specific health impacts of the hurricane. Thanks for joining us, I'm Dr. Dan McCoy and I'm the President of Blue Cross and Blue Shield of Texas. I'm here with my co-host, Ross Blackstone.
Thank You Dr. McCoy, I think Blue Cross Blue Shield of Texas really is in a unique position to provide some really insightful information about the health impacts of natural disasters especially hurricane
Harvey. We have two panelists here to talk to us a little bit more about that. Dr. Leanne Metcalf is Executive Director of Planning and Research and Dr. Bob Morrow is the Southeast Texas Market
President for Blue Cross and Blue Shield of Texas, thank you both for being here.
Happy to be here.
Okay so Dr. Morrow, you're… you are a leader in the southeast region of this state and especially in
the Houston area, most people will remember the impacts that hurricane Harvey had when it hit in
2017 but maybe if you could just remind us what was this storm all about. It packed a pretty big punch didn't it?
Yeah, you know Harvey is really interesting, Harvey started in the Gulf as a relatively weak tropical storm and then it rapidly accelerated and actually hit the mid Texas coast just north of Corpus Christi as a category four storm which is devastating in itself but the ultimate story of Harvey became the fact that it basically hung around for about four days and just sort of went back and forth across the coast pulling up moisture from the Gulf and dumping it in Southeast Texas to the tune of about 60
inches which caused devastating flooding in the whole Southeast Texas region, that flooding made it the second costliest disaster only behind Hurricane Katrina.
So 30,000 people displaced by the storm, one statistic I have is three hundred and thirty six thousand people left without electricity. I mean this storm made news right off the bat.
Absolutely and you know you think about the 30… 30 thousand people displaced, somewhere around
like 13 thousand of them actually had to be rescued, that's that's a big number so a lot I mean a lot of infrastructure and the storm was kind of an equal opportunity offenders so the more affluent areas of the city as well as less affluent areas of the city were significantly impacted and you know the effects of the storm lingers still until today. I know of people actually who even now either are just now getting back into their houses or actually are still displaced.
Okay let me ask so Bob one of the things that was interesting about this storm too was that
people were stranded so…
…there were people displaced that had to leave and I know that one of the challenges that you had to deal with was managing the care for many of our members and helping them manage that care for people that were in that were in Houston that had to come to Dallas but there were a tremendous
number of people that were just stuck in their houses.
Actually you're correct, you've probably heard of the Cajun Navy, where actually you know those
from all along the Gulf Coast including Louisiana came with their own private boats and actually helped evacuate people who needed to be evacuated. It was a very very stressful significant time
for the region.
So we knew that the impact was going to be big right away but it took a little time for us to kind
of identify some of the health impacts, the things that we had to take a look at. Before we get into some of those details that LeAnne has done with her research, Dr. Bob can you kind of give us a
high-level perspective of how a storm like this might actually impact the health of the community.
Well so first you have to sort of maybe if you can get even a mental picture you know so after the flood waters kind of recede, so you know during the flood there's a lot of obvious things high water,
you got to worry about, you know, kids drowning things like that but once the waters recede, you're left with all the damage and we had somewhere around 10 percent of homes in the area were
impacted, many of them completely destroyed, all that debris then lines the streets which creates its own hazards think about things like if it's your house and you're having to saw through sheetrock, you're having to do it that puts all kinds of molds and other dust in the air so are people who have a
propensity for respiratory difficulties that can cause respiratory problems and then those flood waters are not exactly what you would call clean I mean there's lots of things in there including bacteria and so for example people may have cuts on their legs or you know are set up to get
sometimes a pretty bad infection.
So, Leanne we took a look at some of our claims data to figure out what kind of trends were we seeing and how we might be able to take a look at what happened with hurricane Harvey and maybe predict what we might be able to expect for storms in the future. Before we get into some of the details, do you think it's fair to say that the data that we have here at Blue Cross and Blue Shield of
Texas is representative of the whole State, can we extrapolate that to say this is generally what happened across the population?
Yeah, Blue Cross of Texas is in all the counties across the State so we do have representation of the members throughout the State and we do cover a good number of the people throughout the
State so what we have can be extrapolated to say this is what happened across the State. We did focus on those counties that were directly affected or that FEMA had identified as being affected by what happened and so that was around 1.2 million people and so we were able to look at the data
across those that we actually covered to see what were the health effects prior to the hurricane, after the hurricane and then look across a few years just to see, you know, did we see a certain effect at
this time of year, or is this was, if this was actually due to the hurricane itself.
