A vision of healthcare in a post COVID-19 world
By Raphael Rakowski

 

On April 30, I woke up with a deep cough, fever, and an aching body—the symptoms that have dominated the news for months. I had a nasopharyngeal COVID-19 test in a drive-thru at a medical building in Boston, where I work as the CEO of a healthcare company. I got an email 48 hours later, confirming I was COVID negative.

I returned to my home office and joined eight Zoom video calls with health system leaders. One of the CEOs, whose system has treated more than 20,000 coronavirus cases, said, “One thing is for sure, things simply cannot be the same after COVID”.

On those calls, I learned that a significant percentage of patients are frightened about coming back to the hospital for care. Whispers of hospital volumes and revenues being alarmingly low, echoed concerns about hospital financial sustainability.

When the day ended, I opened my mail (with surgical gloves of course) to discover a surprisingly large co-pay bill from the hospital, where I had surgery three months ago — reminding me of how patients live with the uncertainty of the significant and growing financial and emotional burden of their healthcare costs.

COVID-19 and its dreadful death toll will be both a catalyst and propellant for the sweeping healthcare delivery model change many have been waiting for. It has shone a light on the financial, operational and safety challenges that have undermined healthcare systems for decades.

A new set of forces emerging from this crisis will drive healthcare delivery in the years to come.

Uncoupling healthcare assets from healthcare services: Using technology and next-generation logistics, many healthcare services will be uncoupled from their facility-based operations. The explosion of telemedicine over the past 60 days, substituting for the legacy in-person physician visit, points to a future in which the home is the optimal site of medical care.

Patients as the organizing principle for healthcare delivery: While talk of patients becoming consumers has been growing for years, consumer power has yet to fully materialize. Driving this incoherence between providers of care and patients receiving that care are intermediary third parties (i.e. insurance companies, Medicare and Medicare) that pay for the care received by patients. In the future, when patient co-pays and deductibles reach intolerable levels, those patients will demand value, convenience and customer service from their healthcare.

Artificial intelligence, point-of-care diagnostics, and wearable biometric monitoring: These three core technologies, more than any others, will help propel a decentralized care delivery platform. AI will democratize optimum medical care by using large amounts of patient data and best-practice evidence to guide diagnosis and treatment. Point of care diagnostics technologies (think of the Tricorder in Star Trek) will allow medical providers to have instant confirmation of patient diagnoses in decentralized settings. This will reduce costs and accelerate access to appropriate treatment. Wearable biometric monitoring devices will allow patients and medical providers to remotely monitor their medical status, allowing for safe medical care at home or in other decentralized care sites.

Next-generation paramedics: To bring care to patients when and where they need it, paramedics, tethered to physicians in centralized medical command centers, will receive increased training to deliver rapid care to patients wherever they are.

Houses of worship and religion: With growing pressures on the economy and the increase in unemployment and homelessness, the number of Americans on Medicaid roles will grow, and with that growth, there will be a need to provide lower cost creative sites of medical care in the community. Churches, mosques and synagogues will become community-based sites of care delivery for under-served patients.

Clinical trials at home: With a decentralized healthcare delivery chassis in place, clinical trials will be conducted in patients’ homes, enabling a democratization of access to advanced experimental therapies.

Health Campuses: Large hospitals will give way to health campuses, carrying the hospitals’ brands, that provide an integrated community experience of complex care, assisted living, employee housing, health clubs, restaurants, and retail. Following the model already underway in medical facilities across the country, the assets of these campuses will be owned by real estate investors and operated by experts in each field. Healthcare and wellness will melt into one another in this environment.

Complex Care: Hospitals that do not become health campuses will become complex care sites, with a smaller footprint, limited to intensive care and complex surgery. All other surgery will be provided in outpatient surgery centers, already conducting more than half of surgeries in the U.S. today.

Care quarterbacks: There will be very limited patient hand-offs and transfers, as is the case today with our current industrialized healthcare delivery model. Care quarterbacks will be patient advocates who steer patients through the care-delivery system.

Cancer will become a chronic disease: People with cancer will be diagnosed earlier and have targeted therapies that will be delivered at home, supported by a care quarterback and supportive tools for them and their families.

Single payer with a twist: With a price tag of more than $4 trillion for healthcare, reimbursement will likely be consolidated under government payment. Patients will have choice in providers, plans and service offerings, as private health plans will offload the financial medical cost risk from the government and compete on cost, quality and patient experience.

Conclusions – The COVID-19 experience unmasked major deficiencies and inflexibility in our facility-based healthcare system. This crisis created a unique opportunity to fully reimagine and transform our healthcare delivery system that will be co-created with hospitals and rely on a new, more decentralized paradigm, supported by technology and advanced logistics. This transformation has already begun and will accelerate and reach a tipping point, as the tailwinds of increased costs, consumerism, and technology push us to a new future.

 

This article was produced for Medically Home by Scientific American Custom Media, a division separate from the magazine’s board of editors.

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