The material cost of COVID-19 has been at the center of public discourse since the early days of the pandemic. In 2020, growth in federal government spending on healthcare increased 36 percent, compared to the 5.9 percent bump in 2019. While the distribution of vaccines has allowed for a version of pre-pandemic life to resume, hospitals are still not recovered from the high rates of hospitalizations that occurred in March 2020, and the indirect costs of the pandemic continue to loom over the American population as a result of strained health systems. 

During the early days, the cost of hospitalizing a patient seemed obvious: the sheer volume of long stays, expensive ventilators, a lack of one-size-fits-all treatment solutions, and the pause of elective surgeries. Now, Covid-19 continues to wreak havoc on our health systems, but in a more covert way. With only 4% of Americans fully boosted as we move into this winter’s ‘triple-demic’ – and long covid impacting the lives of as many as 16 million people on a daily basis – it’s clear that public health officials need to do more in order to support the American population and our struggling health systems. 

The Cost of Healthcare Provider Burnout 

Across the country, healthcare providers are reporting extreme rates of burnout. It is important to underscore that healthcare providers and hospital systems were stressed prior to Covid-19, but the pandemic has exacerbated it. Employment across healthcare is down 1.3 percent, or 223,000 jobs, from pre-pandemic levels. Over 90 percent of nurses said they are considering quitting their jobs by the end of 2022 in a survey, with 72 percent of nurses stating they had already experienced burnout before March 2020. In addition, the increased stress that doctors have experienced is resulting in worse patient care – with 28% of doctors who reported burnout sharing that the quality of care they are providing has significantly declined. 

We are amid a mass healthcare provider exodus, and, according to estimates, each instance of physician turnover costs healthcare organizations at least $500,000, and each instance of staff registered nurse (RN) turnover costs $46,100. Without proper staffing, hospitals are at risk of closure and patients’ health is at risk of worsening. 

The Cost of Hospital Closures 

Before the pandemic, hospitals closed for several reasons, including insufficient staffing, lack of funding, and/or having a large uninsured patient population. Since March 2020, 21 hospitals across the United States, predominantly in rural areas, have closed. Health systems are still recovering from the significant loss of revenue from canceled appointments – according to a report from The Chartis Center for Rural Health, 82 percent of the rural hospitals surveyed said suspension of outpatient services resulted in a loss of at least $5 million per month. 

So, what happens when hospitals and health systems close? 

Rural areas experience more Covid-19-related deaths than urban communities and public health experts attribute these deaths to the rampant hospital closures, as well as a general lack of healthcare providers. It is a vicious cycle: Covid-19 strains hospital systems, healthcare professionals leave, hospitals close, and more patients will die from infectious diseases like Covid-19, the flu or respiratory syncytial virus (RSV) – not to mention the other reverberating public health complications that come as a result of these closures. Vaccinations have helped these hospitals stabilize, but to keep up with covid fatigue and the ever-evolving variants we need a variety of treatments in our arsenal. 

More Covid-19 Treatments Will Bolster Struggling Health Systems  

Increasing the number of vaccinated individuals around the world, in addition to broadening access to effective non-vaccine treatments, such as antivirals and monoclonal antibody therapies, will significantly lessen the impact of the disease on individuals and lessen the burden on the healthcare system. Antiviral treatments have proven to reduce hospitalization, but diversity in treatments is essential to keep up with the ever-evolving Covid-19 variants. Dr. Andrew Pavia, chief of pediatric infectious diseases at the University of Utah Health, was quoted on the effectiveness of antivirals: “If there is anything we know about viruses and antiviral drugs is that eventually, we will see some sort of resistance.” For the time being, antivirals are effective – this is not a call to leverage one type of therapy over another – this is a call to help patients and our health systems survive by equipping healthcare professionals with as many treatments as possible. 

One such treatment that has proven highly effective when applied properly are neutralizing monoclonal antibody therapies. Like antivirals, monoclonal antibodies reduce hospitalization, the risk of death, and shorten the length of the infection – resulting in better patient outcomes and stronger health systems. 

According to Yale Medicine, it is estimated that about three percent of the United States population, or up to 25 million individuals, is considered moderately-to-severely immunocompromised, making them more at risk for serious illness if they contract Covid-19, or other viruses. Monoclonal antibodies are a highly safe and efficacious treatment, which is extremely important for this vulnerable population, especially as a complement to vaccines for prevention. An infusion can reduce the risk of hospitalization by 80 percent or more in a high-risk person, and unlike antivirals, monoclonal antibodies target specific parts of the virus spike protein leading to fewer side effects and interactions with other drugs. 

Collaboration between the government and the biotech industry will be essential for creating a portfolio of therapies to treat a variety of patient profiles who experience a range of Covid-19-related health issues. With our healthcare systems in such a precarious state, investing resources in the development of these treatments will prepare hospitals for future variants that threaten the health of our nation. The hope is that by bulking up our Covid-19 hospital response strategy, our already volatile health system will have a chance to recover, increase individuals’ access to quality healthcare, and ensure a healthier population. 

About Eugene Y. Chan, MD 

Dr. Chan is a physician-inventor. He is currently Chairman, Co-Founder of Abpro, CEO of rHEALTH, and President, CSO of DNA Medicine Institute, a medical innovation laboratory.  He has been honored as Esquire magazine’s Best and Brightest, one of MIT Technology Review’s Top 100 Innovators, and an XPRIZE winner. His work has contributed to the birth of next-generation sequencing, health monitoring in remote environments, and therapeutics. Dr. Chan holds over 60 patents and publications, with work funded by the NIH, NASA, and USAF.  Dr. Chan received an A.B. in Biochemical Sciences from Harvard College summa cum laude in 1996, received an M.D. from Harvard Medical School with honors in 2007, and trained in medicine at the Brigham and Women’s Hospital.  He is one of few individuals who has been in zero gravity. 

At this year’s World Economic Forum in Davos, the topic of the COVID-19 pandemic and its destructive impact was central to many of the discussions that took place. Among them, was the issue of vaccine hesitancy around the world, especially in underdeveloped nations such as those in Africa. According to Africa CDC, as of September 2022, Africa, the second most-populated continent, has only vaccinated 21% of its people; an inadequate number In comparison to other populated countries such as India (65%) and China (89%). Even in the United States, where vaccination misinformation ran rampant throughout the pandemic, 67% of the population has been fully vaccinated against COVID-19. 

Even though several effective vaccines are available to combat the COVID-19 pandemic, wide disparities in vaccine distribution and acceptance rates between high- and low-income countries are major threats to achieving population immunity. It’s easy to blame low vaccination rates on community unwillingness and distrust, but this may be rushing to a conclusion that is not supported by enough data. We can only properly assess the true extent of hesitancy if we are providing equitable large-scale access to vaccines and delivering them in a culturally and linguistically appropriate manner. Partnerships and innovation is how Africa can achieve superior vaccination results with its limited resources.

