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Perspectives on a selected key
topic
June / July 2020 |
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positives might ultimately result - post-pandemic in our
healthcare system - due to the impact of COVID-19?”
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Hank Osowski
Managing Partner, Strategic Health Group LLC |
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It may be too easy to focus on the many things lost during
the last months as the nation, and the world, has battled
the Coronavirus pandemic; social gatherings, graduation
ceremonies, birthdays, weddings, live sporting events and,
most tragically, the lives of so many of our fellow
citizens, including hundreds of healthcare workers. But out
of this misery we’ve also seen the emergence of many
positive developments and new learnings that have
significant potential to change our industry for the better
as we move into a post-pandemic world.
Perhaps first
among these positives is the broad recognition and enhanced
appreciation for the tireless and valiant efforts of the
hundreds of thousands of healthcare workers who put their
lives on the line each day to serve our most vulnerable. Too
often we place sports figures on pedestals and call them
heroes. With few exceptions (such as Jessie Owens, Jackie
Robinson, Artur Ashe, Muhammed Ali, Pat Tillman, Ted
Williams and Billie Jean King) most are not heroes. The
dedicated and committed individuals providing critical care
in the trenches and far from the spotlight are now
appropriately being recognized for the true heroes they are.
This is one positive trend we hope continues.
Another
important positive outcome is the recognition of the
critical role that clear, concise and accurate
communications plays in addressing the challenges of a
health, or any, crisis. This is important for all points on
the communication chain beginning with federal, state and
city officials, public health authorities, and extends to
local hospital and physician leaders. Certainly, experts may
have differing experiences and opinions and can disagree on
approaches, but as we’ve seen conflicting authoritative
messages sow confusion, skepticism and distrust. Even as a
(non-clinician) member of the healthcare community it has
been difficult to keep abreast of the rapidly changing
information, protocols and recommendations. If we in the
industry cannot find consensus it will be impossible for the
general public to understand the challenges and adhere to
necessary precautions. If the current healthcare crisis has
made us savvier about the importance of communications,
which communication tools to use (and when) and the
importance of selecting the right messenger to deliver
critical information, that will be a valuable and positive
outcome.
Though not a new technology, telemedicine
has emerged as a clear winner during this health crisis.
With stay-at-home orders in place in many communities and
increased pressure on clinical teams to deal with serious
conditions away from the hospital or office setting,
telemedicine has seen rapid growth (Scripps Health reports
going from zero telemedicine visits last October to more
than 3,000 per day during this pandemic) and provides a
valuable channel for patients and providers to connect in a
safe and comfortable environment. It’s not yet perfect, nor
universally available, but as we learn how to improve the
effectiveness of the technology and communications skills of
practitioners, telemedicine has the potential to radically
transform how and where care is received for our most
vulnerable and fragile patients. Telemedicine has already
proven to be a significant win for underserved communities
and patients with mobility challenges. There are
opportunities for Medicare, Medicaid and private insurers to
properly adjust reimbursement so that telemedicine is fully
embraced by physicians.
The healthcare industry has
traditionally been among the leaders in strategic planning
for an environment that is rapidly shifting and advancing
technical developments. Too often we have failed to complete
planning for unexpected contingencies. Those that have done
some contingency planning have mostly focused on natural
disasters such as earthquakes, hurricanes and fires. The
current pandemic has quickly taught us how unprepared we
were for this viral disruption. Critical drugs, supplies,
equipment and personnel were missing or in dramatic short
supply when most urgently needed. It’s clear that we as an
industry, with support from or federal and state leaders,
need to collectively solve the problems of supply chain
restoration, eliminate unnecessary regulatory burdens and
accelerate technical and scientific innovation. If this can
be accomplished, this would be a tremendous win for our
country and our industry.
The resiliency and speed at
which our industry responded to this health crisis is in
itself a significant positive. Rapid development of
vaccines, quick learnings on treatment protocols and PPE
“made in America”. Health plans eliminated barriers to care
and added supports for those who contracted this virus.
Hospitals and health systems prioritized care for those most
at risk and developed new protocols for treating patients
who contracted this disease. Physicians, nurses and
technicians embraced the challenges of treating these
patients, even at great risk to themselves. I’m incredibly
proud of my colleagues in the healthcare community.