So would you find?
Uhm so we've found some pretty interesting things, one of the things that we wanted to look at was the mental health state of the individuals, so we did see that the number of claims that we had for PTSD actually doubled so right and we adjusted for prior years just again to make sure it wasn't a
seasonal affect something and fall at the end of the year and we did see that it did in fact double
across those years. The other thing that we saw, we did see a small increase in substance abuse claims as well for those members and one of the things that we want to be sure as we continue to look at this is to be sure that those are member, continued to get help. So those that were immediately affected, did they get the help they need and then the ones that are continuing to feel these effects how do we help them as well.
So, some of these behavioral health claims you know these are interesting because they're not just
a wound that can heal and all of a sudden you know then it’s fixed. Some of these things can have a lingering impact so we're still trying to make sure that our members are taken care of.
That is correct, yes, so you do have those that had more of an acute anxious episode at the time of the hurricane. We are interested in looking at the ones that are continuing… do you have mental
health effects, you know, now one year after the hurricane.
Dr. Bob had mentioned how the waters are not necessarily the cleanest following a storm like that, any insight into disease infection?
So similar thing, twice as many people in the impacted regions had claims for infectious or parasitic
diseases, something else that we had to look at and we again adjusted for since we didn't know we had a particularly high flu season so we wanted to remove those. Although when we looked at flu
they were also higher than their surrounding counties but we did have twice as many people with infectious or parasitic diseases including meningitis food poisoning cholera typhoid and then
we did see an increase as well in COPD claims.
So all those are certainly acute conditions that would occur as you can imagine from dirty water.
Were you able and I suspect it's probably not an easy thing to assess but what about the issues related to impact on chronic disease because people weren't able to get their diabetes medicines or see the doctor were there any, is there any way to study that or is that something that you might could think was probably worse and thus hard to study.
So those were things that we wanted to look at as well. They were a little bit more difficult to study especially in the case of something like CKD could somebody get to a dialysis center .
CKD meaning Chronic Kidney Disease
Chronic Kidney Disease yeah and end-stage renal disease so those are things that we are
currently studying to understand the patterns of where people went for care in terms of managing their chronic disease.
The other issue is kind of curious about, too, Bob I think you can talk about it, I know that there were some interventions that the company helped in solving some problems. I know one of the issues had to do with the fact that more and more records are stored on electronic medical records but there was no electricity and getting access to the records so even if a patient or member was able to get to
Say, Austin or Dallas, they wouldn't have access to their medical record, but you put in place some measures, talk a little bit about that.
Yeah we were actually able to get providers information about the patient's they were seeing because a lot of these for one, you had providers actually coming in to help out who were not our typical providers and you had our members who were displaced and so they were they were
sort of being forced into situation of seeing providers that they had not seen before or they were seeing their providers who had no access to their own information and so we were able to put in a program that that actually pushed the information we had on our members to the providers where they were while they were seeing the patient.
That's like a clinical snapshot of…
…conditions and drugs acts and things like that because I would assume that some of those patients probably had to start new care management plans and see new doctors and that in and of itself creates some inefficiencies in the system and also in kind of inefficiency in their care delivery.
Well and also you know with that data we’re able to provide a provider with some comfort that this
medication actually is being taken by this patient and so as a physician you know you really don't want to just be prescribing things for people – “oh yes hey I take that all the time” and this proof this gave the providers some reassurance that that they were actually following a guideline that one of their colleagues had implemented.
So Bob I know that we actually have an office in Houston and we also had workers that were displaced and I know as a company we always look back on these sort of tragedies and what could
we do to change things, to make it better in the future? So that we do things differently? So Leanne based on what you're seeing,
are there lessons learned that we might need to think about because I'm going to tell you we're going to have another hurricane season.
So one of the things that we saw in the utilization data was at least we'd rolled out telemedicine last year and so we did see at least within that group those that did have access, that did have electricity access and could get to their phones, were able to also see docs in areas where those providers were
Closed. There’re probably some other things that we could do in order to help patients and providers find each other, kind of educate people on which provider offices are closed but which ones are actually open in that area because some did do a very good job of opening up a day or two after.
So Bob if I remember correctly that was one of the challenges, was that phone service actually was gone but cell phone service actually worked decently well, right?