The vaccination challenge in Africa is nuanced 

The COVID-19 pandemic hit Africa hard and overwhelmed the capacity to test for and treat the disease, highlighting existing gaps within its national health systems. Health resources are unevenly distributed and often of poor quality. According to a 2021 report from AHAIC, only half (52%) of African citizens, about 615 million people, have access to the healthcare they need. The World Health Organization estimates that in the majority of African countries, there is one hospital per one million people, one doctor per 10,000 people and one hospital bed per 10,000 people. A lack of resources (money, infrastructure, equipment, skilled personnel), weak systems and overly centralized reactive models of delivery (patient must go to the healthcare, not healthcare going to the patient) pose a massive challenge to effective access and service delivery in Africa. These challenges are complicated by the large demand from a massive population, socioeconomic hardships, and cultural and linguistic barriers to care. While the lack of adequate resources is a problem, it’s also a massive opportunity to avoid the mistakes of others and build a better, more equitable and effective healthcare system across the continent. 

Equitable and effective healthcare through partnerships

Partnerships and innovation are the only ways Africa can achieve superior health outcome results with markedly fewer resources. Partnerships with NGOs, FBOs, the private sector and its local communities can provide an immediate capacity boost that the country’s government lacks.

First, we need to reinvent the healthcare delivery model from one that expects people to come to the vaccine to one that takes the vaccine to them. In many poorer, rural areas, the financial and personal cost of accessing healthcare far away from home is simply too high. A round trip to the health facility may involve multiple transfers and take a whole day or sometimes more. Individuals have to choose between the cost implications of either reporting to a job or taking the time off to travel to a clinic to get the vaccination. Those with children have to find affordable and safe childcare options. Without the proper education on the threat of a disease, it’s much easier to assume the threat is not worth the inconvenience or the potential lost income. Due to the multiple boosters required, it is simply unrealistic to expect people to do this multiple times for any disease, let alone a disease they know little about.

There are many safe spaces in communities such as schools, houses of worship, workplaces and pop-up space options that can be used as extra screening, testing and vaccination sites. Private companies can support some of the required cold-chain transportation and storage requirements. And finally, there is a large potential workforce that can be rapidly on-boarded and deployed across the spectrum of need- this includes private, NGO and FBO medical and other supply chain-related personnel such as doctors, nurses, pharmacists, drivers and security personnel.

Thirdly, we must combine 21st-century technology with grassroots efforts. Artificial intelligence, big data and cloud computing can help solve the challenges associated with ensuring health facilities have adequate resources, targeting resources for the highest impact, reducing wastage and predicting ahead where the next threats are going to occur. Innovative low and high-tech solutions exist to solve challenges associated with transport (e.g., motorcycle and bicycle delivery) and cold chain management. There are also numerous green affordable technological innovations to provide electrification to rural health clinics. Many of these options offer the dual benefit of creating jobs that can stimulate skills development and job creation in the areas where it is most needed.

The BroadReach team in South Africa has had the fortune of working in collaboration with USAID and the South Africa Department of Health to aid in the rollout of COVID-19 vaccination to clinics within rural communities, where vaccination levels were 25% below the national average. Extensive education and mobilization was done through trusted local leaders and intermediaries in each community prior to the arrival of the actual vaccines. Communities were informed well ahead of time as to when and where the vaccines would be made available. Clear plans were made with employers like farm owners ahead of time to mobilize their workers and either allow vaccinators to come and perform the vaccinations at the worksite or to allow their workers to leave the site to be vaccinated.

Over the initial two months of the program, BroadReach helped to vaccinate more than 50,000 people. With this targeted approach, a success rate of over 90% was across the workforce of farms that were targeted. This radical movement of the needle indicates that a well-prepared community given convenient access shows a high willingness to be vaccinated and that true hesitancy, although present and possibly growing, is not yet the overriding determinant. 

Finally, although strong sustainable local long-term healthcare financing vehicles like National Health Insurance (NHI) will provide the means to ensure more Africans have access to healthcare, this is decades in the making. In the short term, partnerships and collaboration can go a long way in offsetting costs, better rationing the supply and leveraging scarce resources and expertise. For example, if Africa negotiated and procured tests, vaccines and supplies as a continent instead of 54 disparate individual countries, all countries could be assured of the best possible price. Partnerships structures that bring together public health expertise, donor financing and manufacturers can also go a long way in addressing some of the large immediate gaps while the continent develops the much-needed local capacity in manufacturing. A good example of this is the African Vaccines Acquisition Trust (AVAT) in coordination with the African CDC was able to obtain 40% of Africa’s COVID vaccine needs in 2021. 

Hesitancy: a convenient scapegoat

Saying that simple hesitancy is the cause of low vaccination rates in Africa ignores the access issues across the continent. There are many structural factors on the demand and supply side that constrain health systems in Africa. Equal access to quality care, education and financial support are all key components needed in order to improve the systems that currently exist. Governments cannot do this alone. That said, we can do a lot better with what we have if we align behind effective delivery models that improve access and embrace the right innovations and partnerships that allow for intentional, controlled and rapid large-scale mobilization and deployment of all actors who can contribute meaningfully to the mission. These partnerships are the key to expanding the last-mile delivery of health services and will solidify efforts to achieve long-term health access for all. 

About Dr. Ernest Darkoh

Dr. Ernest Darkoh is a founding partner of the BroadReach Group. He is an internationally respected expert in strategic planning, systems and large-scale health system program implementation. His recent work focuses on using new cutting-edge technologies to radically improve healthcare delivery and catalyze broader development sector outcomes.

What You Should Know:

– Andreessen Horowitz (a16z) Bio + Health fund today announced a strategic partnership with Bassett Healthcare Network, an integrated healthcare system in central New York state.

– The strategic partnership aims to leverage digital healthcare technologies from a16z’s portfolio companies to address the inequities and systemic challenges of delivering high-quality healthcare to rural patient populations through Bassett Healthcare Network.

Leveraging Digital Health to Enhance Patient Experience

Bassett Healthcare Network, whose history dates back more than a century, today provides care to thousands of people annually across five hospitals, more than two dozen community health centers, and over twenty school-based health centers across a 5,600 square mile service area. Through this partnership, Bassett Healthcare Network will have access to the companies a16z Bio + Health has backed as well as the broader a16z ecosystem, which comprises innovative companies in relevant fields including enterprise tech, fintech and consumer services. The a16z and Bassett teams will also collaborate to identify emerging areas of unmet need that could benefit from technology-enabled solutions.

The partnership between the two organizations is an element of Bassett Healthcare Network’s vision to leverage digital health to advance the patient experience, assure financial sustainability and position the organization for long-term growth. Already, several collaborations are underway with a16z’s portfolio of companies specifically in the areas of automation, clinical AI and home health; the a16z Bio + Health portfolio can be viewed here. The firm backs bold entrepreneurs who are engineering biology and reimagining healthcare, investing in founding teams from seed through growth stage. Bassett Healthcare and a16z have formed an executive committee for the partnership to explore innovative technologies and platforms, align priorities and oversee implementation of the related tech-enabled transformation.

