To Be Successful Post-COVID-19, Healthcare Can’t Neglect Critical Truths It Learns Now

By Dave Dirks – Castell Chief Operating Officer and William Daines, MD – Castell Clinical Operations Medical Director

The COVID-19 pandemic has forced hospitals, physician practices, payers, and government agencies to adapt quickly in the face of unprecedented clinical and economic upheaval. The road ahead remains uncertain and many more innovations will surely be required. However, it is important to reflect on what has been learned in this short, impactful time and consider how healthcare organizations can further evolve to meet the challenges of the future. Here are three ways successful organizations will be different when we emerge from the crisis.

Healthcare organizations’ shift to value-based care will accelerate.
The pandemic has shone a bright light on the fact that the transactional (and at times adversarial) relationship between payers and providers engendered by the fee-for-service system is not helpful for anyone, least of all patients. Successful organizations will move aggressively to expand the proportion of revenue in value-based care arrangements.

Organizations that are heavily reliant on fee-for-service revenue are experiencing financial losses brought on by decreased utilization of non-essential care during the COVID-19 crisis. At the same time, fee-for-service payers benefit from delayed or deferred care. After elective care restrictions are lifted, hospitals and providers will try to recoup lost revenue through aggressive patient recruitment and service expansion while at the same time, some payers may attempt to limit utilization.

Providers and payers engaged in collaborative value-based care arrangements are relatively protected from these fluctuations in care delivery. Providers receive up-front access to premium dollars, providing a stable revenue source in the face of declining volumes. While payers are protected against aggressive volume recapture by provider organizations. Most importantly, providers and teams engaged in value-based care can continue important care delivery functions during pandemic conditions without undue disruption.

The patient may be out of sight but should never be out of mind.
Historical delivery models have assumed that individuals in need of care would seek it out in a timely manner by, for example, contacting a primary care physician or presenting to an emergency room. Consequently, medical care was designed from the point of a patient-initiated contact onward, without sufficient thought to the barriers patients face or coordination with non-clinical care. The COVID-19 pandemic has shown that many patients and communities face significant obstacles in accessing care. Economic distress during and after the pandemic will exacerbate existing disparities in social determinants of health and related health outcomes.

Going forward, healthcare organizations must embrace the challenge of engaging with individuals and families in a proactive and personalized manner throughout their health journey—not just from the moment they become patients. During the COVID-19 pandemic, Castell has partnered with providers and payers to contact thousands of clinically high-risk patient-members to identify medical or social needs, provide individualized education and planning, and connect people with available resources.

Similarly, patient expectations regarding how and when to access care have changed. The COVID-19 pandemic has forced healthcare organizations, aided by relaxed regulations, to rapidly adopt digital and telehealth technologies to support patients remotely. Patients aren’t likely to forget the ease of accessing clinical information and navigation services through mobile applications or visiting with their caregiver over a video visit. Neither should healthcare organizations. What was once an underutilized enhancement to care is likely to become an expectation. Successful organizations will not only need to quickly adapt to implement these technologies but address downstream impacts such as fixed-asset capacity and utilization, new staffing models, and changes to operational workflows.

The culture of rapid, patient-centered improvement will persist.
Finally, and most importantly, successful organizations will perpetuate the professional pride and innovative spirit that have characterized their COVID-19 response. The response of many healthcare organizations during the pandemic has disproven the myth that healthcare organizations (even large ones) can’t be flexible, innovative, and nimble. It is incumbent upon healthcare organizations—from two-provider practices and large integrated health systems to payers and regulatory agencies—to resist the temptation to return to siloed, bureaucratic “business as usual” or renew the choruses of “we just can’t or don’t do it that way.”

The reality is that healthcare is large and complex. It cares for people in their most vulnerable moments. A robust regulatory system and a spirit of caution are necessary to protect patients and providers. It is our hope and expectation, however, that policy makers and healthcare organizations will build on lessons learned during the pandemic to foster an environment in which rapid innovation remains possible.

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Castell is a comprehensive health platform company that makes the move to value-based care simple for providers, payers, health systems, and accountable care organizations. Castell delivers impactful analytic and service solutions designed to accelerate organizations’ transition from volume to value, improve outcomes, and keep costs more affordable. Castell is an Intermountain Healthcare company.  For more information, visit CastellHealth.com.