The U.S. healthcare system has been broken for a long time. But COVID-19 has brought some of that brokenness—like disparities in access to quality care and patient outcomes—into sharp focus. Record unemployment rates mean millions of people have lost not only their income, but their employer-sponsored health insurance, too. Their options are bleak: either to pay out of pocket for a less expensive, high deductible plan, or forego insurance entirely.
You can see how this is a ticking time bomb. People put off treatment for health issues because they simply can’t afford it. Those health issues get worse over time. Eventually, they will have no choice but to seek treatment. Often, via the uber-expensive ER. Sometimes, when it’s too late.
Obviously, this isn’t good for the patients. But it’s not good for healthcare providers either. It’s more likely that they’ll have to employ more expensive interventions. And less likely that the patients will be able to pay for them. Boom!
Crisis Inspires Progress
Historically, major disruptions—the great depression, both world wars—have demanded that we not just rebuild, but reinvent and rethink. But it helps to think of disruptions on a smaller scale: imagine your well-insured house burns down. When you receive your settlement, do you recreate an exact replica, or design a new home with better materials and newer technology that meets more of your needs?
The time bomb of: COVID-19+an economic crisis+income disparity+racial and gender inequities has set our already broken healthcare system on fire. We need to rebuild, reinvent, and rethink a better system with newer technology that meets our needs. In the process, the practice of medicine—including caring for patients with COVID-19—will greatly improve. There’s no better time, and no more important time, than now to do this.
There’s no need to reinvent the wheel here. We can quickly and easily effect change by looking at new models for healthcare that are already working and replicating them on a larger scale. Here are three examples.
Hardly a new model, telemedicine has been used for decades to deliver care when logistics don’t allow for an in-person doctor visit. An extreme example is when a researcher in Antarctica needed knee surgery after slipping on the ice near the base station. Via video conference, the Chief of Sports Medicine and an anesthesiologist at Massachusetts General Hospital guided the research facility’s family physician, physician’s assistant, and cook (a former veterinarian) through the procedure to successfully reattach the tendon.
More often, telemedicine is used for consults or check-ups that wouldn’t normally require in-person visits. More than just a video visit, telemedicine gives physicians the ability to coordinate care with other specialists, send messages directly to their patients, monitor patients’s health, streamline costs and delivery, and scale their practices.
Telemedicine also gives healthcare consumers more choice in providers, more access to specialists, and the convenience of visiting with their doctors from the comfort of their homes. In six short months (or interminable, depending on your perspective), COVID-19 has taken telemedicine from anomaly to routine. And now that doctors and patients have seen the benefits of this treatment model, they’re wanting more.
Another interesting development spurred by COVID-19 is that almost all states have lifted regulations that previously restricted providers from practicing in different states. There’s currently a compact of 20 states that allows medical providers to practice across state lines. And we’re seeing similar allowances being made for telemedicine. This has the potential to drastically expand consumer access to specialists and scale telemedicine practices.
The lack of cohesiveness and communication among providers has been a major failing of our healthcare system. Traditionally, medicine has been practiced in a very siloed manner, each specialist focused on his or her area of expertise. But your health isn’t siloed. It’s part of a complex and interconnected system called the human body. And often one health issue is impacted by another.
At The Cusp, one of the patients who came to us for expert menopause care explained that she was receiving ongoing care for surgically treated breast cancer and autoimmune disease. “Every single day I’m doing my own searching and advocating. I feel like I’m an admin at the Mayo Clinic, keeping my rheumatologist, my oncologist, and my primary care doctor all on the same page. None of them is talking to the others unless I specifically request it. And I’m the one gathering the notes and sharing their recommendations.”
Some health systems, like Kaiser Permanente and Intermountain Healthcare, have used technology to develop robust coordinated care models that have enhanced communication across all of their specialists. So they’re able to deliver more cohesive and comprehensive care. As more systems follow suit, healthcare will become more streamlined, personalized, effective, and affordable.
In an effort to improve care and lower costs for Medicare, the Affordable Care Act (Obamacare) introduced a new accountable care system that incentivizes medical provider groups (Accountable Care Organizations or ACOs) to provide coordinated, high-quality care at lower cost. Per the Centers for Medicare and Medicaid Services (CMS), “The goal of coordinated care is to ensure that patients get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors.” When an ACO delivers high-quality care, while spending Medicaid dollars more wisely, CMS compensates it based on the savings it generates. So far, this model is working, for providers, patients, and CMS.
In addition to incentivizing providers to work together to keep their patients healthy, the concept of accountable care inspires innovation. It demands that companies develop products and services that can treat more people, more effectively, at lower costs. There are many innovative health companies that are already doing this well. Omada Health, for example, makes the Diabetes Prevention Program available online at no cost to at-risk individuals, via employers or insurance providers. Their product increases access to quality care for individuals. And payer cost is based on participants’ outcomes in the program.
Another exciting company is Maven Clinic, which is a telemedicine network that provides healthcare for women before, during, and after pregnancy. Their service, offered as an employee benefit, connects women to the providers they need—ob-gyns, nutritionists, lactation consultants, etc.— via chat or or video. It even helps them transition back to work. Employers benefit by cutting down on sick days and keeping parents in their jobs.
These are just three ways we can move quickly to fix our healthcare system. Obviously, it will take more to rebuild a system that works for all, but we have an excellent starting point and some blueprints to work from. We need state governments to harmonize their regulations so effective practices can expand swiftly across the country. The FDA needs to continue to modernize its handling of applications for foods, medical devices, and drugs so they can come to market more quickly. Insurers need to adopt accountable care measures to incentivize providers correctly, and providers need to adapt their systems so they can plug into the accountable care infrastructure that’s coming. Healthcare innovators already have incredible new tools to enable the rapid improvement of healthcare delivery. They need to keep pushing in order to bring those solutions to market.
All that may seem overwhelming. But as all the players take on their own piece of the reconstruction, we will see this change happen quickly. Now is the time to do it. Because we can. And because we have to.