How COVID-19 Is Changing the Future of Healthcare

The COVID-19 pandemic has impacted every sector of public life, with some of the most significant and perhaps long-reaching effects surfacing within the healthcare industry. During the early months of the outbreak, the rapid spread of the virus left health industry leaders scrambling to find effective ways to address the crisis, as unprecedented demands for care overwhelmed emergency rooms and hospitals across the nation. And, as the crisis drags on, it seems increasingly clear there will be no return to business as usual when it comes to traditional healthcare models. Experts say the industry is in a state of flux, and many predict ongoing challenges and financial pressures.

“It’s an emphasis on the haves and have-nots of healthcare providers,” said Justin Gernot, vice president at healthcare advisory firm Healthbox. Gernot outlined a number of issues during a virtual media event on the impact of the pandemic on the future of healthcare that was sponsored by the Healthcare Information and Management Systems Society. “The organizations that had a tight digital strategy, that were good at telehealth, had money in the bank, by and large, those healthcare systems, unless they are in hard-hit areas, those systems will do well and emerge with an eye toward acquisitions and advancing the position of strength they have,” he said. “The smaller, rural, less financially healthy systems will come out of this crisis in a bad way.” Gernot went on to say that COVID-19 also led to myriad financial pressures for hospitals: “There are a lot of cracks in the system that have been exposed, from supply chain for personal protective equipment (PPE) to how underserved populations are more exposed and much more at risk for COVID than others.”¹

In fact, the COVID-19 pandemic surfaced critical flaws in hospital supply chains for vital equipment like PPE. Many health systems struggled with shortages and often competed with one another for necessary supplies.² In addition (at the time of this writing), hospitals across the country are bracing themselves for a potential second wave of the virus, with the potential to put even more strain on limited supplies and financial resources. 

Turning an Eye Toward Supply Chain Optimization

As hospitals have struggled to maintain proper levels of PPE, ventilators and medications, hospital leaders have shifted their priorities toward supply chain optimization. A survey of 138 hospital leaders³ found supply chain optimization has become hospital leaders’ second-highest priority, right behind patient safety. The survey also found supply chain analytics ranked second out of nine technologies that hospital leaders said has increased in importance. 

Because the coronavirus that causes COVID-19 is spread primarily through droplets in the air, PPE is critical to protect medical staff and other patients from contracting the respiratory disease. As medical facilities all over the world required more PPE, equipment vendors were pushed well beyond their normal capacity. The sudden and unexpected demand forced hospitals to look at the sources for their equipment supply; many took for granted that products manufactured overseas would always be available. 

While it is not possible to control external factors that affect the healthcare supply chain (such as one caused by a global pandemic), what hospitals can do is instigate changes now to ensure they are more prepared for future disruptions. Experts suggest some key areas to focus on include: 

• Updating and automating current systems. Healthcare significantly lags behind other industries when it comes to supply chain management technologies. To close the gap, transitioning to automated processes will make it easier for hospitals to track and analyze data efficiently. This includes data related to inventory, which will enable faster responses to shortages and more informed use of limited resources.

• Investing in demand forecasting technology. Supply chain management technology is available that can help hospitals plan for, better manage and more quickly recover from supply chain disruptions. For example, incident and peak demand forecasting tools can support inventory planning and management during disruption periods and during periods of normalcy.

• Prioritizing contingency plans with increased scope and duration. COVID-19 was novel in many ways, including illustrating that hospitals must have stronger contingency plans in place. Sourcing plans for secondary and tertiary resources should be included in these plans, and hospitals should consider forming coalitions with other organizations to enhance resource-sharing when necessary and possible.

The Rapid Rise of Telemedicine

COVID-19 and the subsequent and immediate need for social distancing quickly put the spotlight on digital health tools like telehealth and remote monitoring as healthcare providers pivoted to technology-led patient care. Almost overnight, digital health platforms went from being an interesting idea to a fundamental necessity. According to the Centers for Disease Control and Prevention (CDC), while telehealth technology and its uses are not new, widespread adoption among healthcare providers and patients beyond simple telephone correspondence had been relatively slow — until 2020.⁴ In this rapidly evolving landscape, even professional medical societies now endorse telehealth services and provide guidance for medical practices. 

CDC outlines several telehealth modalities that are currently being successfully implemented:⁵

• Synchronous: This model includes real-time telephone or live audio-video interaction typically with a patient using a smartphone, tablet or computer. In some cases, peripheral medical equipment (e.g., digital stethoscopes, otoscopes, ultrasounds) can be used by a nurse or medical assistant who is physically with the patient, while the consulting medical provider conducts a remote evaluation.

• Asynchronous: A “store and forward” technology where messages, images or data are collected at one point in time and interpreted or responded to later. Patient portals can facilitate this type of communication between provider and patient through secure messaging.

• Remote patient monitoring: This allows direct transmission of a patient’s clinical measurements from a distance to their healthcare provider. The transmission may or may not be in real time.

In addition to supporting social distancing guidelines, telehealth services can reduce the strain on healthcare systems by minimizing patient demand on facilities, and reduce the use of PPE by healthcare providers, putting less pressure on the supply chain.

