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A pandemic reinforced our belief in population health

The disproportionate impact of the pandemic on the underserved, Black Americans, Latinos, and those with chronic conditions requires an industry-wide foundational response.

The pandemic has shown the best of American healthcare in the collaborative, selflessness of our physicians and nurses, but also the vexing challenges of a payment system based on episodic acute care.

And yet, in an industry known for resistance to change, transformation is suddenly in full swing. The acceleration toward an integrated, holistic healthcare system—one that prevents illness and maintains the health of both clinically and socially vulnerable populations—has forced broader recognition for change due to Covid-19. Now is the time to inject models of care and payment systems with a new perspective and proven innovations.

Three ways Covid-19 is an impetus for transformation
The disproportionate impact of the pandemic on the underserved, Black Americans, Latinos, and those with chronic conditions requires an industry-wide foundational response. And three truths tell us that a more equitable, effective system that delivers real value to patients, providers, and payers is possible:

  1. Healthcare can change: Suddenly, in a matter of weeks, healthcare has demonstrated that, in fact, it can pivot and innovate new models of care delivery: telehealth and virtual care, wide adoption of home monitoring technology, and population health on a broad scale in the form of social distancing.
  2. Health equity and social determinants have a direct impact on outcomes: At the same time, the role of social determinants in health outcomes has never been clearer. Vulnerable and underserved populations are experiencing rates of infection and complications of the virus at devastatingly higher rates than other populations. Now is the time to understand why and act.
  3. Primary care cannot survive in a transactional system: The pandemic has also laid bare the inadequacy of a fee-for-service reimbursement system for primary care. Community physicians are struggling in the pandemic to keep their lights on if their reimbursement is transactional and episodic—even as their patients need them more than ever. Population-based value care initiatives also incentivize primary care providers to focus on those patients most at risk.

A head-start on transformation
The pandemic opened the door to broad change across the healthcare ecosystem — a better system that connects care across a continuum, spanning from primary to acute care to provide a seamless, high-quality patient experience. This model avoids unnecessary duplication of services, and data proves the ability to lower the total cost of care for payers.

Three key principles of transformation:

  1. Holistic, integrated care of patients begins with taking care of physicians. An infrastructure of support and technology enables doctors to spend more time with their patients. By streamlining workflows, enhancing communication, and reducing the burden of paperwork, doctors can be free to be doctors. A shared EHR puts hundreds of small practices on a uniform platform with population management tools that feed data insights and analytics to the network, including identifying significant inflections and trends in medical expenses.
  2. Support patients throughout the continuum, depending on their medical complexity and their social challenges. In the pandemic, leveraging existing data analytics platforms that support population health management strategies can find those most at risk of infection or other conditions and target messaging to those patients. This helps identify and address populations with a disproportionately higher burden of disease and implement specific individualized interventions to mitigate the risk of costly complications that have a significant impact on the quality of care.
  3. Primary care must collaborate with acute care, forming the foundation of our clinically integrated network. Addressing the full continuum includes going upstream to address social determinants of health, like food and transportation, preventing acute illness and reduce hospital admissions through primary and preventive care, and providing access to acute care hospitals to provide advanced therapies for cancer, cardiac, neurosurgery, and other complex care that cannot be done outside of the four walls of a hospital.

An approach tested and proven in the pandemic
These principles demonstrated their potency for broad transformation when Covid-19 first struck. The need to connect community-based preventive and basic care to acute care was evident. From identifying and protecting high-risk patients to data-mapping to ensure adequate ICU beds, a connected continuum of care is foundational to every step in addressing the crisis.

Covid-19 has also accelerated innovations in home-based and virtual care. Patients recovering at home need care across the continuum, too – ensuring they have food and support from caregivers, that they’ve received and taken their medications, and that they have access to telehealth to connect with their providers. Care moved into homes, monitored and coordinated through population platform and tools, is a new delivery model that will remain after the virus relents.

Transformation must be supported by innovative payment models
Going forward, there will also be a greater push toward member attribution, being paid for providing care continuously and being accountable for the overall care and total cost of care for the patient. The system of relying on individual transactions, whether encounters or procedures, in the overall care and well-being of the patient is clearly inadequate when pressure tested as it has been by the pandemic. Fee-for-service reimbursement will almost certainly have a role in a transformed health system, but it must be complemented by innovative new payment models. When we connect the right payment structure to the right type of care, we can ensure the connection between patients and their physicians cannot be broken, even by a pandemic.

The healthcare industry has an unprecedented opportunity to emerge from this pandemic in a new and better way – one that focuses on value over volume, connects care across the continuum, and puts physicians and patients at the center.

Photo: elenabs, Getty Images

 


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Esteban Lopez and Dr. Sanjay Doddamani

This post appears through the MedCity Influencers program. Anyone can publish their perspective on business and innovation in healthcare on MedCity News through MedCity Influencers. Click here to find out how.

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