“Bassett Healthcare Network is doing transformative work at the intersection of digital and rural health,” says Paul Uhrig, Chief Legal and Digital Health Officer for Bassett Healthcare Network. “This partnership with a16z and their portfolio companies opens the door for Bassett to not just better serve our patients but also create a framework and infrastructure that help build healthy rural communities across the country.”

We are witnessing an accelerated pace of amazing breakthroughs and advancements in cancer care today, with new treatments emerging almost weekly and unprecedented opportunities to help improve patient outcomes every day. However, if a doctor is not working in an academic setting, reading every new paper, and recruiting patients for new studies, how can they be expected to keep up with the latest treatments and approaches to specific cancers? When a community oncologist sees a patient with an unfamiliar cancer diagnosis, they need a way to get timely, trusted advice on the best treatment plan. We have a tremendous opportunity to use modern technology to share medical information, and I’d like to examine some promising approaches to exchange knowledge between Academic Medical Centers (AMC) and Community Oncology Practices (COP).

Breakthroughs in molecularly targeted therapies and immunotherapy have revolutionized the cancer treatment landscape for patients. More than 50 novel anti-cancer therapies were approved in 2020, a five-fold increase over the past decade. That’s almost one new therapy a week. While the pace of progress is impressive, the need for care is also increasing. The CDC estimates that the number of cancer cases will increase by 49%, from 1.5 million annually in 2015 to 2.3 million in 2050.

There are approximately 13,365 licensed oncologists in the US today, and only 10.5% of those physicians practice in rural areas, according to the American Society of Clinical Oncology’s 2022 workforce snapshot. At the same time, about 80% of cancer care occurs in community health centers. 

The community oncologists who provide the majority of cancer care may treat a wide variety of malignancies every day, and may often see 30 patients with 30 different diagnoses per day – a vast range of diseases and potential treatments. Many therapeutics target a particular gene mutation or specific protein and are paired with diagnostic tests that probe tumor cells or blood for these biomarkers. Knowing which new treatment is best for a specific patient can require overwhelming work by COP doctors to stay up to date on a broad range of cancer types.

Patients living in rural areas can also find it challenging to see a specialist. The National Rural Health Association found that in urban areas, there are about 263 general specialists per 100,000 people – but only 30 in rural areas. This gap severely restricts the ability for patients to meet with subspecialists or find out about new trials. 

In the 2000’s, HIPAA mandated standardized EHRs, which enabled more efficient medical care (eventually). The COVID-19 pandemic pushed many in the medical community to utilize telehealth technologies for safer patient interactions. While there is no question that oncology has become very high-tech, when it comes to digital communication, it is as if the revolution in mobile devices, social networking and information technology has passed medicine by. 

Doctors may be able to scan forums, pour over guidelines and read academic papers, but the ability to find the right solution for a particular patient often requires advice from their local network of COP colleagues. Yet, most patients cannot receive the latest cancer treatments without having access to oncology subspecialists based at an AMC. If we really want to work towards improving the health care system, we need better ways to share information that improves outcomes in community settings.

Today’s options – curbside consults, tumor boards, external referrals

Community oncologists need answers fast when they face a tricky treatment decision. It can be a matter of life or death. Cancer is uniquely complex, with many types and sub-types, and every patient has distinct circumstances. Cancer’s complexity makes it challenging for a community oncologist to decide between multiple treatment paths, unless they have expertise in that specific cancer subtype.

Finding the right oncology subspecialists can be nearly impossible for community oncologists working within their limited personal networks. When faced with a quandary in deciding on a treatment plan without local support, many doctors either refer patients to subspecialists or submit their cases to a formal tumor board for guidance. Sending a patient to subspecialists may involve hundreds of miles in travel and weeks away from home for many patients, and should be used only after thoughtful consideration. At the same time, organizing and scheduling a tumor board to review one case is cumbersome, requiring the coordination of the schedules for multiple practitioners. Moreover, a tumor board may not get scheduled according to the patient’s ideal timeline. When clinicians need quick advice about the best treatment option for their patients, many take advantage of the so-called “curbside consult” and ask their immediate peers for feedback. 

Tumor boards and typical curbside consults pull from a limited pool of colleagues. A “curbside” gets its name from the serendipitous hallway or sidewalk meeting of two colleagues, and not from the targeted insight of a physician with deep knowledge of the patient’s issue. Worse, tumor boards and hallway meetings are both “synchronous” approaches to knowledge sharing – requiring all parties to meet in real-time to address the problem – making scheduling more difficult. Patient care should not depend on the convenient relationships of their physician. Rather, it should benefit from the latest knowledge about the patient’s diagnosis and treatment. 

Doctors can confer within their own medical group, yet there is currently no efficient means for treating oncologists to access the knowledge they need about the most innovative treatments across the field of medicine.  An “asynchronous” communication method borrowed from email and other online communication might allow doctors to address questions on their own schedule. Existing technology can be used to virtualize the curbside consult and the traditional tumor board.  

Connecting COPs and AMCs can improve outcomes

Several projects have looked at connecting experts over large distances via remote consultations. Recent innovations are producing effective ways to share knowledge in a HIPAA-compliant context. The best approach I’ve seen comes from several pilot programs connecting community HCPs with outside experts and researchers. In addition to providing new options, COPs may be able to enroll patients in specific new trials so their patients can access the latest available medical treatments.

These programs have all helped to mitigate setting-based discrepancies by helping AMCs and COPs collaborate via e-consultations and video conferencing. This approach is especially beneficial for doctors working in rural areas like the U.S. Southwest or Rocky Mountain region. Imagine how challenging it can be for patients in rural towns to access specialized care. 

Project ECHO was created to ensure the right knowledge exists at the right place at the right time for patients, initially focused on hepatitis C in New Mexico. A recent scoping review of Project ECHO looked at 15 studies that connected remote doctors to centralized specialists and found that this approach eliminated almost half of ER visits. The authors noted, “For patients in rural communities, the limited presence of specialists can be a significant barrier to comprehensive, appropriate, accessible and timely care.” The review found that approximately half of the presented cases resulted in immediate changes in the care of the patients whose cases were reviewed.

Can this same approach achieve similar results within oncology? I believe it can. 

COVID-19 introduced new challenges for healthcare providers. Social distancing, masking, and staff shortages dramatically impacted our ability to deliver high-quality care. Furthermore, routine screening and preventive medicine visits were delayed, resulting in more advanced disease, and negatively impacting cancer outcomes. Practice standards changed during the pandemic with the expansion of remote medicine, shorter treatment regimens and delayed elective treatments. The cancer community has adapted to COVID-19 by adopting new technologies and accelerating the utilization of digital health solutions. However, these changes raise even more questions from community oncologists.

