The coronavirus has truly upended U.S. healthcare. However, some healthcare providers, like Geisinger Health System, quickly activated emergency response plans and canceled all non-urgent procedures and clinic visits. Such healthcare systems also shifted the non-clinical workforce to work from home and saw that virtual communication with patients exploded. Because of the pandemic and the emergency created with an influx of an unexpected number of patients, healthcare systems dealt with shortages of personal protective equipment (PPE) and important medical equipment for the first time.
All healthcare systems have and continue to experience negative financial impacts from the coronavirus that will total to hundreds of millions of dollars. Just as healthcare systems adapt to their new reality, WHO is predicting Covid-19’s second wave in the near future.
Many aspects of how U.S. healthcare has previously worked including fee-for-service business model – were exactly the elements that left the healthcare systems vulnerable to the crippling impact of the pandemic. It is difficult for healthcare systems to get back to business as usual so they need to instead focus on creating a new normal post-pandemic. Creating the new reality means speeding up the positive transformation that is underway towards value based care, and determining which of the activities healthcare systems have stopped and should not resume.
Now is an excellent time to mobilize your team in order to boldly transform the healthcare systems for the better from learned experience in ways that previously were not possible. Healthcare systems need to take this opportunity to fix what has not worked and direct full attention to new and better goals that are centered on delivering better outcomes and creating true value for patients.
How Can Healthcare Systems Create Better Value for Patients?
Many healthcare systems are directing their focus on mitigating the impact of the coronavirus on their staff, business, and patients. Some are also paying attention to what comes next – like Geisinger – while some have formally initiated post-crisis planning just days into the pandemic by organizing a group of leaders from all parts of the organization. It is important to realize that this critical task should be viewed and executed as a strategic and operational innovation initiative, not as some damage mitigation exercise – or for the sake of restoring revenues.
Healthcare systems can create a steering group for this initiative that defines core areas of business such as HR, finance, IT, clinical enterprise, the health insurance representatives, pharmacy, and others. Workgroups can be created across each of these that are tasked with defining new approaches. Each workgroup can include leaders from outside of the workgroups’ focus. This is vital because some activities may have to be stopped to develop transformation but may be resisted by those closest to them. Outsiders can bring a neutral perspective in the discussion.
This framework presents 4 stages in the transformation.
- Resuming non-urgent work
- Beginning of the New Normal
- Post-crisis Activity and preparing for the second wave of Covid-19
- Operational and economic recovery in a transformed system
Members of the group will have to carefully consider the impact at each stage on patients and front line employees by focusing on their needs and what changes for them, and what will make them feel safe. Each activity in these different functions can be categorized as work to ‘start’, ‘continue’ or ‘stop’. The groups will have to use a scenario planning approach for the work as it cannot be assumed that the future will look like the world we knew before Covid-19. When planning exercises, the groups develop plausible scenarios (e.g., higher reimbursement for telehealth visits) and determine the impact on patient care and the business. This way, the groups can establish common assumptions about the ‘new normal’ and how the healthcare system/organization should respond.
Stage 1: Resuming Non-Urgent Work
Most healthcare organizations are resuming their systems. Stages 2 to 4 where innovation and transformation are crucial are the main focus of this blog. In each stage, we will discuss a few examples of the scores of topics that each of the workgroups can tackle on the road to transformation.
Of course, the patients’ and employees’ safety comes first and has been the center of attention during the crisis for most healthcare organizations. It will continue to be so when they will resume non-urgent clinical work. Covid-19 testing is crucial in preventing transmission and healthcare organizations need to validate and continue to perform in-house testing. Contact tracing is also important for containing any epidemic around the country. While this task has traditionally been given to the local and state health departments, many of those resources were spread thin during the national emergency.
Healthcare systems with resources should support the public health departments’ contact tracing as a public-private partnership. Did you know that the U.S. is falling short of the estimated 300,000 contact tracers needed? Many hospitals have the expertise to manage testing, communicating the results, and treating those who test positive. If these capabilities can include contact tracing, it would be a natural extension for many systems. It will definitely contribute to the public good and will also help reduce their own Covid-19 caseloads. Healthcare organizations that begin to perform this will also find the experience valuable if and when the second wave of Covid-19 hits. Contact testing will benefit providers, patients, and communities.