COVID-19 and Behavioral Health

From isolation and economic setbacks to the very real fear of contracting the coronavirus, the pandemic fallout has negatively affected many people’s mental health and created new complications for people already suffering from mental illness and substance use disorders. 

A poll conducted by the Kaiser Family Foundation (KFF) found nearly half (45 percent) of adults in the United States reported their mental health has deteriorated due to worry and stress over the virus.⁶ As the pandemic wears on, it’s likely the mental health burden will increase as measures taken to slow the spread of the virus such as social distancing, business and school closures, and shelter-in-place orders lead to greater isolation and potential financial distress. Though necessary to prevent loss of life due to COVID-19, these public health measures expose many people to experiencing situations linked to poor mental health outcomes. 

Although recognition that behavioral health is a crucial component of whole-person care and positive health outcomes, it remains underfunded and inaccessible for many. Many mental health experts are concerned the country is on the verge of another healthcare crisis as isolation, fear and desperation around financial concerns generate widespread psychological trauma.

Yet, allocation of resources for mental health comprises only a small portion of the trillions of dollars Congress passed in emergency coronavirus funding was aimed at mental health support. Therapists have struggled to bring their practices online and to reach vulnerable groups because of restrictions on licensing and reimbursement. Community behavioral health centers treating some of the most vulnerable populations are struggling to stay financially solvent and have begun closing programs.

Assessing the Advantages of Value-Based Care

As the coronavirus crisis continues to reshape healthcare delivery, advocates, payers and providers are grappling with how best to navigate dramatic shifts in the system.

In a joint webinar, experts from the University of Michigan’s Center for Value-Based Insurance Design (V-BID) and the Smarter Health Care Coalition outlined challenges providers face amid the pandemic and the benefits of increased access to high-value care during the outbreak and beyond.⁷

The webinar pointed out that in early April, visits to ambulatory practices fell nearly 60 percent below the pre-COVID-19 baseline before rebounding in mid-June. However, rates plateaued at around 10 percent below baseline from then through the end of July, according to data presented by Michael Chernew, PhD, a founding partner of V-BID Health and co-editor-in-chief of the American Journal of Managed Care (AJMC).

In addition, rebounds in visitation rates in June and July varied by specialty. In areas such as pulmonology, orthopedics and neurology, for example, the drop remained very significant, with the potential for resulting in clinical ramifications. “I’m not sure we have yet sorted out what those clinical ramifications are, and I think there’s going to be … a lot of interest in understanding what we’re losing in terms of health when all these visits went down,” Dr. Chernew explained.⁷

And, despite the large uptick in hospital admissions for COVID-19 patients, data show these visits did not make up for the loss of routine procedures and other visits postponed or cancelled due to the pandemic. COVID-19 admissions also skew toward those with Medicare coverage, which results in lower payment rates for hospitals compared with commercially insured patients. Meanwhile, hospitals face increased costs due to reconfigurations of floors, excess need for PPE and staffing shortages.

In total, Dr. Chernew predicts total healthcare spending will be about 5 percent below where it otherwise would have been in 2020. Due to a large national deficit and a looming recession, employers may also reduce their generosity when it comes to providing coverage. And although insurers are spending less money, not all of those funds will be refunded to customers and most will likely go back to employers. Insurers could also face increased costs in the future as new treatments and tests for COVID-19 are developed.

Looking to create a more efficient healthcare system in the wake of COVID-19, Mark Fendrick, MD, director of V-BID and co-editor-in-chief of AJMC, explained the importance of reallocating money already within the healthcare system. “There are more clinically nuanced ways of coming out of the COVID-19 pandemic,” he said. To transform the pandemic into a potential path to improve healthcare efficiency, he recommended the following strategies:⁷

• Build on existing alternative payment models that base reimbursement on patient-centered outcomes, increase reimbursement for high-value services and reduce or cease payment for known low-value care.

• Leverage the widespread adoption of electronic health records to make it easier to order high-value care with simplified processes and discourage the use of low-value care with alerts.

• Align patient cost-sharing with the value of the underlying services, reduce out-of-pocket cost on high-value services and increase patient cost on low-value care.

The concept has received bipartisan support over the years, noted Katy Spangler, co-director of the Smarter Health Care Coalition, who also spoke during the webinar. For example, in March 2020, Internal Revenue Service notice 2020-15 was published, which allows health savings account-eligible high-deductible health plans to provide predeductible coverage of “medical care services and items purchased related to testing for and treatment of COVID-19.” In addition, both the Families First Coronavirus Response Act and the Coronavirus Aid, Relief and Economic Security Act have encouraged high-value care during the pandemic.

A Catalyst for Change

The coronavirus introduced significant scientific, clinical and financial challenges that will permanently change the healthcare industry and the way we live our lives. Without question, how we manage our physical and mental health and obtain healthcare services have to evolve to become increasingly innovative and efficient going forward. 

While COVID-19 has created unprecedented social and economic challenges, it also has provided a unique catalyst for meaningful change. Access to more complete, timely and accurate healthcare information, collaborating across boundaries and using advanced predictive models are keys to addressing the challenges presented by a global pandemic. They are also foundational for improving outcomes, enhancing patient experiences and reducing the cost of care.