AccessHope by the City of Hope studied how remote experts can provide better treatment recommendations for COPs. One key innovation for the program was the use of an asynchronous review of patient records by subspecialists, who then wrote a report listing potential treatment options for the local oncologist to consider. The program identified evidence-based protocols that changed the patient’s treatment in 28% of the 101 patients studied, and suggested improvements to the treatment plan in 92% of patients.

We believe that the asynchronous peer communication introduced by AccessHope improves upon traditional meeting formats that are so cumbersome for busy clinicians. However, a one-time expert review and opinion where local doctors can receive recommendations, but not necessarily ask follow-up questions disincline COP physicians from interactive dialog with AMCs. An ideal solution would permit asynchronous iterations between the community oncologists and the subspecialist.

Earlier this year Cigna announced a program with the National Cancer Institute, connecting community oncologists with national subspecialty experts within the insurer’s network. An initial pilot found that among the reviewed cases, 40% of patients with complex cancers benefited from updated treatment guidance.

When we look at the many challenges facing oncology care, from an increasing population of patients to a steady flow of novel treatments, there’s a clear need to connect COPs and AMCs across practices so community doctors can benefit from the latest knowledge coming from academic experts. 

We see glimmers of hope in some of these ongoing and pilot projects, mainly driven by the rapid growth in options and the expansion of telehealth and remote treatment delivery methods. We can text a friend on the other side of the world today, but finding the right oncology subspecialists is still a challenge – we need to change this.  

Cancer is one of the most fragmented, specialized, and complex medical fields today. Community oncologists deliver excellent cancer care in the local setting, but as generalists, it is impossible to keep pace with the rapid changes across all subspecialties. A modern, informed, and efficient process can improve outcomes for cancer patients and care providers. 

If we bridge experiential insights from subspecialized oncologists with on-the-ground insights from community oncologists, we can improve outcomes for cancer patients across the country. 

We have an opportunity to help eliminate the disparity in cancer care for populations living outside of major medical centers. This will directly impact the care of thousands of patients, create new ways to accelerate the spread of knowledge across the medical community and advance oncology care for everyone. The scale of the problem is only going to grow.

About Corey Zankowski

Corey Zankowski, Ph.D., is CEO & Co-Founder of Primum, a platform that connects community oncologists with oncology sub-specialists to help with complex treatment
decisions and accelerate the adoption of new and innovative therapies. Corey possesses over 20 years of experience in the oncology medical device industry. His vision and ability to execute in technology innovation have shaped the field of radiation oncology.

What You Should Know:

– Homeward raises $50M Series B funding round co-led by ARCH Venture Partners and Human Capital.

– The funding round also includes participation from General Catalyst, which led Homeward’s Series A funding, and Lee Shapiro and Glen Tullman, Co-Founders of 7wireVentures, one of the country’s most successful early-stage healthcare venture funds.

Value-Based and Comprehensive Care

Americans living in rural communities are experiencing increasing health disparities due to accelerated rural hospital closures and physician shortages. In fact, Americans living in rural communities suffer a mortality rate 23 percent higher than those in urban communities due to the lack of access to quality care. Homeward is rearchitecting rural health and care for the 60 million Americans living in rural communities. As a new value-based care provider, Homeward employs multidisciplinary care teams, available in-home, virtually, and on the ground via mobile care units, with remote monitoring to better connect patients to high-quality, affordable, and comprehensive care.

Homeward is an in-network provider that deploys an integrated care model including mobile, community-based care and technology. Through this approach, Homeward improves convenient access to care, supports ongoing health management, and appropriately triages clinical services to help healthcare professionals practice at the top of their licensure. Homeward providers see members in mobile clinics throughout the community, virtually, and in members’ homes. These teams conduct physical exams, perform diagnostic tests, and integrate with regional health systems, local physicians, and specialists to provide care coordination, referring members to local in-person services as needed. Using cellular-based remote monitoring, Homeward keeps members connected to their multidisciplinary care team wherever they are, and uses the information to deliver a deeply personalized care experience and positive health outcomes.

VBC Partnership with Priority Health

Homeward also announced its first value-based care (VBC) partnership with Priority Health to deliver comprehensive care to Medicare Advantage members in rural Michigan. The company will use the new funds to accelerate expansion into new markets through value-based contracts with health plans. Homeward will also invest in scaling its on-the-ground and virtual multidisciplinary care teams, including specialty care, as it expands into additional states in the coming months.

“Homeward has combined an impactful mission with what we believe to be an incredible leadership team,” said Armaan Ali, co-founder and chief executive officer of Human Capital. “We’re impressed with their early success as they continue improving access to care while also striving to uplift communities within the markets they serve. We’re excited to help build what we feel is a world-class team at Homeward.”

What You Should Know:

– Appalachian Regional Healthcare (ARH), based in Lexington, Ky., will use Biofourmis’ virtual care and AI-based predictive analytics technology to support a new Rural Home Hospital program delivering acute hospital-level care inside patients’ homes–including a clinical trial studying this care model in rural areas.

– ARH joins Blessing Health System—which is also using Biofourmis’ solution—as one of only two U.S. participants selected for the Rural Home Hospital program. The program will enable caregivers to deliver hospital-level care in patients’ homes across a range of acute conditions instead of admitting them to a medical facility. Randomized controlled trials have demonstrated that these programs, utilizing Biofourmis’ technology, can lower hospital readmissions by 70%, with a 38% reduction in healthcare costs.

The Rural Home Hospital Program

The Rural Home Hospital program—a joint venture between the @Harvard T. J. Chan School of Public Health and @Brigham and Women’s–will apply lessons learned from earlier initiatives to build, launch and evaluate a program that serves the unique care needs of rural residents across the U.S. The program addresses a high-need issue: Nearly 80 percent of rural America is deemed medically underserved by the federal government. Today, 1 in 5 Americans live in rural areas and depend on their local hospital for care, but rural hospitals are closing and consolidating in record numbers. Residents must drive farther not only for emergencies but for the kinds of diagnostic tests and treatments usually provided in a hospital.

ARH and Blessing Health System in Quincy, Ill., which has also partnered with Biofourmis, were the only two U.S. participants selected for the program out of a pool of 700 applicants (Wetaskiwin Community Health Centre, Alberta Health Services in Canada is also participating in this three-year randomized controlled trial of the rural home hospital model.)

“Home hospital is a care model that has seen encouragingly positive outcomes and satisfied patients, and we believe it could make a true difference in rural Appalachia,” said Maria B. Braman, MD, MBA, ARH vice president, medical affairs and chief medical officer. “Biofourmis’ technology, which has been demonstrated to improve outcomes and decrease costs, has been successfully deployed in urban and rural home hospital programs. The solution will give us the digital health and remote clinical support we need to help make our program a success so that we can eventually expand to more hospitals and patients.”