Telehealth Solutions Like Hucu Can Reduce Operational Cost for Healthcare Organizations
Stage 2: Beginning of the New Normal
During the pandemic, healthcare organizations have seen an acceleration of strategies that were previously slow to get acceptance. For example, before the coronavirus, healthcare had 50-80 telehealth visits per day. Many constraints like patient and provider reluctance and reimbursement issues in hospitals prevented the wide adoption of telehealth. However, because of the crisis now, hospitals are seeing almost 4000-5000 telehealth visits daily, half of which are video visits). Most private and government health coverage plans are now reimbursing telehealth visits at the same rate as in-person visits apart from waiving co-payments associated with these visits. What really helped in the increased adoption of telehealth visits? It is the change in the patients’ perception from ‘this provider does not think my problem is important so they are scheduling a telehealth visit for me” to “this provider cares for my safety and therefore, is seeing me via telehealth”.
Many healthcare providers saw the benefits of telehealth visits including that patients who have chronic conditions can now avoid coming to hospitals. Also, providers have a valuable view of patients’ home environments which can provide insight related to their conditions. Healthcare organizations need to plan and build this momentum and continue to expand the use of telehealth and all forms of virtual encounters even after the pandemic ends.
Telehealth solutions like Hucu are a great example of how communication and operations can be sorted out smoothly around patients, doctors, and staff of a healthcare organization. Hucu is a HIPAA compliant text messaging application that offers a platform to patients, doctors, staff, and families to stay connected remotely in a very systematic way. Doctors can check in on their patients virtually and also communicate about the patient with the care team in separate channels. The care team provides real-time updates to families of nursing home residents through Hucu. The healthcare organization can use Hucu to create operational plans following an emergency in minutes via groups. Hucu eliminates the traditional task of contacting individuals and relaying important information every time. Hucu is a complete communication solution that can save staff time up to 50%, increase work efficiency, and reduce costs for the hospitals.
Another program that can empower healthcare organizations to remotely promote and maintain patients’ health is a pharmacy organization. Organizations need to launch mail-order pharmacy which can benefit the patients. Healthcare organizations can deliver prescriptions to patients in a more efficient way and save costs. When these are passed along to the patients, they will be keener to adhere to their medication regimens. Patients can save money and avoid travel, and physical contact which can protect them and others from the spread of the virus. This will also help in wave 2 of Covid-19.
Stage 3: Post-Crisis Activity And Preparing For The Second Wave Of Covid-19
Some of the critical changes that healthcare systems have made in response to the coronavirus are likely to stay with them. For example, many allowed a great chunk of their workforce to work from home. The benefits of this shift included increased employee safety and access to an expanded talent pool since work from home employees can live and work from literally anywhere around the world. As long as the staff can effectively work from a remote location after the pandemic, healthcare organizations can anticipate potential cost savings from the elimination of leases, sale of real estate, and conversion of current administrative space to clinical space. Perhaps the healthcare organizations can work out a WFH model in which part of the workforce can WFH completely which a part can work in hybrid WFH and office-based roles.
A large part of the clinical activity will likely continue as telehealth, so healthcare organizations will have to revise a facility plan for the years ahead. Healthcare systems that had success with WFH during the pandemic can determine what proportion of their workforce could WFH permanently. This will result in decreased operational costs too.
Stage 4: Operational And Economic Recovery In A Transformed System
The fee-for-service business model of the U.S, designed with misaligned incentives that stunted care innovation before Covid-19, was destined to fail under pressure and it did. Covid-19 compounded the already present shortcomings of such an approach – particularly its reliance on maximizing elective procedures and volume in general. The crisis necessitated the quick acceleration of virtual care and care at home as hospital systems and patients deliberately reduced inpatient hospital admissions and avoided ER utilization. Virtual care and home care can reduce costs and improve patient engagement. However, these same efforts also lead to significant reductions in revenue under the present fee-for-service reimbursement scheme in healthcare.
Consequential payment reform should create funding systems that make prevention and population health – rather than maximizing reimbursement – the true focus of patient care. This will need a significant financial incentive to create alignment between value (better health outcomes at lower cost) and reimbursement. Such incentives have to be sufficient to encourage investments needed to transform the care delivery model in the healthcare industry.
Such a model will lead to improved quality of healthcare and reduce costs as more patients will get the right care in the appropriate settings. Without such a shift, U.S. healthcare systems will continue to suffer from the effects of prioritizing volume over value and will be financially exposed and vulnerable in the upcoming second wave of the pandemic just like they were in the first one.
What We Conclude
Covid-19 has caused morbidity, health complications, and devastating economic burden. It has placed a lot of strain on a national healthcare system.
There is a need to leverage the lessons learned throughout this pandemic to transform the way healthcare organizations care for patients. There is a need for private and public payers to work with healthcare systems to continue implementation of value-based care models.
If healthcare organizations can transform the care delivery and payment systems in ways that will improve healthcare for patients, providers, and communities then we would have found the silver lining of Covid-19.
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