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The Covid-19 pandemic has tested society as a whole and made an undeniable impact on healthcare across all care settings, while at the same time illuminating ways the industry must improve moving forward. The strain the virus has placed on care delivery serves as an opportunity for both reflection and growth, as we look to advance our public health infrastructure.
Lessons Learned from Covid-19
Regarding advance care planning, Covid-19 provided everyone with a rare example of why it is so vital to communicate end-of-life wishes in a clear and easily accessible way. It also exposed the greater need for providers to proactively engage in these discussions with patients and their loved ones as a critical component to achieving patient-centric value-based care.
The pandemic has also highlighted the importance and the shortage of palliative care providers in the U.S. With the sudden surge of patients overwhelming EDs, some hospitals have responded by embedding palliative care physicians in the ED, leveraging their expertise in conducting goals-of-care conversations to provide their patients with increased access to goal-concordant care. Some have leveraged additional palliative care support through telehealth, as their onsite clinicians found themselves unable to keep up with demand. Palliative care will continue to be in high demand during the pandemic and beyond, and there will need to be a strong effort to drive more providers into the field.
Despite the ongoing shift to value-based care, health systems still rely heavily on procedures, imaging and infusions to drive substantial portions of their top-line revenue, and Covid-19 has opened the industry’s eyes to the fragility of these revenue streams. Hopefully, this realization leads to further engagement in value-based initiatives – at minimum as a way to hedge against future disruptions of fee-for-service revenue, but ultimately because these reimbursement models have the opportunity to deliver higher quality care at lower costs. Even aside from pandemics, there are always threats to an organization’s fee-for-service revenue that present risks, such as competition in the market, losing a physician specialty group and more.
Covid-19 has also exposed weaknesses in the healthcare supply chain. Exhibiting typical healthcare exceptionalism (which plagues the industry), some health system executives placed the blame on the concept of just-in-time supply chain simply not working for healthcare. The reality is that just-in-time supply chains can work during “black swan” events. However, they require planning and investment in supply chain infrastructure, and Covid-19 exposed some of these deficiencies.
Additionally, the pandemic has highlighted the importance of ongoing investment in public health. As a medical student, I worked in Toronto, a SARS hot spot, and now, less than 20 years later, we have a pandemic of far greater magnitude. From a pandemic readiness perspective, there is more we could have done through proactive and ongoing investments in public health over the last several decades. We need to prioritize preparedness within our connected global community, so we can effectively respond to future pandemics and other public health emergencies.
The Road Ahead
As we look to a post-vaccine world, some changes are expected to have permanent implications on care delivery, while others will likely prove to be more fleeting. Engagement with digital technologies and virtual/remote models of care have been accelerated because of Covid-19. The pre-pandemic barriers to adoption were related to payment/reimbursement, not the state of the technology. At the beginning of the pandemic, many people thought long-term reimbursement of these technologies and services was an inevitable outcome. While this is true, the actual reimbursement landscape is going to be more nuanced than that. For example, some healthcare facilities are no longer able to receive a facility fee when delivering services by telemedicine. For health systems that have invested heavily in brick-and-mortar infrastructure as part of an expansion strategy, this is a real problem. However, it opens the doors for true disruption in the space with new ways of delivering care – just not necessarily by traditional healthcare models.
The pandemic has also forced a lot of crossover in how and where we deliver healthcare. For example, many non-traditional organizations, from cosmetic surgery providers to dentists, were offering self-pay Covid-19 tests. There have been some interesting dynamics over the last few years that suggest this could be a catalyst for bigger trends such as clinics popping up in retail pharmacies, for instance, and Covid-19 may accelerate many of these changes that were already coming down the pipe.
Beyond Covid-19, consumerism in healthcare will only continue to grow in importance. As healthcare costs rise, and more of these expenses are borne by the consumer, expectations of exceptional customer experiences, cost transparency and choice are going to increase as well. Streamlined advance care planning enables health systems to provide an exceptional customer experience for individuals with serious illness navigating a most difficult time of life. It provides an opportunity to provide goal-concordant care while increasing both patient and family satisfaction.
The pandemic has forced the healthcare industry to take stock of what is working and where care must progress to the benefit of both providers and individuals. Insights brought to the forefront by the pandemic serve as essential building blocks for a better future for all.
Photo: Nuthawut Somsuk, Getty Images