Rural Home Hospital enables caregivers to deliver hospital-level care in patients’ homes across a range of acute conditions instead of admitting them to a medical facility. Shifting acute care to the home allows hospitals to optimize capacity and ensure that hospital beds are available for more critically ill patients. Other outcomes include higher patient satisfaction, lower readmission rates and fewer hospital-acquired conditions, as well as a reduction in the overall cost of care. For example, one randomized clinical trial leveraging Biofourmis’ technology found that a hospital at home program reduced hospital admissions among participating patients by 70% and lowered costs by nearly 40%. For rural communities, home hospital programs also reduce patient and family travel burdens and out-of-pocket costs associated with facility-based care.

ARH is launching their program with 10 virtual beds, which will equate to approximately 30 patients per month. Patients will be equipped with wearable biosensors, blood-pressure cuffs, pulse oximeters and weight scales to collect physiologic data from home. The health system is also leveraging Biofourmis’ remote clinical support team that offers registered nurse-level monitoring for patients overnight from 7 p.m. to 7 a.m.

Remote Clinical Support and Real-Time Insight

ARH providers will visit patients in their homes and utilize Biofourmis’ technology to remotely monitor them through the biosensors and a patient-centric companion app. Continuously streaming data from the wearables and electronic patient-reported outcomes (ePROs) are fed into the Biofourmis artificial-intelligence (AI)-powered Biovitals® Analytics Engine, which establishes a personalized patient baseline via machine learning and delivers real-time notifications to providers as patient conditions change.

The Rural Home Hospital project will apply lessons and processes learned from early home hospital entrants such as Brigham and Women’s to help build, launch and evaluate a nationwide program to serve the unique care needs of rural residents across the United States. Rural Home Hospital will include patients with acute exacerbations of conditions such as heart failure, chronic obstructive pulmonary disease, asthma, gout, chronic kidney disease and others. For the research study, roughly half of the participants will receive facility-based inpatient care and the other half will receive home-based care.

What You Should Know:

– Homeward, the comprehensive rural care provider network launched by former Livongo titan, Dr. Jenny Schneider, has announced a partnership with Rite Aid to deliver onsite care to rural Americans, starting with Medicare.

– Homeward’s work with Rite Aid will also support the pharmacy retailer’s recently announced plans to double-down on pharmacy services, with increased focus on expansion in underserved communities. This is also Rite Aid’s first push to bring real clinical services into their stores. 

Connecting Underserved Seniors with Providers

Pharmacists are among the most trusted members of a local community – especially for the more than 50 percent of Americans living with a chronic condition. Today, Rite Aid has over 6,300 pharmacists across 2,300 locations, including 700 pharmacy locations in rural areas, many of which are healthcare deserts with limited access to doctors and hospitals.

Beginning this summer, Homeward and Rite Aid will partner to connect underserved seniors with providers and other clinical services. Rite Aid pharmacists will be able to introduce Medicare-eligible customers to Homeward’s clinical services, including annual wellness visits, screenings, and risk assessments. In addition, Rite Aid will host Homeward’s mobile care units at select rural Michigan locations to provide care and services to underserved communities with the goal of expanding to additional markets nationwide.

Homeward In-Network Services

Homeward deploys an integrated care model that combines mobile, community-based care with centralized clinical oversight and ongoing care management. Homeward providers see members both in community-based, mobile clinics and in members’ homes, as preferred. Homeward care teams conduct physical exams, perform basic diagnostic tests, and when needed, refer members to regional health systems and specialists if more complicated diagnostics are required. Homeward’s technology-enabled care model also includes virtual visits and in-home, cellular-based remote monitoring that keeps patients connected to their multidisciplinary care team.

Homeward will provide in-network services, including primary care and specialty care beginning with cardiology, in Q3 2022 for individuals covered by Medicare and Medicare Advantage plans. The company will set aside the fee-for-service model – which defaults to in-clinic care settings and limits the ability to leverage new, innovative technology and services – in favor of a value-based, total capitation model.

What You Should Know:

– Blessing Health System, an integrated rural health system selects Biofourmis, a virtual care and digital therapeutics provider to launch its own home hospital services.

– As part of the selection, Biofourmis is supporting the health system with its turnkey, end-to-end, home hospital solution for participation in the Rural Home Hospital project. 

Delivering Acute-Level Hospital Care Inside Patients’ Homes

This new program allows caregivers to deliver hospital-level care in patients’ homes across a range of acute conditions instead of admitting them to a medical facility. This allows them to optimize capacity and ensure that hospital beds are available for more critically ill patients. Other outcomes include higher patient satisfaction, lower readmission rates and hospital-acquired conditions, as well as a reduction in the overall cost of care. For rural communities, home hospital programs also reduce patient and family travel burdens and out-of-pocket costs associated with facility-based care.

Blessing Health System providers will visit patients in their homes and utilize Biofourmis technology to remotely monitor them using biosensors and a patient-centric companion app. Continuously streaming data from the wearables and electronic patient-reported outcomes (ePROs) are fed into the Biofourmis artificial-intelligence (AI)-powered Biovitals® Analytics Engine, which establishes a personalized patient baseline via machine learning and delivers real-time notifications to providers as patient conditions change.

“Participating in a home-based hospital program in our rural area required choosing an experienced and knowledgeable technology partner offering a comprehensive solution that we could easily expand as the initiatives added more patients and more conditions,” said Mary Frances Barthel, MD, MHCM, SFHM, FACP, Chief Quality and Safety Officer, Blessing Health System. “Although we considered several solutions, Biofourmis offered the most comprehensive, highly scalable and user-friendly solution. We are confident that it will enable us to successfully participate in this program, but more importantly, deliver the high-quality care that our patients expect in the comfort and convenience of their homes.”

Rural Home Hospital Program Background

To date, most home hospital programs serve primarily urban areas. Over the next three years, the Rural Home Hospital project will apply lessons and processes learned from those earlier initiatives to help build, launch and evaluate a nationwide program to serve the unique care needs of rural residents across the U.S.

The Rural Home Hospital was created by a joint venture of the Harvard T. J. Chan School of Public Health and Brigham and Women’s Hospital in Massachusetts. Blessing Health System was one of only two U.S. participants selected out of a pool of 700 applicants. Rural Home Hospital will include patients with acute exacerbations of conditions such as heart failure, chronic obstructive pulmonary disease, asthma, gout, chronic kidney disease and others. For the research study, roughly half of the participants will receive facility-based inpatient care and the other half will receive home-based care.

Blessing Health System is also one of 92 health systems in the nation to receive the Acute Hospital Care at Home waiver, with 204 hospitals in 34 states participating (as of March 17). The Acute Hospital Care at Home Program provides 1:1 Medicare reimbursement parity for hospitals that admit patients with a wide range of acute conditions to their homes. As with the Rural Home Hospital project, patients receive a combination of in-person and virtual visits from providers, as well as around-the-clock monitoring and communication.

What You Should Know

– Homeward, a new company focused on improving access to high-quality, affordable primary and specialty care in rural communities launches with an initial $20M investment.

– The organization is rearchitecting care for rural Americans who have a 23% higher mortality rate than those in urban communities.

