Lessons from the covid19 pandemic – part 2

Now that we have identified some of the key issues that landed us where we are, what can we do to address them going forward and not find ourselves flat footed again when the next pandemic strikes? And it inevitably will and likely much sooner than we expect – the annual flu numbers make the case that we have an epidemic on our hands every fall. Of note, here we focus primarily on recommendations that apply to the healthcare delivery system. Our views on the path forward, health status/SDOH, and preparedness will be addressed in follow up blogs.

So, here are our thoughts regarding the healthcare delivery system:

1.     Change provider reimbursement: The healthcare delivery world we live in, one of mostly fee-for-service (FFS), is characterized by caring for people and receiving reimbursement only when a patient comes to an office or hospital, and not having control over provider revenue or the flexibility to deploy resources (space, staff, supplies) in a way that creates the most value for patients. This is especially true in an emergency situation akin to the one we find ourselves in, where the delivery system needs to quickly and significantly expand capacity for a specific patient population (e.g., covid19), while continuing to provide care for those with chronic illness or acute trauma. Having the financial flexibility to leverage telemedicine or other models such as Hospital at Home or wellness care at home can go a long way in ensuring the ability to right-size capacity and give continuous patient access to needed care, without the dire financial consequences many hospitals are currently facing. Following mandates and executive orders, providers emptied their hospitals and offices for the projected covid19 patient surge that did not materialize in most places (the situation in NYC has thus far been an exception rather than the rule). Even the minority of providers that did see a covid19 surge still had significant weeks with few patients and thus a dearth of revenue. We suspect that when the crisis-induced dust settles, some of the providers that care for patients under “risk-based” arrangements (bundles, capitation, global budgets) are going to come out on top, both in patient care and financial terms.

2.     Encourage provider leadership: Healthcare professionals need to step up and take responsibility for their sector, rather than continuing to defer to Washington, DC or the state capitols on the best ways to take care of the patient populations and communities they serve. Instead of following blanket mandates and recommendations that do not fully reflect the demographics and needs of each community, providers should have created and stood by their own contingency plans based on their knowledge and experience with the community they serve. Providers should also take a more active role in the development and validation of new technology, rather than internally bristling while waiting for various federal agencies to give their green light on such endeavors.

3.     Re-evaluate the utility of regulatory requirements, starting with those relaxed by CMS during the pandemic (e.g., scope of practice laws, reimbursement for telemedicine services, some HIPAA provisions) to ensure the most effective and efficient delivery of care. The CDC and FDA could also benefit from a review of their regulatory processes and frameworks to ensure that a) they provide for more flexibility and agility by the healthcare sector to respond to emergency situations like the covid19 pandemic and b) to serve as a facilitator, rather than the bottle neck in allowing providers to deliver the best care to their patients. These government agencies do not practice medicine. Their role is to facilitate the work of those who do, by removing barriers, concentrating on logistics, and managing an effective supply chain. 

4.     Strengthen the supply chain by creating incentives for healthcare manufacturers to a) diversify their manufacturing locations and b) to move beyond “just-in-time” manufacturing, and include the continuous production of “reserve supplies” and/or create and maintain reserve manufacturing capacity that can be quickly brought online to address a sudden peak in demand for products. In fact, if we actually decided to stop being complacent about the annual flu epidemic and tried to reduce its impact on society, it might behoove us to have additional PPE and other medical reserves on hand as part of the “new normal” in healthcare delivery. 

5.     Ensure universal healthcare coverage and let people own their insurance, instead of having it be tied to their employer. Employers (that currently cover >50% of Americans) could still contribute to offset the cost of insurance premiums for their employees, but nobody would be subject to both loss of employment and a loss of healthcare coverage, especially in the midst of a pandemic and yet, that is exactly where we are. And while Congress appears to be working on an insurance fix to address covid19, we need more than a Band-Aid to address the lack of universal coverage in the country. Given the culture of the United States and in our view a need for a bipartisan solution, we feel that a coverage mechanism that builds on the successes of the Federal Employee Health Benefit program, with means-tested subsidies provided by the government, would be a great way to provide universal healthcare coverage.

4 thoughts on “Lessons from the covid19 pandemic – part 2”

  1. I would add another take home message from our current experience:

    Chronic disease prevention and management. Healthy individuals or those with well managed chronic disease are experiencing far less health ramifications from the current pandemic. Improved population health pays dividends on multiple fronts. As we deal with the current pandemic, we should emphasize the dire need to address our epidemic of chronic disease in the United States. It is one of the factors that is leading to our higher death rates compared to higher performing countries with respect to covid-19 response.

    1. We are in complete agreement. You are consistent in emphasizing the importance of tertiary prevention. Payment models that emphasize the value of tertiary prevention are essential. We will discuss these topics later in the series. Thank you!

  2. Thanks, hcblog, for these thoughts. One that deserves increased mining is “physician leadership.” Traditional national associations, build on a federation base, with lobbyists focused almost entirely on physician reimbursement, are poorly positioned to advocate for patients during normal times, let alone in crisis. The associations (and their journals) dependence on corporate dollars for advertising and CME leaves them heavily conflicted. Their sale of data to support physician prescriptive profiling helped fuel the opioid epidemic. And occasional public op-eds and letters to Congressional leadership just don’t cut it anymore. What would true physician leadership look like? How would leaders be selected? How would they serve? On what platform? How would they plan? How would they execute? How would they engender public trust and confidence? All questions worth pondering during this crisis induced pause.

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