This week, the U.S. administered its first COVID-19 vaccine, a welcome signal of hope after a rough 10 months, marked by a pandemic that continues to strain healthcare systems to the breaking point.
As we look to the new year, there is one truth that this historic event continues to reinforce in sometimes graphic ways: healthcare needs to change — and fast. That’s difficult for an industry where transformation is very much circumscribed by the incentives and payment structures it’s so dependent on. But bear with me. It really can be done but only if we acknowledge some fundamental truths and the landscape as it really is right now:
- This is not the last time we’ll see a global pandemic. And that means planning has got to happen now, especially for those institutions that are historically slow-moving. Businesses are pretty good at adapting their continuity plans to include the pandemic phenomenon among the list of “Things We Wish Won’t Happen But Very Much Need to Anticipate Anyway.”
Governments are doing the same but more slowly. Those RFPs that just came out in the spring to build the necessary supportive infrastructure? The timelines need to be collapsed. This needs to be like software: minimal viable product, then iterate. Perfect is the enemy of the good here.
- Anticipate big changes on the payor mix in 2021. Elevated unemployment will lead to a rise in Medicaid and uninsured patients because people will no longer be on employer-sponsored commercial insurance. As furloughs turn into layoffs, and as benefits like COBRA subsequently run out, watch for an accelerated rate of change in the payor mix for hospitals.
- Consumers are welcoming telehealth but we need continued support on fees. The Centers for Medicare & Medicaid Services (CMS) gave major flexibility for Medicare reimbursement for telehealth, but those flexibilities are set to expire in January, even as we’re still in the acute phase of this pandemic.
Meanwhile, recent research from Deloitte reinforces the idea that telehealth will continue to increase in adoption with the percentage of virtual video visits projected to increase fivefold in 2021 over 2019 levels. So why can’t we get some flexibility permanently embedded in the system – from reimbursements to being allowed to practice telehealth across state lines? Why can’t we have billing parity for in-person versus telehealth appointments?
- Mental health needs to be a focus for patients and healthcare workers. We’ve seen the numbers about higher suicide rates, more overdoses, increased depression and anxiety, and more around COVID-19. If we start prioritizing mental health as a standard part of care, it will translate into lower medical care costs, lower employee turnover, and higher satisfaction.
Set all this against the backdrop of other urgent problems. Think about the COVID long-haulers, who will need chronic care to manage conditions we don’t yet fully understand by teams who are not yet stood up to help them. Longitudinal care programs should become mainstream to support them; hospitals and primary care models are not the answer.
Think about the disparities rooted in race and income, which limit or complicate access to the very digitally-enabled models that could extend the reach and efficacy of care for these populations. If we shift market share to innovative care models and therapeutics that leverage digital, we will open up that access, drive down clinical costs, and enhance the patient experience.
A lot of eyes have been opened in this country to the limitations of our healthcare systems, due to the pandemic. A lot of minds are now laser-focused on solutions. And the will to drive change is there. Our job is to carry all of that forward into 2021 – the knowledge, the ideas, and the determination – to find our way. A better way.
About the Author:
Michelle Pampin is the CEO of Welkin Health, a Care Management platform focused on improving health outcomes for people living with chronic diseases. Michelle is an accomplished leader, with a track record of advancing high-growth Silicon Valley software companies. Michelle speaks three languages: Spanish, French and Portuguese. When she’s not busy leading Welkin, she is busy staying active with her Samoyed, Avi.