The Impacts of COVID-19 Blog Series
The COVID-19 pandemic has been characterized as a black swan—an event that happens so rarely that it is incredibly hard to predict and even harder to prepare for. With the benefit of hindsight and knowledge of our current reality, this blog series approaches and attempts to answer a series of questions about our present state and our future. The first post dissects the U.S. healthcare system and discusses the structural weaknesses that this pandemic exposed. The series follows with a post on how innovative healthcare stakeholders are responding to these weaknesses with incredible problem solving and resiliency. Building off this foundation, we continue the series with a look forward into the future of healthcare (Part 1, Part 2) through the lens of this pandemic. We conclude the series with the viewpoint of the investment community and unpack what pre-COVID-19 themes will persist or be accelerated and what new categories will emerge.
In this post, we will build off the prior discussion on structural weaknesses and focus on how stakeholders across the healthcare ecosystem are responding to the COVID-19 pandemic.
In times of crisis, we must lead with empathy… empathy for the patients and families suffering from COVID-19, the healthcare workers fighting on the front line, and the essential workers keeping us safe and our food secure. We must lead with empathy, and we must follow with opportunity. This crisis has exposed weaknesses in the healthcare system that we have an opportunity to address. Many stakeholders—including providers, payers, governments, public and community health agencies, and startups—have risen to that call and are responding to the stress this pandemic has placed on the system in both innovative and necessary ways.
Physical and Technology Infrastructure
To prepare for the expected capacity constraints, healthcare systems are pushing boundaries to find ways to reduce the shortage of ICU and MedSurg beds. About a month ago, the U.S. Surgeon General urged health systems to cancel their typically profitable elective surgeries that would otherwise compete for scarce resources (beds, personal protective equipment [PPE], labor, etc.). To continue to improve capacity, governments and healthcare systems are coming together to build field hospitals in only a manner of days; for example, Wuhan, China built two emergency hospitals in just 10 days.
Technology has shown to be key in solving the capacity problem. Despite years of slow adoption, there has been a remarkable increase in the adoption of virtual care, which is being employed to triage COVID-19 needs; without it, hospitals would be overcome with unnecessary visits. Importantly, virtual care is also being used more effectively for primary care, specialty care, surgical consults, etc. This Google Trends report shows that telehealth searches have skyrocketed compared to the last five years. Updates to reimbursement and regulation for telehealth visits are also making this change more financially attractive, as referenced in the financial section below.
The application of AI and predictive analytics in healthcare has been slow; there is often a distrust in the black box that provides recommendations on healthcare delivery. However, organizations that have been able to adapt their processes to include AI are able to manage the system’s stress more proactively. More organizations are using chatbots to make conversations about COVID-19 more efficient and effective. Orbita has launched its COVID-19 screening tool at no cost to organizations, allowing patients to do an assessment of their symptoms and be triaged to the appropriate place.
Predictive analytics are starting to gain more traction as more data becomes available. Stanford developed a predictive model to establish guidelines for and conserve PPE in the operating room. Once we are past the crest of the first wave of COVID-19, health systems will need to assess how their infrastructure operated under stress and where they should invest for stability before the next wave hits.
Healthcare systems are being asked to fight at the front line but don’t all have the appropriate resources. Many stakeholders are getting creative on filling critical supply gaps—from grassroots crowdsourcing supply drives to completely repurposing manufacturing lines for hand sanitizer, PPE and ventilators to reusing existing assets to produce needed products. Some universities, manufacturing companies and technology firms are addressing the PPE shortages through 3-D printing. Healthcare systems are developing key supply chain partnerships, like LifeBridge and Under Armour, to produce PPE. The FDA has addressed the PPE crisis by issuing an emergency use authorization to reprocess N95 respirators so that they can be sterilized and reused.
Ventilators are also a critical supply shortage. To bridge this gap, innovators are rethinking the traditional design, purpose and capacity of ventilators. An MIT-based team has deployed an open-source, low-cost (only $500 to develop vs. ~$30,000) ventilator, and Mount Sinai is turning sleep apnea machines into ventilators. On top of these innovations, the Trump administration just announced a ventilator exchange program that is intended to utilize unused ventilators by sending them to hospitals in coronavirus hot spots.
Healthcare workers are being pushed to new limits, working more hours in undesirable conditions. Various stakeholders are stepping up and finding ways to expand the healthcare worker’s capacity. From a regulatory perspective, CMS has eased the out-of-state telehealth and top of license rules to expand what and who advanced practice providers can support during the crisis. Hotspot cities, like New York and Detroit, are growing their volunteer workforce by embracing temporary clinicians from organizations that have a workforce surplus. Cleveland Clinic and Intermountain Healthcare volunteers are offering support to systems in need, and they are also using this time to learn and bring best practices back home. Even medical schools, such as NYU Grossman School of Medicine, have graduated students early to start their residencies and in turn, bolster the workforce.
The pandemic is going to pose a long and difficult financial recovery, especially for healthcare organizations. However, the government and payers are taking some steps that may ease, even if only temporarily, the financial burden for health systems. The CARES Act is a multifaceted package delivering $100 billion in funding to hospitals; HHS has partnered with UnitedHealth to quickly disperse the first $30 billion. In addition, the CARES Act requires payers to cover COVID-19 testing. Commercial and Medicare Advantage plans, like Blue Cross Blue Shield companies, are responding with additional coverage, even waiving cost sharing of treatment for inpatient stays. CMS is temporarily reimbursing telehealth visits at the same rate as in-person visits. And many payers have also started to incentivize virtual care utilization by waiving the costs or copays for telehealth visits.
Healthcare has historically been slow to adopt innovation compared to other industries. It could take months or even years to develop an evidence-based protocol, onboard a new technology or test a new device. However, the healthcare system is currently proving that it can adapt and innovate at high speed when the pressure is on and incentives are aligned. The pandemic has provided the push for healthcare stakeholders to innovate, while government policy and regulations have been the pull. Simultaneously, the culture in response to COVID-19 has been to share best practices and collaborate—for example, through the HIMSS COVID-19 Digital Think Tank—so that the entire ecosystem can benefit. We now know that healthcare can rise to the challenge, and that momentum must continue even once the motivation that is COVID-19 has slowed.
The way we respond today will alter the healthcare system in the near- and short-term. It will change the way that consumers, workers and businesses behave. To that end, we must learn from the positive responses that we are seeing and build on them over the next weeks, months and years.