Over 135,000 thousand deaths.[1] Between 1.4 million and 2.1 million businesses shuttered.[2] Over 40 million people laid off from their jobs.[3]
The COVID-19 pandemic has wreaked havoc across the nation and continues to hold many parts of the country hostage as efforts to reopen sputter in the face of rising infections. The virus has changed the country in many fundamental ways. Nowhere has that change been more profound that in the healthcare industry which continues to be on the front line of the most important battle of most of our lifetimes.
Here is our list of the top ten ways the COVID-19 Pandemic is changing U.S. healthcare systems.
1. Greater Acceptance of Telehealth – Everyone’s number one choice is telehealth – and for good reason. Since first arriving on the U.S. healthcare scene in 1989, telehealth has not been able to gain real traction with providers and payers. The pandemic changed that in a hurry and now all types of virtual care visits are finally having their day. Telehealth/medical visits are here to stay and have fundamentally changed the way patients’ interface with their health systems.
2. Expanded Covered Services – Once the 2020 Presidential Election is in the rearview mirror, a base level national standard for covered health services will come about because of the COVID-19 pandemic. It may not be Medicare-for-All, but perhaps it could include covered testing for all, covered vaccines for all, and covered telehealth consults for all. Some of these benefits exist today such with CVS providing flu shots at no charge and some employers providing free telehealth consults. However in our post-COVID crystal ball we see a minimum set of expanded covered services that all health plans, Medicare, and Medicaid will have to provide, much like the Affordable Care Act mandated that all health plans needed to cover pre-existing conditions.
3. More CMS Mandates – The way hotspot U.S. hospitals rapidly shifted from modest-ICU beds to almost-all-ICU beds and set up testing in parking lots has been impressive. In the future it is likely hospitals and health systems will be mandated by CMS and state governments to flex as needed in any future public health crisis as they were able to do during the COVID-19 outbreak. This is similar to how CMS mandates today that any hospital that accepts Medicare (effectively 100% of U.S. hospitals) must abide by certain regulations (e.g. not turn away patients who can’t pay).
4. More State Mandates – States will take a more proactive position with respect to “commanding” how hospitals and Health Systems share and collaborate in the future (think supply chain, bed mix, etc.). Prior to reaching the COVID-19 apex, N.Y. Governor Andrew Cuomo invoked executive authority to move resources as needed among the state’s 200+ hospitals. This will happen more broadly across more states in future crises.
5. The Bigger Get Bigger – Strong health systems are going to grow even larger as most weaker systems and standalone hospitals aren’t likely to survive this storm. Healthcare M&A activity continued unabated during the height of the pandemic. Two recent examples include: (1) Lifespan and Care New England Health Systems (Rhode Island) resumed talks of a possible partnership and (2) Advocate Aurora Health (Illinois /Wisconsin) signed a letter of intent to explore a merger with Beaumont Health (Michigan) – a transaction that could result in a $17 billion revenue system. In all, hospitals and health systems announced 14 transactions during the second quarter of 2020 and the impact of COVID-19 will likely cause this trend to accelerate.[4]
6. Increased Central Control – Health systems formed through mergers and acquisitions over the last decade have allowed some level of local control and flexibility. Those day are over. Health system corporate leaders will almost assuredly exert greater centralized control over everything going forward.
7. Increased Pressure to Reduce Variation – The after-action-reporting on the COVID-19 response by health systems is going to show wild variation in the efficacy of care provided. The responsiveness of communities, health systems, and individual clinicians has been amazing. However, when we take a deeper look back on the crisis, we will discover best practices that should have been put in place prior to the pandemic to save lives and improve outcomes. These revelations will result in more pressure on organizations to focus on incentive-driven outcomes measurement to ensure we are better prepared for future outbreaks.
8. Growth of Command Centers – Health system leaders like Johns Hopkins (MD), AdventCare (FL), and Hartford Health (CT) had physical command centers up and running in time for the COVID-19 outbreak. As the pandemic began to rage, every hospital in the US subsequently rushed to put a temporary situation center in place to deal with patient, employee, and community issues. As a result of the effectiveness of these actions, every health system in the US will likely put in place a physical command center going forward.
9. Increased Focus on the Supply Chain – Demand for- and ultimately the shortage of – personal protective equipment (PPE), testing resources, and other vital supplies exposed the U.S. hospital supply chain in all the worst ways during the COVID-19 outbreak. The strain put on the supply chain revealed intra and inter-hospital issues, state to state challenges, and dependency on unreliable sources for key materials. Fundamental change to the healthcare supply chain is coming in a big way.
10. Bringing Care to Patients – In the pre-COVID days, patients were at the mercy of health system assets. The scheduling nexus was tied to the MRI or testing site and not to the needs of the patient. The COVID-19 crisis has clearly highlighted the real costs of taking a patient to a site. During the pandemic, a CT scanner loses about two hours of productive time per COVID patient because of the need to clean and prep for the next patient. Many patients were denied the opportunity for a CT or an MRI because the risks to move someone on a ventilator were too great. As a result of learning that lesson, portable CT’s, MRI’s and ultrasound will become the norm not the outlier. Drive-thru testing sites have proven their worth and more sites will become much more patient-centric.
The Pandemic has shown us that the U.S. healthcare system is capable of rapidly adapting to the demands of a health crisis and that at its best can provide amazing care to our citizens. I am reminded of the quote often attributed to Plato who said, “Necessity is the mother of invention.” The COVID-19 crisis has ensured that the future of U.S. healthcare will be different and, in many ways, better than it was before the pandemic. That will have to be the silver lining we must hold on to as we continue to work our way through the crisis.
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[1] Johns Hopkins COVID-19 Dashboard, https://coronavirus.jhu.edu/map.html
[2] Which small businesses are most vulnerable to COVID-19 – and when, by Andre Dua, Kweilin Ellingrud Deepa Mahajan, and Jake Silberg, McKinsey & Company, June 18, 2020
[3] How Many U.S. Workers Have Lost Jobs During Coronavirus Pandemic? There are Several Ways to Count, by Eric Morath, Wall Street Journal, June 3, 2020.
[4] Healthcare Mergers & Acquisitions Activity Report: Q2 2020, by Anu Singh, KaufmanHall