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Mark Lutes
Chairman, Epstein Becker & Green, PC |
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The public health emergency has created a Zoom (and
equivalents) work place with profound implications for
methods of communication. The stress of the PHE has produced
church attendance by zoom and even the elderly have begun to
embrace the internet video.
What we define has
health care has, as a consequence, “zoomed” into new
dimensions. Clearly, protectionist regulatory barriers to
telehealth are, as a consequence, “doomed”. The
liberalization of coverage and payment for telehealth
services will also be an enduring legacy of this period with
beneficial consequences for “adherence” as well as ongoing
infectious disease risk management.
Importantly, the
experience of home health, hospice, PT, mental health and
other providers during this period is resulting in a
reconceptualization of telehealth to go beyond mere
physician visits by smart phone and webcam. Telehealth
post-PHE will include a broad array of providers working
care paths that have been reworked to embrace the power of
this technology. Social workers, nurse practitioners and
others can be more prominent parts of the care
paths—designed to manage chronic illness in the home as well
as many acute episodes as medical director imagination
permits. The efficiencies of this care path redesign will be
one of COVID’s “silver linings.”
The PHE is also
going to leave us with a second wave of technology induced
provider consolidation. There was a first wave of provider
consolidation as the unintended consequence of legislated
federal involvement in electronic health care
transactions—claims submission, remittance advice etc. etc.
When faced with the cost and complexity of adoption, many
providers joined delivery systems to finance and implement
the installation and operation.
The new technology
demands of 1st class web care implementation will instigate
additional aggregation and consolidation. Of course that
trend will have an equally compelling progenitor – the
desire to reduce exposure to volume losses during periods of
quarantine orchestrated by governments as well as periods of
public concern with obtaining care in congregate settings.
Thus the PHE will bequeath us tech enabled organized
delivery systems which may have the wherewithal to make
great advancements in cost and quality if public policy
helps these organizations assume global risk on a prepaid
basis. These are synergistic silver lining opportunities
coming out of the PHE.
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Pam Nicholson
Director
BDC Advisors |
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Out of every personal challenge there comes opportunity to
grow, to change, and to make a difference. The question is
whether you are willing to make the changes and live your
life anew or fall back into the same way of doing things.
Health Systems are not that different. COVID-19 has changed
everything for everybody in all aspects of their life but
especially in healthcare.
Health systems of today
are dealing with numerous challenges from ensuring enough
ICU beds, to re-designing their supply chain, to responding
to changing consumer preferences and the re-surging of the
virus that will continue to wreak havoc with revenue and
expenses. As all this can seem overwhelming, there are
opportunities a health system should be considering as they
develop their plans for moving forward. All health systems
are grounded by their mission and vision.
Commonalities across the health systems include taking care
of those that are ill and improving the health of
communities they serve. Health systems should be listening
to their communities, their patients, and their workforce to
design new processes that provide confidence, safety, and
trust. Services can be redesigned to focus on increasing
value to the patient. Duplicative services can be
eliminated. The transition from inpatient to ambulatory,
home care and digital may need to accelerate.
Health
Systems should continue to advocate more than ever for the
health and betterment of their communities. This includes
partnering with payers and state governments to ensure care
is accessible and affordable for all. It means working with
other advocacy groups focused on the social determinants and
finding solutions that are equitable and inclusive. The
positives from doing this will be many: growth
opportunities, increased efficiencies, decreased costs, and
most rewarding will be the increased trust among all
parties. Health Systems with the courage to change have the
opportunity to come out of this crisis stronger and even
more impactful to the lives they serve. That would be a
lasting positive for us all.
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Patrick Horine
CEO, DNV GL Healthcare, Inc. |
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“There are some things you learn best in calm, and some
in a storm.” - Will Cather
The challenges
brought about by COVID-19 have required us to learn in the
midst of an incredible storm. There have been so many
devastating results in the battle against COVID-19. This has
brought to light so many of the weaknesses of our healthcare
system, but without doing so we would have stayed on the
same path and eventually find ourselves in an even worst
position in the future.
