What’s next for healthcare in light of COVID-19

Two weeks ago, Rock Health President Tom Cassels convened with practice leaders Darryl Jue of Accenture, Amanda Berra of Advisory Board, and Pete Masloski of ZS to discuss how healthcare industry leaders must adapt to the forces that will become more prominent in the post-pandemic world. The conversation was rich, and we were fortunate to have so many of you (1,138!) in the healthcare community join us and participate in the discussion. For those who were unable to join, or for anyone looking to relive the conversation, read on for our key takeaways. You can also view the full recording of the webinar here and listen on the Rock Health Podcast.

Moral obligation and imagination—addressing the crisis today while setting ourselves up for future success

From frontline clinicians to policy makers and lab scientists, healthcare stakeholders are feeling a moral obligation to meet the emerging challenges associated with identifying, tracking, and treating COVID-19. Amanda Berra, Managing Director at Advisory Board, shared that some hospital systems are coming up with new ways to pivot the organization while protecting and supporting staff members—and not just in terms of physical safety. For example, rather than furlough some non-clinical staff idled by the pandemic, Vanderbilt Health System re-trained them as temperature screeners. And Mt. Sinai launched a Center for Stress, Resilience and Personal Growth to address the psychosocial impact of COVID-19 on the mental health and lives of frontline health care providers.

The call to duty is not just limited to traditional healthcare stakeholders. Government officials at CMS and HHS have also pushed through new policies to increase provider adoption of healthcare technologies (e.g., telemedicine and remote patient monitoring tools) and subsequent access for as many patients as possible (see our recent podcast to learn more about opportunities in healthcare’s new regulatory era). Darryl Jue, Managing Director at Accenture, shared how his “Health Convergence” team is sharing ideas with retailers like Amazon and Best Buy to leverage their assets and infrastructure to address the unmet healthcare challenges created by the pandemic. By acting on today’s moral obligation, the healthcare industry should be better positioned to take on the challenges from the impending second wave or any similar future crisis.

Simultaneously, Tom posited that we have a “moral imagination” to leverage the pandemic to radically reimagine the healthcare system. At Rock Health, we strongly believe collaboration between legacy stakeholders and digital solutions will deliver radical innovation for what healthcare needs today and in the future.

Looking ahead: US healthcare in the next 12-18 months

The conversation then shifted to what healthcare stakeholders need to do to continue operating in the near-term. Pete Masloski, Principal at ZS Associates, describes the next 12-18 months as “business unusual” in America. While we transition out of crisis mode and slowly re-open the economy, we will encounter spontaneous regional flare-ups in COVID cases. To proactively identify and understand primary and secondary effects of COVID outbreaks, Pete suggests healthcare stakeholders either build or partner with intelligence centers at the regional level. These centers can subsequently work with businesses to better prepare for potential shutdowns or continue to operate and compete in COVID-impacted environments.

Among a lengthy laundry list of to-dos, Amanda’s top priorities for health systems are to reinvent post-acute and nursing home care to be virtually-enabled. There is genuine interest amongst the industry at large to use emerging telehealth technology platforms and engage with digital health vendors, but gaping access holes prevent many patients from adopting those tools. For example, many rural areas lack consistent broadband connection, making it challenging or impossible to leverage telemedicine and remote monitoring solutions. Amanda believes stakeholders across the country must quickly convene to close these gaps that stymie the acceleration of widespread digitally enabled care.

What services did we need yesterday? We’ll need to reinvest in post-acute settings to make them more digital, and to enable people to visit their loved ones who right now are sequestered away.

Amanda Berra, Managing Director at Advisory Board

Building on Amanda and Pete’s points, Darryl provided his thoughts on what employers must do to outmaneuver uncertainty and facilitate a return to a new normal in the next 12-18 months. Employers need to consider safe and effective ways to bring employees back into the workplace and create an infrastructure to trace employees who become ill, all while maintaining employee privacy rights. Darryl sees an opportunity for major tech players like Apple and Google (who are both already working together via a rare partnership) to partner with employers and provide them with the necessary technology infrastructure to screen and trace employees. The Rock Health team previously shared thoughts on big tech’s emerging role in contact tracing. Shortly after the webinar, Microsoft and UnitedHealth Group announced a partnership on a new return-to-workplace protocol and COVID-19 symptom screening app, while our portfolio company Collective Health launched a new employer tool called Collective Go—a digital front door solution to facilitate safe workforce reentry.

Looking ahead: US healthcare in the next 2-3 years

All three practice leaders agree digital transformation will accelerate in the next two to three years, especially among health systems and medical groups. Providers face significant financial ramifications associated with the outbreak and future outbreaks as they lose revenue from postponing elective procedures. As providers become even more cost sensitive, Pete suggested they will increasingly embrace digital transformation and the adoption of virtual tools such as telemedicine to “keep the lights on”—while also supporting shifting consumer behaviors for those who continue to utilize virtual tools.

