These days, my inbox and social feeds are full of telehealth articles that are being driven by the COVID-19 crisis response. While I am pleased that providers, consumers, and regulatory minds are finally opening and exploring the value of out-of-office care, I believe this insatiable industry focus on telehealth is a bit of a red herring. The role of digital is not only much bigger than telehealth—it is now core to survival. Because of COVID-19, digital innovation has suddenly become existential.
The emergence of COVID-19 has catalyzed change alongside two vectors for health systems:
One vector is around disease response—including the mobilization and mitigation of COVID-19 itself. New technologies, models, and thinking are now essential to post-COVID care—and important components are distributed care and digital health. It’s interesting to note that telehealth is only a small part of the new distributed care requirement, which includes new forms of care access, engagement and personalization, multi-modal care, smart navigation, care pathway automation and remote patient monitoring, and even home-friendly medical equipment and services.
From the mitigation perspective, with the absence of a centralized or coordinated federal approach, health systems are required to innovate locally to manage risk and maintain the trust and safety of their patient population. This requires new, scalable digital tools that help us manage trust and safety with patients and care communities. Health systems now need engaging consumer-facing tools that communicate, educate, support patient health in a highly dynamic environment—a very new requirement.
Business Model Disruption
The second and more challenging vector for health systems is business model implications associated with driving recovery and evolution post-COVID. The most fundamental of all changes is that the historically slow walk toward risk will significantly accelerate—and the forms it will take will be more discriminating and deliberate. Providers must push to affordability through risk-based arrangements with Medicare and Medicaid patients; and affordable, accessible, personalized, and simplified care for commercially insured and self-pay patients.
COVID-19 has exposed the fundamental flaws of the traditional fee-for-service system. It will create a bifurcated market with an increase in alternative payment models for some patient groups, namely Medicare Advantage and Managed Medicaid patients, and an increase in consumer-driven care for other groups, namely commercially insured patients to whom greater and greater healthcare cost has been shifted. We can expect to see digital technology to play a key role on both the value-based side through digitally enabled offerings and more, and on the direct-to-consumer side with scalable, self-service capabilities for the price-sensitive consumer.
As we traverse these two vectors, a broad set of second order impacts and outcomes can be expected:
DISTRIBUTED CARE & DIGITAL HEALTH
The surge in virtual care brought on by COVID-19 will begin an era of decentralization powered by virtual modalities and enablers of care in the home and certainly outside the health care facility. This will require new payment, regulatory, operating models, and frictionless, connected experience to maintain and sustain digital adoption and distributed care models among patients and providers. This surge will have impacts across the care continuum ranging from hospital at home, remote patient monitoring, outpatient and non-urgent virtual care, and virtual chronic disease management.
Consolidation, driven primarily by health plans and private equity, of distressed and strategic assets will impact standardization around technology platforms for integrated systems of care and disrupt affiliated referral channels. Providers will need to focus on integration and referral management to ensure business recovery and long-term business model goals can be achieved with this form of disruption.
NEW WORKFORCE & FACILITY MODELS
Health care organizations have struggled to flex their workforce and facilities to respond to COVID-19, indicating a new need for flexibility that allows workforce and facility adaptation across geographies and modalities of care—including virtual—based on clinical need. In the future, we might expect to see the utilization of integrated virtual care staffing, digitally-enabled float pools, collaborative staffing across systems, even gig-economy workers from a staffing perspective and multi-use, home-based and co-working spaces
EXTENDED SUPPLY CHAIN MODELS
Surging demand and limited supply of specific resources such as PPE, ventilators, and other supplies, exposed the vulnerabilities of the health system supply chain. There is a need for improved internal data availability, increased source diversification, and flexibility to shift supply chain models into the home and community by and increased balancing of price, value, and preparedness.
VULNERABLE PEOPLE AND UNDER-RESOURCED COMMUNITIES
The economic impacts of COVID-19 highlight an unprecedented need to identify innovative solutions and business models through creative partnerships to deliver low-cost care, address social needs, and improve health outcomes for vulnerable people. Massive racial disparities in care delivery that have always existed have been painfully exposed during COVID-19.
SCALABLE BEHAVIORAL HEALTHCARE
COVID-19 has exacerbated a looming mental health crisis—forcing health systems to re-engineer under-resourced behavioral health services to account for ongoing supply and financing challenges and deliver efficient, scaled behavioral health care.
This brings me back to my premise. We have to be thinking about post-COVID digital in a much broader way than simply telehealth. Now is the time to make deep investments in digital technology that will support both our need for COVID-19 disease response, but maybe more importantly, our needs as we navigate the inevitable business transformation.
ABOUT THE COVID-19 DIGITAL INSIGHT REPORT SERIES
This blog post is based upon content from the COVID-19 Digital Insight Report Series published by the Providence Digital Innovation Group. Providence is one of the nation’s largest non-profit health systems and was also the first system in the United States to care for a COVID-19 patient in January 2020. These reports couple direct experience with primary research conducted through over 100 interviews with health system, technology, and innovation leaders from within Providence and across the health care industry.
Through the publication of these reports, our hope is to offer new insight, promote collaboration and discussion around the impact of COVID-19 on health systems, and examine the role digital innovation will play as we move through recovery and into the next normal.
The entire series may be downloaded here