Homeward – a San Francisco, CA-based mobile, in-person, and telehealth hybrid care model (with specialty and primary care providers) for people in rural communities, today announced it has emerged from stealth with $20M from General Catalyst. The funding was led by General Catalyst, whose health assurance thesis aims to transform the delivery of healthcare and champion health access and equity for people everywhere. Homeward is the first investment in General Catalyst’s new $800M Creation fund, which focuses on collaborating with world-class executives to create and build new businesses in the firm’s core areas of interest.

Today’s healthcare isn’t working for rural Americans.

Today, 60 million Americans living in rural communities are facing a crisis of access to care. In the U.S. healthcare system, rural Americans experience significantly poorer clinical outcomes and higher costs. This trend is rapidly accelerating as rural hospitals close and physician shortages increase, exacerbating health disparities. Americans living in rural communities suffer a mortality rate 23 percent higher than those in urban communities, in part because of the lack of access to quality care

Led by key executives who drove Livongo’s success, Homeward will be the first comprehensive provider to take on full risk in rural markets. Homeward delivers a new, hybrid model of technology and services that will immediately increase access to primary care and specialty services, beginning with cardiology. Homeward employs a multidisciplinary care team, available both virtually and on the ground via mobile care units, with in-home remote monitoring that keeps patients connected to their care team. Rather than rely on broadband in these markets, Homeward will employ cellular-based monitoring devices and virtual services to better connect to even the most remote members

For example, under a traditional care delivery model, a patient suffering from heart failure is often diagnosed only after they arrive in the emergency room. Homeward will rearchitect this typical patient journey using a sequence of more proactive measures, including remote patient monitoring to detect the signs of a heart problem early; followed quickly by an in-home visit to test, diagnose and treat the problem; followed by virtual visits until the issue is resolved.

Homeward’s commitment to innovation extends to payment for care. It will replace the fee-for-service model – which defaults to in-clinic care settings and limits the ability to leverage new, innovative technology and services – in favor of a value-based model. Homeward will embrace the responsibility and risk of improving the health of its patients as well as their care experience – all while reducing costs.

And by working with existing, trusted healthcare provider networks, Homeward will augment rather than displace local primary care physicians and hospitals. When needed, Homeward will refer its members to local facilities for appropriate and timely care, thereby reducing total cost of care and avoiding costly admissions to hospital emergency rooms. The company will initially partner with regional Medicare Advantage plans, many of which are seeking innovative solutions to engage traditionally hard-to-reach members living in rural communities.

“Homeward was created to provide high-quality and affordable care for people who live in rural communities using a model that is designed to meet their unique needs,” said Dr. Jennifer Schneider, CEO of Homeward. “We believe that by combining easy-to-use technology, evidence-based care delivery, in-home and in-community services, and aligning the care model to the right incentives, we’ll be the first to offer a new approach that provides the high-quality care that everyone deserves – no matter where they live.”

Executive Leadership

As a physician and business leader, Dr. Schneider has focused her career on finding innovative solutions to some of the healthcare system’s most challenging problems. In her most recent role, she shepherded Livongo as president through its growth stage, IPO and subsequent $18.5 billion merger.

Homeward features one of the strongest leadership teams in the industry, including:

– Amar Kendale, former chief product officer at Livongo, who joins as co-founder and president

– Dr. Bimal Shah, former chief medical officer at Livongo, who joins as chief operating officer

– Dr. Aaron Friedkin, former senior vice president of care delivery transformation at Blue Cross Blue Shield of Michigan, who joins as chief revenue officer, and

– Brian Vandenberg, former general counsel at both the American Medical Association and Livongo, who joins as chief administrative officer and general counsel

What You Should Know:

– Marshfield Clinic Health System, one of the largest rural, integrated health systems in the country, is partnering with NowPow and a broad range of community organizations to connect patients with local resources to improve their health and quality of life.

– Marshfield Clinic Health System and NowPow are working together to build a comprehensive network of agencies and programs serving northern, central and western Wisconsin, ensuring that individuals have access to all the latest and most relevant community-based resources.

NowPow’s screening and referral platform will connect patients with community-based organizations to address social factors that affect health

Marshfield Clinic Health System will leverage NowPow’s personalized community referral platform to identify the social determinants of health (SDOH) needs of patients and community members and provide tools to connect individuals with resources to address these needs.

This initiative supports the efforts of Marshfield Clinic and its affiliated health plan, Security Health Plan, to embrace an accountable care model that has been able to lower health system care costs thereby decreasing out-of-pocket care costs for patients and returning money to communities the Health System serves. The NowPow platform’s ability to track referrals and encourage individuals to fulfill their self-care goals fosters engagement and provides insight into referral outcomes. This data will help efforts to map unmet needs in communities, inform future expansion of the referral network and provide a more comprehensive picture of an individual’s health needs.

“The pandemic made more obvious than ever the pervasive inequities that still define life for far too many Americans,” said Dr. Susan Turney, CEO of Marshfield Clinic Health System. “We are proud to be part of a paradigm shift that recognizes a person’s health for the complex picture it is, and works to address the structural inequities and socioeconomic factors that affect it. It is a privilege to partner with NowPow on this work to connect patients and families with needed resources so they can attain their full health potential.”

What You Should Know:

– Cerner launches new Video Visit platform for CommunityWorks clients at no cost through 2021 to support rural health organizations.

Today in honor of National Rural Health Day, Cerner has announced the launch of their new telehealth offering to support rural health organizations through these tough times. The Video Visit platform will be offered to Cerner CommunityWorks℠ clients at no cost through 2021. The platform, which was announced at a virtual event for community and critical access hospitals earlier this week, aims to help make it easier for those living in rural areas to see providers. Initial sites have already started to go-live and are seeing strong adoption.

The CDC estimates about 46 million Americans live in rural areas, which face distinctive challenges during the COVID-19 pandemic. Key features of Cerner’s NEW CommunityWorks Video Visit Trial Program include:

•  Video visits are part of a comprehensive suite of virtual healthcare solutions that enable organizations to provide near real-time, interactive communications between consumers and clinicians from any location.

•  Delivers a comprehensive, integrated experience that empowers consumers to be active participants in their health and care.

•  Consumers receive convenient, quality care using their modality of choice.

•  FREE and rapid implementation and trial of Cerner Video Visits until 12/31/21.

•  Expedited implementation taking place in days, not weeks or months.

“Throughout the pandemic, we’ve seen a significantly increased desire from both consumers and health care providers for virtual health solutions and rapid innovation and adoption of existing products. One of those products is Cerner’s Virtual Visit solution that we are now offering free of charge to our eligible CommunityWorks clients through the end of 2021. This trial program delivers a comprehensive, integrated experience that empowers consumers to be active participants in their health and care. I am excited to formally launch this on the 10th annual National Rural Health Day as we celebrate the Power of Rural and I look forward to helping our clients provide another way to adapt to, and overcome, challenges presented by this pandemic in order to provide the best care and experience for their patients,” said Mitchell Clark, President, Cerner CommunityWorks, Senior Vice President at Cerner in a release statement.