We are seeing a fundamental shift in new habits, behaviors, and expectations…how many that have had a seamless telemedicine experience will be accepting and willing to drive to a physician’s office and spend half an hour in a crowded waiting room just to see their physician for five minutes?

Pete Masloski, Principal at ZS

While provider digital transformation will accelerate, Amanda noted that certain providers are better positioned to make the transition than others. Those who were first movers in digital adoption pre-pandemic already have the basic infrastructure, technical know-how, and clinical buy-in to effectively scale these operations. Similarly, providers with significant cash on hand will be able to buy enough time to begin the digital transformation process to effectively position their business in a post-COVID world. Unfortunately, rural facilities and smaller provider groups that were facing significant financial pressure pre-pandemic will likely be unable to make the transition—it’s worth noting that these financial constraints may catalyze another round of provider consolidation in the market.

To proactively support providers facing financial pressure during this transition, Darryl believes there must be greater collaboration between payers and providers. One strategy Darryl suggests is for payers to consider pre-paying providers for certain types of virtual care with significant pent up demand (e.g., dermatology specialty consultations). While this could be an effective strategy to mitigate short-term financial pressure on providers, Darryl stressed that providers will need to continue to be vigilant in their care delivery via telemedicine such that clinicians do not miss things that would otherwise be surfaced in an in-person consultation (e.g. vaccinations and wellness care).

Addressing health (in)equity head-on

Another sobering reality from the pandemic is the disproportionate impact on disadvantaged populations (e.g., aged, disabled, people of color, and growing uninsured). There is legitimate concern that these groups will face restricted access to COVID specific therapies and vaccines as they roll out. To mitigate this, Pete believes we should risk-stratify the population at large and prioritize vaccine distribution to individuals who are at highest risk (e.g., front line clinicians and aged).

Darryl and Amanda both suggest that pre-pandemic initiatives by new healthcare entrants and de-novo primary care service models will provide many Americans with adequate access to basic care during the crisis. In particular, Darryl highlighted Walmart Health’s Care Clinics as an example of a new way for folks in rural areas to receive primary care. Amanda also called attention to the growing concept of segmented primary care and sees organizations such as ChenMed, Iora Health, and Oak Street Health that focus on chronically ill, aged populations as another mechanism to care for vulnerable populations.

I am optimistic about the continued availability and accessibility of primary and urgent care to the vast majority of Americans. Initiatives like Walmart Health, which is targeting rural areas, and Amazon Care, which is targeting virtual care, will make quality primary and urgent care more accessible.

Darryl Jue, Managing Director at Accenture

Tom also highlighted the important work of our colleagues at HealthTech4Medicaid, who are forging innovative solutions to solve real problems faced by Medicaid enrollees and the entities that serve them.

Telemedicine is having a moment—but how long will it last?

Before the pandemic, 32% of US consumers reported using live-video telemedicine (2019) and major telemedicine companies were barely touting double-digit utilization percentages. But now more than ever, people are relying on telehealth and virtual health resources to help them get through these tough times in a convenient and safe manner. Telemedicine is bridging the gap between people, physicians, and health systems. It’s enabling everyone, especially symptomatic patients, to stay at home and communicate with physicians through virtual channels, helping to reduce the spread of the virus to vulnerable populations and medical staff on the frontlines.

CMS and HHS have done their part to facilitate the recent uptick in utilization, waiving licensure restrictions nationally and establishing payment parity for certain virtual consultations. But the question now becomes: will these changes stick after the pandemic? Without a doubt, all three practice leaders believe the waiving of cross-state licensure requirements is here to stay. Reimbursement, on the other hand, is a point of contention. Darryl suggests that there will continue to be discrepancy amongst payers in their approach to valuing and reimbursing for certain types of virtual care. Pete suggests payers may worry about an uptick in utilization of virtual services, which would not generate the level of savings payers seek to remain solvent.

Rock Health portfolio company Doctor on Demand recently became the first nationwide telemedicine provider to make its services available to the nation’s 33M Medicare Part B beneficiaries. Our bet is reimbursement for these services will not be rolled back even once COVID retreated.

Let’s make healthcare massively better, together

Though we did our best in 60 minutes, we just skimmed the surface of questions that must be asked for the future of US healthcare. We’re grateful to our amazing panelists for sharing their insights and ongoing work to make healthcare massively better. We at Rock Health are excited about these unprecedented times. We are actively investing in technologies and teams that are working diligently to address the new challenges COVID has created for our healthcare system. We are also grateful for the opportunity to work with enterprise healthcare companies as they re-tool and rethink their approach to operating in a post-COVID world. If you are interested in learning more about Rock Health’s corporate research membership or consulting services, please reach out to us at partnerships@rockhealth.com.