Defining the New Normal for Post-Pandemic Healthcare in America
Before the coronavirus pandemic took hold across the planet in March 2020, America’s healthcare industry faced a range of uphill battles including an aging population, ballooning costs, increasing demand for care, and more.
The public health crisis highlighted and intensified the industry’s shortcomings.
But the silver lining may well be the contagion’s ability to catalyze necessary transformation and accelerate progress.
“As bad as the pandemic is, could we end up doing better work when it’s over?” asked Marc Harrison, president and CEO of Salt Lake City–based Intermountain Healthcare, in a recent Harvard Business Review report. “Can [COVID-19] teach us anything about how to serve our patients better and more affordably than we did before?”
A collection of learnings emerged as executives, consultants, and providers weighed in and experienced the evolutions of this past year. But patients are at the forefront of this revolution, and their needs and preferences are pushing improvements in philosophies, products, services, and mechanisms to serve them, compelling a transition to patient-centric care across geographies and socio-economic groups.
Total up the economic impacts of the pandemic—a sputtering economy, joblessness, benefits, and bottom-line cuts—to a model that was already unsustainable cost-wise, and both providers and patients are up against an affordability nightmare.
“So how can the tension between humanity’s basic moral impulse to avoid needless pain and suffering and its finite economic resources be resolved?” Binkley and Levy ask. “Where do ethics and economics find a common ground on this matter?”
Last year alone, inpatient COVID-19 hospitalizations were projected to cost the U.S. healthcare system between $9.6 billion and $16.9 billion, according to health consultant Avalere. Commercial payers are expected to bear the brunt of those billions.
But the true scope of the toll doesn’t just fall on patients. The system is suffering as well, especially as the pandemic’s grip was at its tightest.
“The pandemic left many physicians underemployed during much of [last] summer,” says Dr. David Graham, infectious disease doctor and author of “From Killer to Common Cold: Herd Protection and the Transitional Phase of COVID-19.” “Hospitals, operating rooms, emergency departments, clinics … often it felt like a sad spring break year-round, and someone forgot to turn out the lights when they left.”
The debate over healthcare reform before the Affordable Care Act passed in 2010 concentrated on the expansion of insurance coverage and how providers ought to be paid.
“Incentives matter in healthcare,” Graham says. “The incentives are not aligned to provide good care of folks … as demonstrated by the poor overall health of our nation.”
As costs have skyrocketed at an unsustainable rate, patient outcomes still differ dramatically.
According to numbers tracked by the American Action Forum, approximately 60 percent of an individual’s overall health is determined by his or her lifestyle and environment, while 30 percent is attributed to genetics.
That leaves just 10 percent due to healthcare itself.
“That means the best way to improve people’s health and the affordability of healthcare is [through] social determinants of health. They include factors like stable housing, joblessness, hunger, unsafe neighborhoods, access to transportation, etc.,” Harrison writes.
“The system is designed to fail for many segments of the population,” Graham says. “Doctors get paid to treat illness rather than promote health. Folks look to magic pills rather than lifestyle changes. We have the most unhealthy population in the world, and the worst healthcare delivery system. And [when we look at the pandemic] we wonder why so many died.”
The notion that healthcare is “sick care” exclusively for the physical body is starting to expand to include total well-being, and care providers are being encouraged to integrate this into the design of their practices.
“I’ll tell you a secret I’ve learned in 30 years as a physician,” Harrison adds. “People like health a lot more than they like healthcare. Keeping people healthy—and keeping them out of clinics and hospitals—is the best and least expensive way to improve people’s health.”
He notes that: “Preventative care is the epitome of consumer-focused priority.”
In 2000, Intermountain Healthcare started incorporating mental health services into its primary care.
“Our study of the outcomes, published in the Journal of the American Medical Association, showed better rates of mental health screening, more adherence to care protocols, and greater use of self-care plans along with improved clinical outcomes, lower rates of ER visits and hospitalizations, and lower costs.”
Diversity in Care
Harrison further recommends addressing systemic discrimination across these systems, noting that the pandemic forced providers to address disparities across racial and ethnic groups, geographies, and age brackets.
Case counts, hospitalizations, and deaths among non-white racial groups reflected poorer underlying health, housing, and job conditions.
“Those disparities are disastrous to begin with, and the novel coronavirus puts that danger in high relief: If all of us aren’t safe, none of us is safe,” Harrison said.
Some solves his organization tested include expanded hiring and governance practices so providers could better reflect the communities they serve. Connecting to patients where they live and expanding training to provide care on their terms also proved valuable.
A Care Delivery Evolution
As the pandemic unfolded, healthcare services were relocated to non-traditional venues including parks, parking lots, boats, hotels, and more.
The previous hesitancy of many providers to embrace telemedicine was largely due to restrictions on reimbursements for said services and concern that quality may be compromised.
However, the Kaiser Family Foundation found that 23 percent of enrollees in large-employer health plans used telehealth during the pandemic, compared to just 2.4 percent in 2018. Another survey, conducted by the Harris Poll says that 42 percent of Americans used telehealth at some point during pandemic.
“The number of virtual doctor’s appointments has boomed since the pandemic began,” Harrison noted.
Consumers are coming to expect their care to be available how and when they need it most, including virtual care, prescription delivery, remote monitoring, and decision support. As the pandemic moves toward our rearview mirror, it seems likely that this kind of care will only continue to be in demand.
COVID-19 showed us that U.S. healthcare can and must pivot on a dime. The challenge now is to rebuild and use this momentum to improve care delivery at lower costs and with an eye toward resiliency for future crises.