It did, cell phone service worked well. You know we had over a million members in the impacted area as has been mentioned and so there were a lot of lessons learned just to follow along on that, our response, I was very proud of our response but it was a company-wide response, it really took all
facets of this company to respond in a meaningful way to what was going on and so one of the things we've done as a result of that is we sort of put a playbook together that captured some of the things that went well and we also debriefed on some of the things that we felt like we could have improved upon so that in the event, which will be inevitable at some point, this or a similar disaster happens, we can take a lot of that learning and apply it in the future.
It seems like… did social media play a role in your education efforts?
Social media played a big role you know what I found, one of the things I think that is probably, should be I guess to some degree self-evident, you cannot over communicate. You know we used every communication avenue that we had including social media and we were sending alerts out to people on landlines, on cell phones, via email, via text, social media… all of those things, not one person ever complained that we were sending too much information.
So I guess the flip side is that telemedicine is sort of that outbound reach, right, yeah, but that works on the inbound of educating members then certainly as these storms progress in the future and that modality starts to improve. Telemedicine certainly will become a very important thing to think about in terms of a storm.
Yeah one of the otherthings that we noticed as well, especially for people who use telemedicine. It allowed for those physician offices that were open to see those more chronically ill patients that
needed to physically sit in the office so some of the infectious diseases could be handled over teleMed and then it freed up the docs to see some of the more critically ill patients and so understanding how we can continue that work as well if we do have another natural disaster.
Dr. McCoy I was actually part of Dr. Bob's Task Force during Hurricane Harvey and I can tell you that we really needed to have our customer service phone lines open for extended periods of time, our
provider service phone lines open for an extended period of time. We were the first, maybe not, I shouldn't say that for a fact, but if not the first, certainly one of the first to adopt regulations that were recommended on behalf of this state to adjust and be a little flexible with how we were review claims because we didn't know if a member that might have been coming from an impacted County might have been getting service in another County that wasn't impacted so there were a lot of a lot of moving pieces that we had to consider when trying to decide how to best take care of our members but to that end Dr. Bob, I… before we go, I would like to just also address how we've supported the
community because we've done a lot there and I think it's important that people recognize that during a time of crisis when you have economies being impacted, homes being impacted, Health's being impacted… it's really a responsibility of all of the businesses in that area to step up to the plate and to help support their community. Could you just kind of touch on a little bit about what we did?
Well sure now, you already mentioned a few like extending the call center hours. We actually did outreach I mean outreach to members in the area to proactively ask them what were their needs, well good what can we do to help them. We provide actually boots on the ground help at some of the relief centers where people could come they could recharge their cell phone they could actually watch a live stream, you know, TV. They had access to Wi-Fi and we could help answer their insurance questions, provide them with temporary ID cards and we did this both for our members and for others basically anybody at these relief centers that needed help. We also are… we have such an incredible support from our employees at Blue Cross and Blue Shield, in our customer care advocates, our think blue teams, the community affairs teams, our employee volunteers all of them came together. We donated over 10,000 items things like hand sanitizers, wipes, stuff like that for the community to use, stuff backpacks for the community to use and then we gave monetarily, we ended up given about two million dollars and we did that in a very intentional way, I mean, we did
that in stages so as we looked out to see where we felt like there was a significant need that's where we allocated those funds so we sent, we provided funding to things like the United Way, the Greater Houston Community Foundation, Feeding Texas, the Red Cross, the Urban League, Catholic Charities and food banks, things like that to make sure that we were really targeting the areas where the need was the greatest,
We've covered a lot here. I think it's safe to say that most most businesses and most communities in Texas really did step up to the plate but just to wrap things up in terms of you know this additional
information that's really unique for Blue Cross and Blue Shield of Texas to offer to the conversation as Leeanne had mentioned PTSD claims doubled… infectious and parasitic diseases up 12% compared
to counties that weren't impacted, cases of pneumonia and COPD all went up so you know I think we have a lot to learn and a lot to work for as we head towards the next which is definitely another and
another hurricane season in the future.
And I think it's fair to say too, that the one message that we can send out is, that listen to the emergency management
There you go…
They tell you to stay in stay in, if they tell you to evacuate then evacuate because these are
real problems and we saw that in our data today. Thanks for being here.
Thanks for being a part of it and thanks for joining us for this edition of Blue Promise.
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