One thing is clear is that
so many now understand the importance of our healthcare
system. From those that provide it, govern it, regulated it
and receive from it, the impact COVID-19 on healthcare was
never foreseen as we have experienced but will bring about
lasting changes that will improve healthcare. Dare I say it
but will also help prepare for the next pandemic, but let’s
hope that is no time soon.
If you have read other
articles about the impact on the future of healthcare, there
are common aspects that appear; improving access to care,
advances in telehealth, domestic supply chain, and insurance
ties to employment. Here is my perspective on some similar
issues but also reflecting on other aspects that will be
positive for healthcare.
Along with improving or
enhancing the access to care, given the level of
restrictions that have impeded our means to go to the
hospital or see a physician, the ability to still provide at
least a level of care to patients, demonstrated where the
advances in telemedicine have become of incredible
importance. There is a reason that Google and Amazon
Healthcare have emerged. The means for providing such a care
model with the innovative technology being developed has
been done at such a fast pace but also to be more
accessible. In a recent article in STAT 1, Chris Jennings,
policy consultant and former health care adviser to the
Obama and Clinton administrations stated; “There’s the
assumption in primary care that you always had to have
in-person contact, and that telemedicine would be
unsatisfactory, or wouldn’t fill the void. That’s been
exposed — actually, it’s safer, it’s quicker, and it’s
easier…… People are now seeing this model, which we thought
would take years and years to develop. And it’s probably
been accelerated by a decade.” What was once a threat to
hospitals and providers is now an opportunity, as it has
been demonstrated in managing their way through the COVID-19
pandemic and has been proven to be remarkably effective. You
will see more hospitals investing in this technology to
further enhance what they can do by way of telehealth.
Not only have we experienced the increased demand on our
hospitals and providers, we have also been at their mercy.
At or exceeding capacity in the critical care units, limits
of available equipment and supplies, and taking care of the
clinicians and others directly caring for patients. The
billboards and ads thanking our healthcare workers has been
astounding, and very well deserved. With such reliance on
our healthcare system, we will see more in the way to
support the healthcare delivery system. This could come
through changes in reimbursement models, federal funding
changes, and further incentive through value-based
purchasing. Our healthcare system has been our savior but
has also suffered significantly as we manage all that we can
to handle the incredible demand.
The crippling of so
many industries and companies, the ripple effect of one
thing to another, wrecking the economy and affecting so many
individuals, has been nothing anyone ever imagined. Bringing
politics into this mess, we can all share in the debate of
the where we have succeeded or faltered. What has been
amazing is how we have moved mountains to reduce regulatory
burden and bureaucracy. Hospitals being provided waivers and
reduced regulatory burden so they can put their resources
and attention in managing the influx of patients. We have
seen that we need to refine the process to enable a means to
expedite approving testing methods or development of new
pharmaceutical medications. We have hundreds of studies
currently under way working to get a vaccine for COVID-19
available. It is not uncommon for the stages of development
for a vaccine to take as long as 10 years or more. While not
likely, but now conceivable, we could see a vaccine for
COVID-19 from development to FDA approval being done within
a year.
Whether a vaccine comes from the US or
abroad doesn’t matter given the circumstances we find
ourselves, but we know that we need to have more reliance on
US made products. This is not a reflection of stating that
products developed abroad are always inferior, but rather
being able to get products developed and delivered quickly
becomes more challenging when international trade issues are
impeding what we need, to care for our citizens. As we saw a
shortage of equipment for so many in need, very similar to
World War II where we had plants converting to create
military equipment to support our armed forces, we saw
companies like Ford that changed the assembly lines to
produce ventilators instead of cars, numerous companies
making masks and other PPE to get these to our providers.
The healthcare supply chain is very critical and some
perished as a result of not being able to get equipment and
supplies that were essential to have in place.
“Change is inevitable, and the disruption it causes often
brings both inconvenience and opportunity.” - Robert
Scoble.
We have suffered a great deal and the number
of deaths associated with this virus have been
extraordinary. For those of us fortunate enough to have
survived or stayed clear of this virus, we have dealt with
disruption and inconvenience. With the shutdown of States,
new restrictions in place and now a resurgence of this
virus, it is imperative we change, or we will suffer even
more. It is important to take advantage of what we have
learned providing for the opportunity for positive change to
occur!
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(c) 2020, MCOL, Inc. All Rights Reserved. No redistribution allowed.
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