May 21, 2020                         By  David Stievater

 Accelerating the Shift in Care Settings

The US healthcare system is under amplified stress and will be for at least the next 18 months. To protect patient safety and reduce pressure on our healthcare system, providers and other clinical workers will continue to adjust methods and locations of care delivery.  Some of the changes that we are seeing – such as shifting care outside hospitals – are a continuation of a longer term trend. Other changes to how and where patient receive care are new, and some that we have not yet seen, will undoubtedly emerge as unexpected by-products of the pandemic.  One thing is clear –  to reduce the risk of infecting healthy patients and to adjust for changes in consumer behaviors, alternative settings are being and will continue to be considered for all needed care.

In Part 4 of its series on COVID-19’s impact on the US Healthcare industry, Commonwealth Health Advisors (CWH) takes a deeper look at potential changes in care settings.  While CWH has previously written about telehealth (Part 2 in the series), there are many questions regarding where and how patients will receive care in the future that are outside of those satisfied by telehealth.  Will consumers shun hospitals for fear of infection, and shift to alternative methods of seeing a physician? What will the role of hospitals be going forward? Will more physicians, nurses and other clinical staff shift care provision back to the home? Will stay-in-place approaches to treating our most vulnerable populations persist after the pandemic subsides?

We hope the following perspectives and questions raised help your organization frame its response to COVID-19.

COVID-19 has profound implications for hospital facilities

The role of hospitals and hospital capacity will be fundamentally rethought. How will we create and maintain surge capacity for handling pandemics, natural disasters and mass casualty events? How will our healthcare system pay for this? How will hospitals sustain themselves if more low acuity/noninfectious disease care shift away from an in-patient setting? How will this trend (which was already underway) accelerate post-COVID-19?

The home will become an increasingly important care setting

Home-based primary care will grow enormously. What are the key drivers, opportunities, and challenges of this trend? Which market segments and specific companies will be the winners? What operating models will be most attractive to treat home-based populations, especially seniors? What reimbursement models will make the most sense? How do we move patients out of in-office settings while still providing the appropriate level and type of care? Can we actually improve outcomes at lower cost?

Virtual channels are here to stay

More care will be provided through virtual channels. How prevalent will telemedicine, remote patient monitoring and other forms of telehealth become? Will the current surge in telehealth be sustained long-term? To what extent will the use of video be complemented with integrated apps and cost-effective patient monitoring? How will provider behavior (both individually and organizationally) actually change after COVID-19 is behind us?

Demand for elective surgeries will be permanently impacted

The ‘forced experiment’ of delaying or canceling elective surgeries and non-critical ambulatory visits will impact demand for the long-term. How will patients perceive their health and outcomes in the absence of elective events? What unexpected consequences will accrue for providers and the general healthcare system if some of this utilization reduction is permanent? Will our view of outcomes evidence change? How will managing risk change?

Transitions of care must be adjusted thoughtfully

The entire post-acute/sub-acute continuum will continue to change, but more rapidly. How will transitions from hospital directly to home be made and improved?  Is there room for new entrants in this market space, or will incumbents continue to own it? What programs will be incorporated into the care system to better serve this population? How rapidly will payers attempt to shift risk to providers that are willing to take responsibility and financial risk? 

Self-care tools will become more prevalent and easier to use

Home-based self-care programs will surge. What home-based programs will become available? How widely will they be used and proven effective for exercise, rehabilitation and wellness? What are the gating factors for uptake, and what will accelerate this? What players will participate, and which will win here?

Temporary workflow changes due to COVID will become permanent

Patient workflow in traditional in-person healthcare settings will adjust. What role will social distancing regulations (and consumer demand) play in the way patients choose providers or facilities? How will care settings be forced to evolve based on what patients are or are not willing to do? Which care settings will be governed by regulation and local/regional differences? What cost will this impose on providers?

As healthcare executives consider the many questions that will surface during and after this pandemic, Commonwealth Health Advisors is working with companies to figure out the answers.  We look forward to the opportunity to apply critical thinking, strategic direction and actionable plans to organizations needing help re-imagining how this pandemic will affect their future, growth and profitability