Wars and other national crises force society to act differently for a while. But in doing so, they highlight organizational actions and innovations that should not end with the crisis and should be allowed to play a greater role in the future. The coronavirus disease 2019 (COVID-19) pandemic has similar features, and it should spur policymakers who shape the health care systems, to—as Apple Computer co-founder Steve Jobs often urged—“think different.”
The worldwide response to the COVID-19 pandemic highlights several strategies that should be emphasized more in the management of the health care systems. These strategies include reconsidering the role of hospitals and other institutions as hubs for care, expanding the use of telehealth/telemedicine, and bringing together funds from multiple programs to improve the delivery of health care and health-related services.
Rethinking the Role of Hospitals and Other Institutions as Hubs
The enormous pressure on hospitals because of the COVID-19 pandemic should bring about a reexamination as to whether these institutions should be the first resort when people are sick. Reconsidering the best settings for different patients could mean that with appropriate infection control practices, thousands of skilled nursing homes and inpatient rehabilitation facilities could be available for patients with COVID-19 and for other patients currently being sent to hospitals.
This observation raises the broader issue of where people in different places should get their care, as well as the future role of hospitals as hubs for care. Urgent care centers and walk-in clinics at pharmacy chains, and even Costco, are certainly changing patterns of care. But when considering integrating clinical care with social services, housing, and other nonclinical services—addressing so-called social determinants of health—there is a need to recognize that a variety of institutions may sometimes be better locations for care. Schools and public housing are particularly good examples. It is also time to consider some hospitals as possible hubs for a wider range of services related to wellness, rather than providing only clinical services. Many managed care organizations and community clinic systems are already diversifying in this way, with some even providing education and employment training through partnerships.
It is no surprise that telehealth has been surging during the last few weeks, and many health plans are incorporating it in a variety of ways. Some systems, have been using telehealth routinely for years, and employers—especially larger employers—have been adding it to coverage at a rapid clip, using it to increase worker convenience and to cut costs. Telehealth has also in recent years gradually come into use in obstetrics care, typically in rural areas but also in some urban areas where some people may be less inclined or able to visit medical facilities.
The response to the COVID-19 pandemic seems likely to trigger a sustained demand for telehealth. It has been on the brink of much greater use and acceptance for some time, but broader use of telehealth has been held back by payment systems and regulations that were designed for an era when telemedicine was seen mainly as just a second-best alternative in rural areas. Medicare took an important step this March to reduce the payment obstacle by covering telehealth in many more settings, at least temporarily. But such steps need to be made permanent; public and private insurers need to make sure this important medical tool can flourish after the pandemic is over.
The urgent steps that have been taken to make the health care system more flexible and innovative during the COVID-19 pandemic should not be forgotten once the crisis is over. Many of these steps need to become central features of the health care system.