Co-authored with Mark Ackley
COVID-19 has exposed vulnerabilities as well as opportunities in healthcare practices across America.
In the United States, despite having the highest healthcare cost per capita in the world at about $11,100 per person in 20191, we still do not have an integrated healthcare system as much as we have a healthcare industry. The U.S. response to COVID-19 has shown that, despite our enormous healthcare costs in this country, we do not see a proportional expected value of care.
COVID-19 Illuminates Weaknesses in Current Systems
COVID-19 has illuminated weaknesses in the current systems and organizations providing health and medical services. While many of these vulnerabilities have been developing for years, COVID-19 has made them abundantly clear. These healthcare system vulnerabilities fall into four categories:
Medical device and supply manufacturers are struggling with disruptions to their businesses as a result of the coronavirus pandemic, with many experiencing adverse impacts to their supply chain operations, financial expectations, and emergency response plans.
According to an FDA news release, the FDA has been working closely with PPE manufacturers to understand their supply capabilities during this pandemic. The agency is also aware of challenges throughout the supply chain that are presently impacting the availability of PPE products and is taking steps to mitigate shortages that healthcare facilities are already experiencing.2
The need for production to be at full capacity remains as manufacturers try to balance keeping their employees and their families safe while meeting demands from customers at the same time. Subsequently, production teams are not able to work remotely or exercise social distancing. The net result is a dried-up supply chain that was vulnerable to begin with, and now more so. Perhaps in the new world, traditional supply chain strategies may be replaced with a more intelligent system that uses a predictive model as opposed to a retrospective or Just in Time (JIT) model.
The gradual shift of healthcare to outpatient settings with the corresponding reduction in hospital beds and closure of smaller rural hospitals has contributed to reducing our capacity to care for large numbers of sick people.
According to the Agency for Healthcare Research and Quality, healthcare/system redesign involves making systematic changes to primary care practices and health systems to improve the quality, efficiency, and effectiveness of patient care. Frameworks, models, and concepts such as the Chronic-Care-Model and the Patient-Centered-Medical Home (PCMH) are useful independently or utilized together to reorganize care delivery to improve patient outcomes.3
In any case, there is a pressing need for reengineering our healthcare delivery system in a more rapid fashion that meets the needs of patients without sacrifice in quality, cost or access. Hospitals are already looking at structural modifications that would allow for more critical, and other specialty, care surges.
Processes of Care
Much of the healthcare economy relies upon high-volume elective procedures performed in offices, ASCs, ambulatory facilities, and hospitals. During the pandemic, these elective procedures are experiencing a decline to divert resources toward providing care to COVID-19 patients, and to decrease exposure risk to patients having these elective procedures.
In March 2020, CMS released recommendations on adult elective surgeries, non-essential medical-surgical, and dental procedures during the COVID-19 response. These recommendations are here.
Ability to Pay
Patients who are losing their employer-provided healthcare insurance or who are not adequately insured are not going forward with elective procedures or deferring treatment of their chronic conditions.
According to the Washington Post, as of April 2020, more than 17 million people had filed for unemployment.4
That means that millions are without health insurance, and millions more will struggle to pay premiums and copays for the coverage they do have. The economic reality puts even more pressure on hospital systems that are already under enormous financial strain because they have an ethical and professional mandate to treat all patients with emergency conditions, including the uninsured.
COVID-19 Exposes Inequalities
Social Determinants of Health and Health Equity Considerations have been an issue for some time. The pandemic has further exposed these vulnerabilities, and the reality of these inequities will and should inform the future of how we organize and deliver healthcare in this country going forward.
The data shows that people with pre-existing co-morbid conditions are six times more likely to require hospitalization for COVID-19 treatment and 12 times more likely to die from the disease. Yet the debate over insurance coverage for people with pre-existing conditions continues to be a hot button issue. People of color are three times more likely to contract COVID-19 and twice as likely to die from it than caucasians.
The inequitable impact of the pandemic can be observed by zip code, which highlights the distribution of the disease by neighborhood, showing COVID-19 has a more significant impact on disadvantaged communities.
What We Expect to See in the Aftermath
The economic and social realities will have an impact on how healthcare will change after COVID-19. Due to these systemic failures, there will most likely be more attention paid to decoupling healthcare insurance from employment status and political pressure on having a government-sponsored basic level of healthcare insurance.
Specialty physicians who have had significant disruptions in their income are being actively encouraged to develop innovative payment models with a focus on demonstrating value and aligning themselves into more efficient networks that can work in a shared risk environment.
There will be increased use of technology to deliver care, especially to underserved populations. This expanded use of technology will include a more comprehensive and permanent commitment to telemedicine.
With more digitally-based patient interactions, there will be a focus on consumerism. Patients will become more discriminating in finding care. Practices will need to be more transparent, publishing their costs and outcomes. They will also need to be more responsive to the marketplace in providing services that fit the needs of the patients and communities they serve.
Patients will interact with their physicians more frequently through digital means. As a result, practices will provide their patients more formalized care management systems, particularly for chronic disease.
We see more pressure for practices to gather clinical outcomes data, using it in real-time to aid in clinical decision making as well as combining it with practice management data to develop systematic approaches to value-based care.
The organizational structures and governance will reflect the changes in how care is delivered. Specialty practices will need to become more nimble and be able to pivot towards more efficient care for larger populations of people.
Need Help Handling the Changes and Expectations of Healthcare Providers in the New Normal?
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1Peter G. Peterson Foundation, July 14, 2020, How Does the U.S. Healthcare System Compare to Other Countries?
2FDA NEWS RELEASE – Coronavirus (COVID-19) Update: FDA Continues to Facilitate Access to Crucial Medical Products, Including Ventilator, March 2020
3 March 18, 2020 – CMS releases recommendations on adult elective surgeries, non-essential medical, surgical, and dental procedures during COVID-19 response.
4Abbe R. Gluck and Timothy Stoltzfus Jost, Washington Post, April 13, 2020. “What happens when our insurance is tied to our jobs, and our jobs Vanish”