What You Should Know:

– Intermountain Healthcare and Sanford Health sign a letter of intent to merge that will created a combined health system employing more than 89k people at 70 hospitals and 435 clinics across seven states.

Intermountain Healthcare and Sanford Health, one of the nation’s leading systems in rural health care delivery and clinical research, have signed a letter of intent to develop a strategic partnership. The boards of both not-for-profit organizations approved a resolution to support moving forward with the due diligence process. The organizations will enter this activity with the goal to sign a merger agreement that will bring both health systems together as a model for improving access to high-value healthcare across the U.S. The merger is expected to close in 2021 pending federal and state approvals.

The combined organization will employ more than 89,000 people, and operate 70 hospitals, many in rural communities. It will operate 435 clinics across seven states, provide senior care and services in 366 locations in 24 states, and insure 1.1 million people. The organization will have headquarters in Salt Lake City, Utah, and corporate offices in Sioux Falls, South Dakota.

“Intermountain and Sanford have a shared vision of the future of health care and have the aligned values needed to better serve more communities across the nation,” says Marc Harrison, M.D., president and CEO of Intermountain Healthcare. “This merger enables our organizations to move more quickly to further implement value-based strategies and realize economies of scale. Through coordinated care, increased use of telehealth and digital health services, we will make health care more affordable for our communities.”

What You Should Know:

– FCC releases Public Notice providing additional information and guidance for potential applicants interested in applying for its Connected Care Pilot Program.

– The Connected Care Pilot Program will provide up to $100 million from the Universal Service Fund (USF) over a three-year period to selected applicants to support the provision of connected care services.

The Federal Communications Commission (FCC) today released a Public Notice providing additional information and guidance for potential applicants interested in applying for its Connected Care Pilot Program.  The Pilot Program will provide up to $100 million from the Universal Service Fund over a three-year period to support the provision of connected care services, with an emphasis on supporting these services for low-income Americans and veterans.  The FCC will release a subsequent Public Notice with details regarding application procedures, including the timing of the application window.

Connected Care Pilot Program Background

The Pilot Program is open to nonprofit and public eligible health care providers that fall within the statutorily detailed categories of “health care provider” in section 254(h)(7)(B) of the Telecommunications Act of 1996, whether located in rural or non-rural areas.  To prepare to submit an application, eligible health care providers can take steps now to obtain an eligibility determination by filing an FCC Form 460 with the Universal Service Administrative Company (USAC) to obtain a Health Care Provider (HCP) number and eligibility determination.  An eligibility determination and HCP number is required for each health care provider site that will be included in an application for the Pilot Program.  Health care provider sites that USAC has already deemed eligible to participate in the FCC’s Rural Health Care Program or COVID-19 Telehealth Program may rely on that eligibility determination for the Pilot Program.

The Commission adopted final rules for the Connected Care Pilot Program on April 2, 2020.

Specifically, the Pilot Program will use USF funding to help defray costs of connected care services for eligible health care providers, providing universal service support for 85% of the cost of eligible services and network equipment, which include:

(1) patient broadband Internet access services;

(2) health care provider broadband data connections;

(3) other connected care information services; and

(4) certain network equipment. 

The Pilot Program will not provide funding for devices.

“This year, our country has pivoted to a newer model of delivering health care, one that finds connectivity at its core, and the FCC has risen to the challenge in supporting connected care services throughout the United States,” said FCC Chairman Ajit Pai.  “Our Connected Care Pilot Program will help us to look to the future and determine how universal service support can shepherd telehealth services into a new era of healthcare delivery.  Today’s Public Notice provides critical program information to help health care providers prepare to apply for this universal service program.  I’d like to thank my colleagues at the FCC for working diligently on this effort and Commissioner Carr for his leadership on this important initiative.”

For more information, download the public notice here

What You Should Know:

– Agencies sign a memorandum of understanding to establish an interagency Rural Telehealth Initiative Task Force comprised of representatives from each agency to keep rural Americans connected to vital health services.

The Federal Communications Commission (FCC), U.S. Department of Health and Human Services (HHS), and U.S. Department of Agriculture (USDA) today announced that they have signed a Memorandum of Understanding to work together on the Rural Telehealth Initiative, a joint effort to collaborate and share information to address health disparities, resolve service provider challenges, and promote broadband services and technology to rural areas in America.  This action delivers on President Trump’s recently signed Executive Order on Improving Rural Health and Telehealth Access.  The ongoing coronavirus pandemic has highlighted the critical importance of telehealth in delivering quality healthcare to rural Americans.

As part of this Memorandum of Understanding, the agencies intend to establish an interagency Rural Telehealth Initiative Task Force comprised of representatives from each agency.  This Task Force will regularly meet to consider future recommendations or guidelines for this effort and exchange agency expertise, scientific and technical information, data, and publications.

Why It Matters

Rural Americans are acutely affected by gaps in the healthcare system, from hospital closures to a lack of specialty care.  According to the Centers for Disease Control and Prevention, rural Americans, who make up more than 15% of the U.S. population, face numerous health disparities compared with their urban counterparts.  Rural Americans are more likely to die from heart disease, cancer, unintentional injury, chronic lower respiratory disease, and strokes than their urban counterparts.  Telemedicine plays an increasingly critical part in treating patients, improving health outcomes, lowering costs, and helping health care providers maximize their impact on their communities, especially in rural areas of the United States.

“From the beginning of my tenure at the FCC, I’ve heard and shared the view that telemedicine is a game-changer for rural America.  The COVID-19 pandemic has made the rural healthcare challenge even more serious and has complicated healthcare providers’ efforts to serve rural Americans,” said FCC Chairman Ajit Pai.   “More than ever, these areas of the country need enhanced connectivity to provide vital health services to residents.  With the adoption of the $200 million COVID-19 Telehealth Program, the FCC acted quickly to approve 539 funding applications for a wide array of health care providers, including community health centers, mental health clinics, and non-profit hospital systems in both rural and urban areas of the country.  This effort allowed for more patients to be treated at home, freeing up valuable hospital beds for those who most need them, and reducing the risk of exposure to the virus.  By joining forces with HHS and USDA, the FCC is extending its commitment to connect rural Americans to telehealth services—today and into the future.”

In the late 1940s, the United Kingdom was busily reassembling country and what remained of the empire in the aftermath of World War II. Among many revelations, the war had convinced Britain’s leaders of the need to provide healthcare for all in the event of calamity upending the basic functions of a civilized society. With that, the UK’s National Health Service (NHS) was born.

In 2020, all perspectives about quality and the time it takes to see a provider aside, the NHS remains quite popular among UK citizens and is an enduring source of national pride.

With the United States in the midst of its own upheaval, it’s for a related question: Might the current COVID-19 situation give rise to significant changes to the American healthcare system? 

