Coronavirus has overwhelmed hospitals, staff, and supply chains, stripped many Americans of health care coverage along with their jobs, and affected billions of people worldwide with mounting fatalities.
Despite its massive human toll, the pandemic offers the promise of a much-improved health care system for the future. Our response to this tragedy paves the way for integrated, value-based health care systems in which patients receive the care they need without exhausting resources; doctors practice medicine without borders via telemedicine; hospitals function without walls; and supply chains are redundant and function more reliably.
By stressing known weaknesses in the United States’ health care system, the pandemic has forced health care and government leaders to make immediate changes that have spread best practices and promise long-term benefits.
Alleviating cost concerns for both patients and providers
In the U.S., already with the highest cost of care per capita, this pandemic has only exacerbated the cost divide such that, according to a recent poll, 1 in 7 Americans would not seek treatment because they fear they cannot afford it. Patients aren’t alone in suffering the economic impact. Physician groups whose revenues come from traditional private insurance — which pays a fee for each service after it is provided – experienced sharp drops in revenue as shelter-in-place orders halted office visits. Many primary care doctors subsequently urged the government and private health plans to advance monthly payments on their usual billings to bridge revenue gaps, and Medicare started offering the option to its providers.
Some physician practices have called for advance payments to continue beyond the crisis. Such moves could accelerate a shift from traditional fee-for-service models to integrated, value-based care, which can include a monthly payment per member with a mechanism to reward better health outcomes. Should this shift succeed, it could reduce the overall cost of U.S. health care. It would also better position the country to survive this and future public health crises because integrated, value-based systems encourage providers and payers to work together to scale innovations that lower costs and improve health outcomes. Such innovations have included developing and investing in population health data systems that can be used to track patients at high risk for contracting emerging diseases.
Doctors without state borders
Similarly, telehealth originally was a value-based solution to provide care by phone or video to patients living in remote areas, and that quickly spread to urban areas. During the pandemic, telehealth allows physicians to transcend shelter-in-place orders and physical distancing boundaries to care for patients, who have embraced it. In recent weeks, telehealth visits have increased as much as fourfold in some health systems as patients turn to video and phone visits for conditions ranging from skin rashes to COVID-19 symptoms. To support and augment the physician workforce in a state, during the pandemic, many state governments issued emergency licenses and relaxed existing requirements, allowing qualified physicians to practice medicine virtually and in-person across state borders. Telehealth also turned home health care into a new front in the fight against COVID-19, freeing surge hospital capacity by enabling some patients to receive acute, hospital-level care at home. To augment hospital capacity for critical coronavirus patients, while giving uninfected patients the care they need, the Centers for Medicare & Medicaid Services in March released its waiver, “Hospitals without Walls.” The waiver allows hospitals to bill for services to patients who meet certain criteria and can be cared for in offsite facilities, including hotels or community facilities, by a virtual physician 24/7.
The shift to providing care offsite, or in such alternative venues of care, in the post-COVID era likely will accelerate a decade-long trend of declines in hospital utilization. Advances in anesthesia and minimally invasive and robotic surgery minimize the risk of morbidity and mortality, reduce recovery times, and shift procedures and care into outpatient settings. For example, most ophthalmologic surgeries now occur in ambulatory settings.
Future inpatient acute care will move in two directions: consolidation and specialization, in which hospitals care for sicker patients; and a shift of short-term acute care to less specialized settings closer to or where patients live, e.g., in their homes. In both or either, centralized hubs with virtualist physicians and clinicians monitor and provide virtual care throughout the system. This acute care ecosystem will be enabled by highly adaptable workforce of caregivers without borders, robust supply chain, technology, and agile federal and state regulations – all of which must work to ensure safe, high-quality, affordable health care services.
Building resilient supply chains and more
The global need and utilization of testing supplies, ventilators, pharmaceuticals, and personal protective equipment in this pandemic has highlighted critical flaws in the U.S. and global supply chains. For example, many supplies – N95s, gloves, swabs, testing reagents, to name a few– came from a single source, often located in hotspots including Wuhan, China, and Northern Italy. In the future, the U.S. health care system needs more supply chain redundancy and stable stockpiles. We need systems and processes for flawless delivery of equipment and services where and when they are needed.
Improving supply chains, leveraging telehealth, and creating more efficient and effective acute care ecosystems are among the many lessons of the COVID-19 pandemic. Now is the time to turn those lessons into action and re-imagine, re-engineer, and rebuild our health care system to deliver safe, effective, and high-quality affordable care for our patients and communities. We must not waste the opportunity this crisis presents.
Imelda Dacones is an internal medicine physician and can be reached on Twitter @ImeldaDaconesMD.
Image credit: Shutterstock.com
