As we continue to experience the tragic loss of life from COVID-19, the question being asked is what will be the new normal in healthcare post-pandemic. How do we plan for this new normal? When will it stabilize and become predictable? Will it stabilize at all?
We are in the early stages of a tidal wave that is going to irreversibly reorder the process of care delivery. The new normal is really going to become the regular balance of profound instability. One example seen in the midst of this pandemic is large hospital systems laying off thousands of healthcare workers. It seems counterintuitive. Why was this happening? The fact is, routine or elective procedures and the chronic care of previously diagnosed patients came to an abrupt halt. People were passing on important diagnostic tests, dialysis, chemotherapy and other ongoing health care regimens out of fear of catching COVID-19 while seeking treatment. This literally emptied out the “supply chain” in the healthcare assembly line.
Increased telehealth is not the panacea, it is one component of the tidal wave of change that we are going to experience. Medicine is an art as much as it is a science, and the components of the art of medicine are very nuanced. The quality physician-patient relationship is a holistic one. We tell our physicians much about us when they see us as a whole person and when they physically examine us as they pursue a diagnosis. Thus, going forward, the patient is going to have to be much more engaged in the diagnostic process. We, the patients, are going to have to become a diagnostic tool for a physician to effectively utilize telemedicine beyond its present boundaries.
The consolidation of healthcare systems will continue to be another disruptive force in the marketplace. We are presently experiencing hospitals turning into MASH units and we know the Army Corps of Engineers has the capacity to build a 2000 bed field hospital in a few weeks. What are the implications of this transformation? Will we as a society need 1000-2000 bed hospitals, or will we begin to see a more strategic approach utilizing micro hospitals and certified centers of excellence? Further, in these consolidated systems, the emergence of reference pricing and other tools for capitated healthcare costs will shift the power to purchase care to the consumer as more transparency is demanded in the marketplace. The “Charge Master” that has been the “Blue Book” for each hospital to establish their own prices is going to become an historic artifact. As corporations aggregate to purchase healthcare directly from the providers, as they have started doing for the last decade, they are going to alter the financial structure of the delivery system.
With healthcare consuming close to 20% of the GDP of our country we are reaching another tipping point in this tidal wave. We can’t afford to continue to provide care at the costs the incurred today. In a study published in January, 2020, by the “CommonWealth Fund”, the United States presents a decidedly mixed picture. The authors state “Compared to peer nations, US has among the highest number of hospitalizations from preventable causes and the highest rate of avoidable deaths.” Yet, earlier in the article the authors state, ” the United States has worse outcomes and spend more on health care, largely because of greater use of medical technology and higher prices, compared to other high income countries.” This confluence of forces and tensions within the healthcare process is very costly as the authors indicate, “A recent analysis estimated that as much as one quarter of total health care spending in the US—— between $760 billion and 935 billion annually—-is wasteful. Overtreatment or low value care— medications, tests, treatments and procedures that provide no or minimal benefit or potential harm—-accounts for approximately one 10th of this spending.”
As we move beyond COVID-19, hopefully in the very near future, we are going to have to face this tidal wave of change in the process of delivery and the cost of care received. We will need a healthcare system that is more agile, less brick-and-mortar intense, and focused on individuals living well to prevent the illnesses that are accelerating costs. We have deferred addressing this issue for decades, but the pandemic is forcing us to this reckoning. How we respond as a society and how the health care system adjusts will determine the quality of life of the next generation of Americans