Virtually no one thinks the correct answer is ‘No.’ Things will change. The question is how and to what extent. The healthcare system in place in the United States now is dramatically more complex than that in use by Britons after WW II. There are so many moving parts, so many things that can break. 

So, in which aspects of the current American healthcare system are we likely to see changes after COVID-19 is dealt with?

Telehealth: Someone always benefits in a catastrophe. In this case, that someone may be Zoom shareholders.

From 10 million daily users in December, Zoom rocketed to 200 million in March and nearly 300 million a month later. Much of that was healthcare related. 

Of course, Zoom is not the only direct beneficiary of coronavirus as venerable meeting platforms like WebEx and Skype, among others, have also experienced dramatic growth.

Hospitals and health systems were incrementally implementing telehealth services prior to the coronavirus outbreak, but there was no sense of urgency that accompanies a rapidly spreading virus. Since then, the federal government, states and insurance companies have allocated funds and rewritten regulation to expand the use of telehealth. 

But there are more telehealth related-issues to address, some of which have thorns. Service and payment parity across insurance companies is an issue. If telehealth is going to be a regular component of healthcare, technology gaps will have to be addressed, especially in rural areas. 

This is something the federal government recognizes. The White House recently drafted an executive order oriented around improving rural health by expanding technology access, developing new payment models and reducing regulatory burdens. The EO tasks the secretaries of health and human services and agriculture to work with the Federal Communications Commission to “develop and implement a strategy to improve rural health by improving the physical and communications healthcare infrastructure available to rural Americans.” But until Congress gets involved and provides funding for something like this, it will probably never get out of the proposal phase. 

In fact, there are enough concerns—parity, technology gaps, added costs—associated with telehealth to wonder if it will endure after coronavirus is in the rear view. Enough about telehealth benefits both providers and patients for it to stick and proliferate, but that could also be said about any number of healthcare initiatives that seem to languish for lack of coordination and political will. 

Health Insurance: This is where the NHS analogy is the most relevant. Many millions of workers are furloughed or simply laid off with the impact of COVID-19 on frontline jobs like restaurant worker, massage therapist and barista. Those who had insurance through work may not have it anymore, leaving them doubly vulnerable—no coverage, no income—to illness or accident. 

Mass unemployment episodes reveal, each time, the weakness in the patchwork employment-based healthcare insurance system we’ve sort of made peace with for decades. Sure, Medicaid exists to fill the gaps, but it may make sense to render Medicaid unnecessary, especially since its value is questionable in particular states.

“You notice the number of band-aids that Congress is having to apply to help people who have lost their jobs,” said former CMS Administrator Don Berwick, MD. “What we have now is a whole series of band-aids and special measures. What if instead, we just had universal health insurance?”

What if, indeed. Will COVID-19 be the straw that burns the bridge of employer-based health insurance, to mangle a metaphor? That may depend on how long the pandemic lasts, who is president sometime after November 3 and how much damage is done to the national fabric before economy and society start a process of repair.

Payment Models: For years now, hospitals have been in the middle of slow shift from fee-for-service care to value-based care and alternative payment models. That transition didn’t happen quickly enough to prevent most hospitals from falling into a financial chasm. If elective procedures are a big part of revenue, it follows that revenue will fall if those procedures disappear. 

To be fair, the hit to hospital finances has been catastrophic enough—more than $200 billion in losses over four months, according to the American Hospital Association—that federal government support would have been necessary even if a full pay-for-quality model had been in place.  

But the pandemic spotlights the downside of treating essential services like healthcare as though they are mere services one selects or rejects. And it exposes the folly of not making sure everyone has insurance coverage (a payer) when the individual costs for COVID-19-related hospital admission can range from $20,000 to $88,000. 

End-of-Life Care: According to one analysis, 42 percent of COVID-19 deaths have occurred in nursing homes or assisted living facilities. The families of those unfortunate souls who’ve died while in a facility have generally endured the agony of saying goodbye outside a window or over a video link. It’s hard to believe, after COVID-19, that the assisted living industry will continue as before. 

“The crisis surely will lead nursing home administrators to reconsider the way patients are cared for,” says Modern Healthcare. “Among the ideas Harvard’s [Professor David] Grabowski believes will get a longer look in the wake of the pandemic are using telemedicine services, creating specialized Medicare Advantage plans for the homes and pursuing smaller settings.”

Perhaps. And perhaps a son or daughter that remembers coronavirus will simply choose not to risk everything by putting their parent in a home. Could enough of them make such a decision that the industry contracts? Is forced to take quality care more seriously? Attracts more serious federal regulation? 

As the deaths mount, it’s hard not to give every option serious consideration. 

Supply Chain: These days we’re bickering in public and on social media (looking at you, maskless Karen throwing food in Trader Joes) about whether or not masks should be mandated. Look back with me  to February, however, and you’ll fondly recall concerns about there being enough masks at all. 

Back then we learned that the United States had exactly one mask manufacturer, and that all other masks are sourced from overseas. That it takes longer to get stuff from China than from Amarillo creates obvious potential problems when a crisis hits, but it also pits hospitals and government entities against one another and guarantees that the winner will pay more for supplies than they would in less-critical times. 

It also creates weird, unnecessary scenarios that could be avoided using coordination and leadership. The governor of Maryland, for example, used his wife’s connections to South Korea (her country of birth) to secure 500,000 coronavirus tests, which he then put in an undisclosed location and protected using national guard troops. 

What’s the remedy? 

Modern Healthcare has called for a national supply chain czar, which in other times may have just been the head of FEMA. The suggestion, however, highlights the need for a coordinated central clearing house where supplies can be ordered, managed and dispersed based on need. 

Individual hospitals, clinics and health systems can also help themselves by using a robust supply chain software system that keeps track in real time of available supplies, covers all ordering systems and methodologies, and reacts swiftly to certain thresholds. 

The uniquely unfortunate aspect of the American political system among western democracies is that, for the most part, it responds to the demands of special interests. Think about your local representative. Chances are good the shouts of specific business interests are ringing in his or her hears so loudly that little else is audible. 

As such, there is a significant danger that the American healthcare system will return, post-COVID-19, to the same dynamic it had when the virus arrived, which will be unfortunate. What we need post-pandemic is not necessarily specific changes to hospitals, clinics, insurance companies, etc., though they could be part of an overall solution. What will be necessary is an examination of where every aspect of the healthcare system overall, inasmuch as there is one, didn’t do its job.   

Disasters are social sodium pentothal that, while active, force groups of people to take an honest look at their failures. Once the disaster is passed, however, there is a danger that Upton Sinclair’s maxim—“It is difficult to get a man to understand something when his salary depends upon his not understanding it”—will rule the day. 

No one hopes for more dramatic damage to the American economy and social fabric, but the irony is that necessary change sometimes only comes when reality is undeniable, as in a shellshocked Britain instituting the NHS. If COVID-19 doesn’t shock us sufficiently into making substantial changes to the healthcare system, it’s a pretty safe bet the same disaster will occur again.