The COVID-19 Pandemic Reveals the Gaps in our Legacy Healthcare Delivery Model
Building a Solution – A Virtual Hospital Without Walls
– By Raphael Rakowski – Medically Home®
As the COVID-19 crisis exerts its heavy toll on our lives and our economy, it has unmasked major deficiencies in a healthcare system built on a facility-based chassis. This crisis creates a unique opportunity to fully reimagine and transform our healthcare delivery system. We owe it to America to retool our system for a new and improved future.
The Emperor Wears Few Clothes
In this crisis, we see a hospital-based centralized care delivery system that in many COVID-19 hot spots lacks the workforce and physical capacity to deliver needed medical care. We see hospitals unable to effectively triage and segregate COVID-19 infected and non-infected patients safely and efficiently. We see a decimated primary care system, built on the construct of the in person visit, as providers rush to scale their telemedical capabilities. We see longstanding and sacred federal and state rules and regulations, long identified as barriers to innovation, waived. We see a system that is financially unsustainable, as $800+ billion/annum is siphoned from the economy, to fund the bricks and mortar overhead costs for facilities. We see a lack of aligned interests between payers and clinicians that financially short-changes primary and community-based care, in favor of subsidizing hospitals. Finally, we see a system that is siloed and not organized around the needs of people.
Without a new paradigm to overcome the inadequacies of a facility-based approach, value-based care will be continuously challenged to deliver a patient-centered, sustainable economic model that can adapt to current and future pandemics.
Vision for A Post-COVID-19 Health Care System
Now is the time to adopt a new paradigm for our healthcare system. We envision a health care system, co-created with hospitals, in which hospitals focus on complex care in their emergency departments, operating rooms and intensive care units, while all other hospital-level care is delivered in a patient’s home or in the community. We see a healthcare delivery chassis that combines centralized and decentralized work forces and leverages a technology platform that knits together patients’ homes, (ii) facilities (hospital, skilled nursing facilities, nursing homes), primary and specialty care providers and local community-based resources to improve patient outcomes, workforce reach, efficacy and costs. As the COVID-19 crisis exerts its heavy toll on our lives and our economy, it has unmasked major deficiencies in a healthcare system built on a facility-based chassis. This crisis creates a unique opportunity to fully reimagine and transform our healthcare delivery system. We owe it to America to retool our system for a new and improved future.
A New Flexible Chassis for Medical Care Delivery — The Virtual Hospital Without Walls
The Virtual Hospital Chassis has several key elements:
Patients’ homes are converted into temporary hospital units, supported by communication, monitoring and emergency response capabilities.
A Centralized 24/7 Medical Command Center, staffed by physicians and nurses, that telemedically cares for patients, in both decentralized settings, (e.g. patients’ homes and community centers) and centralized facilities (to reduce pressure on front-line clinical staff).
Decentralized safe, replicable, secure, rapidly-dispatchable community-based service supply chain (e.g. nursing, paramedicine, x-rays, labs, etc.) bringing medical care to patients at home.
Enabling Chassis Software, that guides Virtual Hospital care and integrates with the patient and decentralized care delivery resources.
A sustainable work force, that combines centralized clinicians in a Medical Command Center, with a decentralized clinical work force in the community.
This model creates highly flexible provider capacity, for both facility-based providers (during surge periods) and community-based care delivery.
Virtual Hospital Without Walls Use Cases – During and After Epidemics
The Virtual Hospital Without Walls is an ideal to rightsizing medical care capacity in normal circumstance and in the context of pandemics and other crises.
During normal non-surge periods, Virtual Hospital Without Walls would care for clinically appropriate patients at home, that require non-ICU level hospital care. For hospitals struggling with capacity challenges, a Virtual Hospital Without Walls can reduce the burden on their emergency departments, reduce hospital admissions from patients with lower complexity medical issues and reduce the length of stay that patients require in a hospital or skilled nursing facility.
During a pandemic crisis, Virtual Hospital Without Walls are ideally configured to care for infected patients at home, after they are initially stabilized in a hospital’s intensive care unit and for non-infected/clinically appropriate patients requiring hospital care. Both use cases would significantly increase hospital capacity.
The Virtual Hospital Without Walls model is ideally aligned with Medicare’ goals for value-based care. This delivery model generates superior outcomes at lower costs, with higher patient satisfaction. Medicare would pay the way it currently pays for a hospital admission, and the hospital would use the funds to support the Virtual Hospital Model. Patients would not see any increases in their co-payments.
Scaling the Model
The Virtual Hospital Without Walls model of care can be effectively scaled, supported by national partners with decentralized clinical resources (e.g. home health nursing, paramedics, infusion nursing, and technology deployment services). Health Care leaders who have begun to deploy this model will provide the outcomes data to catalyze the second wave of model adherents.
Healthcare implementation consulting firms have the skills and capacity to support health systems in rapidly implementing the model.
Call to Action
Now is the time to utilize the extraordinary awareness created by the COVID crisis, to begin the conversion to Virtual Hospital Without Walls. Medicare’s March 20 broad regulatory relief for this model of care has opened the door for decisive and sustainable action.
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