Healthcare Upside/Down: Double Down on Pandemic-Inspired Solutions
By Nick van Terheyden aka Dr Nick, Principal, ECG Management Consulting
Twitter: @drnic1
Host of Healthcare Upside Down – #HCupsidedown
Healthcare costs have been rising every year for more than 60 years. Despite multiple attempts to rein in costs, and incentives to move away from volume-based care to a system centered on value, only about one-third of care is delivered under value-based models in the US.
Will the worst healthcare crisis of the past century finally change the way we pay for care?
COVID-19 has claimed hundreds of thousands of American lives, upended businesses and livelihoods, and strained our healthcare system nearly to its breaking point. But it has also prompted innovative care solutions, lowered some traditional barriers to care—at least temporarily—and changed our understanding of how and where care can be safely delivered. The question now is whether policy decisions made during the public health emergency will remain in place for the long term.
“Let’s learn and not repeat mistakes,” says health economist Jane Sarasohn-Kahn. “What we learned in the pandemic is that providers who were taking on value did much better financially than those that were largely volume based, because they were already using telehealth, patient portals, text messaging,” and other technologies to drive health literacy and communicate with patients.
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Jane is the founder of THINK-Health, a strategic health consultancy. Her primary interest is how to leverage technology to drive population health outcomes, enhance the patient experience, enchant providers, and lower healthcare costs—together, the Quadruple Aim. Her focusing mantra is that health is where we live, work, play, pray, and learn, with a strong focus on social determinants of health and digital tech.
On this episode, Jane explains how the COVID-19 crisis can help us redefine value in healthcare and why we need to double-down on pandemic-inspired solutions. Here are three takeaways from our conversation.
Better access to mental health resources.
Telehealth isn’t a product of the pandemic, but its popularity is. And nowhere has that been more evident than in the realm of behavioral health. “The one area of virtual care that is pretty sustaining has been tele–mental health,” Jane says, “which is terrific, because we’ve had such an undersupply of therapists.” And she expects telehealth to endure as a means to connect patients with mental health providers. “Lots of funding is going into that area right now.”
But just as important as the expansion of tele–mental health technology is the normalizing effect the pandemic has had on the need for behavioral healthcare. Jane says that the widespread stress associated with COVID-19 is prompting more people to acknowledge their anxiety and seek treatment for it. “The stigma [associated with mental health] is eroding, thank goodness,” she says.
More care in the home.
Will the success of telemedicine in behavioral health translate into broader, long-term use of technology to keep patients out of doctors’ offices and emergency rooms? In Jane’s view, there was pre-pandemic momentum for the use of digital health to manage chronic conditions, and even acute care, remotely.
”We saw that start to happen just before the pandemic, in 2019,” she says, naming several major health systems that had worked with technology companies to advance the hospital-to-home movement. “Acute care beds are full. So if we can track people, in terms of whether they’re doing well and flourishing from the hospital, we can help start to move people home.”
With quarantines and lockdowns pushing more people to become comfortable using online communication tools and health apps, the foundation has been laid for usage of those tools to expand. “More people, especially more older people…are using these connecting platforms [Zoom, Microsoft Teams, etc.] for daily life,” she explains, and now there’s an opportunity to expand that knowledge to healthcare.
“The more we take on payment for population health—for diabetes, respiratory care, congestive heart failure, etc.—there will be incentives to get more care at home,” she says, citing the potential of care delivered over the phone, through PCs, via television, and through other media. “So I’m hopeful.”
Acknowledging barriers to home care delivery.
Jane is quick to caution that telehealth has some conspicuous limitations. Even the most cleverly designed and user-friendly technology in the world won’t help patients who lack access to reliable broadband in their homes. “We need connectivity, or this will not work,” she says. “And that means really good, resilient networks to the home. I don’t care how we do it. Broadband connectivity is a social determinant of health.”
The concept of increased care delivery in the home raises the bigger issue of health equity and whether expanding healthcare via digital means will improve access for some patients but broaden the care gap for others. Jane reminds us that reliable broadband access is only one piece of the puzzle.
“Is the home set up to be a good place for healthcare if it’s got lots of people in it? Is there a dedicated place where somebody can sleep? Is there a kitchen where food can be cooked, that’s nutritious? Does that home have access to good food?”
Again, Jane is optimistic. She points to an online grocer that accepts SNAP benefits, enabling someone to order food online and have it delivered—provided they have access to the app and broadband. “It’s not a panacea,” she says. “But it’s part of the solution.”
About the Show
The US spends more on healthcare per capita than any other country on the planet. So why don’t we have superior outcomes? Why haven’t the principles of capitalism prevailed? And why do American consumers have so much trouble accessing and paying for healthcare? Dive into these and other issues on Healthcare Upside/Down with ECG principal Dr. Nick van Terheyden and guest panelists as they discuss the upsides and downsides of healthcare in the US, and how to make the system work for everyone.
This article was originally published on the ECG Management Consulting blog and is republished here with permission.
