Throughout this prolonged COVID-19 pandemic, healthcare leaders have been confronted with more systemic changes and challenges over a period of months than most had seen throughout their entire careers—all with little clear guidance, rampant misinformation and partisan squabbling, and no “playbook” to guide decision-making.
Specifically, leaders of the U.S. healthcare industry faced three daunting challenges: first, respond, adapt and transform quickly and as a team in response to previously unimaginable new and unique challenges at every phase; next, address the crippling secondary financial crisis brought on by the mandated shutdowns in many states, the slow restart of elective and non-urgent healthcare services, and changes in consumer behavior; and third, help to lead the national movement to achieve herd immunity and end this pandemic through vaccination of healthcare workers and the larger community.
These challenges laid bare the fundamental shortfalls in how traditional healthcare is financed and delivered, and the devastating impact these shortfalls have on patients, payers/employers, physicians, public health, and the healthcare industry itself. These long-standing shortfalls include overwhelming healthcare cost burdens, glaring racial and socio-economic health disparities, lack of patient access to and affiliation with primary-care physicians, inadequate management of chronic diseases and, insufficient behavioral health resources.
The pandemic has taught us important lessons that ultimately have the power to accelerate our collective ability to better serve our patients and our communities, to be better prepared for the next pandemic, and to reduce the cost of care through innovative payment models.
For example, the pandemic prompted new payer practices supportive of safer, lower-cost care delivery innovations. It catalyzed the use of technology to deliver safer care to patients in their home. Prior to COVID-19, virtual health services were underutilized and underwhelming for most patients largely because of payment barriers. The shutdown exposed millions of Americans to the convenience and effectiveness of “virtual-touch,” high-quality, on-demand care.
Additionally, employers (including health systems) have been hit hard by the impact of the pandemic on their businesses and the financial, physical, emotional, and social well-being of their employees. The pandemic reaffirmed for employers that one of the best ways to reduce costs is to help keep employees healthy, especially those with chronic diseases.
The pandemic also informed the future role of health systems, reinforcing that in order to thrive and best serve our communities, health system leaders must reinvent care and financing models and evolve their cultures to truly deliver on the Triple Aim of better care, better health and better value. The organizations—like TriHealth—that embraced this transformation years ago, were better positioned and performed more effectively on every level throughout the pandemic and beyond. Those without this value-based infrastructure and culture were often victims to the pandemic.
This environment has required health systems leaders to not only lead and embrace disruption, but to serve as trailblazers, shuttering failed fee-for-service financing and care delivery models. Some of us have been calling for change for quite some time, and, if there is to be any silver lining in this tragic pandemic, let it be a catalyst for leaders to propel our industry where it must go in order to get healthcare right for the communities we serve.
At TriHealth, we have adjusted our short-term and long-term strategies in light of the new post-pandemic normal ahead, based upon a number of important insights and key conclusions. One, the pandemic and lingering consumer fears will likely accelerate the shift in site of service from traditional acute-care and emergency department settings to ambulatory, post-acute and virtual care environments. Two, sustained higher levels of unemployment and labor market disruption will contribute to an increase in under-insured and uninsured Americans, putting more cost pressure on the industry to find greater operational efficiencies. This will also drive a higher need for price transparency, especially for out-of-pocket expenses. Three, the economic toll of the pandemic on businesses and state and federal governments will intensify adoption of health plans that lower cost and support improved beneficiary health, with even greater provider accountability and “risk” for delivering on the Triple Aim.
The efficiency and effectiveness of virtual care, combined with expanded permanent reimbursement and greater consumer adoption, will foster continued digital health innovation and integration within the care delivery model. Site of care shifts from higher-margin acute-care settings to less lucrative ambulatory settings will likely impose continued economic challenges on providers and intensify competition on the part of both traditional providers and disrupters, leading to continued consolidation in the marketplace. And sustained high stress and burnout brought on by COVID-19 will likely result in a continued healthcare workforce exodus and labor shortages, further escalating pay and intense competition for healthcare talent.
Healthcare leaders must come to grips with our new reality—there is no returning to the pre-pandemic “normal” for health systems. Throughout the pandemic, hospitals and health systems were forced to do things differently based on what was best for patients and the communities we serve—and these practices should be sustained and supported by payers. Operating in a world of greater uncertainty and increased accountability for delivering on the Triple Aim and the health of the communities we serve is simply the “new norm” for health systems. COVID-19 has taught us it should be!