The volume of health care services is down. Since the start of the pandemic, in many states, non-emergency health care services other than virtual care have not been available to consumers. And it is likely that the return to a “typical” health care practice model will be slow. Health care provider organization management teams are struggling with how to reopen (see Reopening Is Not Recovery and The Lockdown Was Simple—Reopening Not So Much). Consumers are trying to weigh the risks of going outside their homes for services of any type. This drop is reflected in the financial performance of both physician practices and hospitals (see The Sound Of Closing Doors).
A recent Kaiser Family Foundation poll found that almost half of consumers (48%) report that they or their family members have skipped medical care, and only 11% report that the health conditions in question have worsened (see Nearly Half Of Americans Delayed Medical Care Due To Pandemic). PwC’s Health Research Institute (HRI) recently reported that many consumers plan to change their health care habits for medications (11%) and health care visits (16%), with 78% planning to skip at least one visit for care (see The COVID-19 Pandemic Is Influencing Consumer Health Behavior. Are The Changes Here To Stay?). Many emergency rooms have seen a dramatic drop in use—often 40% or more (see The Mysterious Drop In Hospital Visits), and there has been a 50% to 73% drop in vaccinations for measles, mumps, rubella, diphtheria, whooping cough, and HPV (see Vaccine Rates Drop Dangerously As Parents Avoid Doctor’s Visits). And one interesting note, on a web meeting yesterday, I listened to a health plan manager talk about how consumers were delaying even their virtual visits to primary care professionals, but that virtual visits to mental health professionals have surpassed previous face-to-face volume.
The likely effect of these delays in health services raises big strategic questions that our team considers almost daily. Will there be “pent up demand” for face-to-face services once there is a coronavirus vaccine? Will we see increases in certain conditions at some point in the future? For that reason, a recent op-ed by Sandeep Jauhar, M.D., in The New York Times caught my attention—People Have Stopped Going To The Doctor. Most Seem Just Fine. In his article, he said, “Perhaps Americans don’t require the volume of care that their doctors are used to providing. Most patients, on the other hand, at least those with stable chronic conditions, seem to have done OK. In a recent survey [note: the Kaiser Family Foundation poll], only one in 10 respondents said their health or a family member’s health had worsened as a result of delayed care. Eighty-six percent said their health had stayed about the same.”
I would argue that it is a little too soon to tell if the self-assessment of “health” is accurate. And the early data show that the pandemic crisis is causing excess deaths for conditions other than COVID-19 (see The Coronavirus Pandemic’s Wider Health-Care Crisis). An analysis of death certificates (see Preliminary Estimate Of Excess Mortality During The COVID-19 Outbreak — New York City, March 11–May 2, 2020) shows that a fifth of the 24,000 excess deaths that occurred in New York City between March 11th and May 2nd were caused by factors other than COVID-19. Hospitals saw a 38% drop in serious heart-attack cases in March alone, suggesting that even people with acute, life-threatening illnesses have been avoiding medical visits (see Reduction In ST-Segment Elevation Cardiac Catheterization Laboratory Activations In The United States During COVID-19 Pandemic). A nationwide survey conducted in April (see Survey: COVID-19 Affecting Patients’ Access To Cancer Care) found that a quarter of individuals with cancer receiving active treatment had delays in care. The effects of delayed health screenings and the postponed management of chronic conditions are not going to be noticed by consumers—or health care professionals—in the short term.
But, that said, I do agree that there is a lot of inappropriate use of health care resources. We don’t use health care professionals to the top of their capabilities. We have duplication of testing because of lack of electronic health record interoperability and financial incentives to test too much. Productivity rates of health care professionals are hampered by operational process design and consumer incentives. Emergency rooms are used too often for non-urgent situations. And, our system uses highly trained professionals to do work that could be done by technology (for a great overview of this, see Consumer Experience Is Driving Tech Investments, Is The Health Center Of The Future In The Palm Of Your Hand?, and Leveraging Technology To Expand Access, Enhance Consumer Experience & Improve Outcomes In A Behavioral Health Care Marketplace).
In the same article, Dr. Jauhar makes the point, “If beneficial routine care dropped during the past few months of the pandemic lockdown, so perhaps did its malignant counterpart, unnecessary care. If so, this has implications for how we should reopen our health care system. Doctors and hospitals will want to ramp up care to make up for lost revenue. But this will not serve our patients’ needs. The start-up should begin with a renewed commitment to promoting beneficial care and eliminating unnecessary care.”
I agree with his goal. In my local area, now that health care facilities are opening, there is a marked increase in consumer advertising focused on “we are open and come on in.” But I see the likely solution to “eliminating unnecessary care” in the start-up as moving more reimbursement away from fee-for-service (FFS) to value-based reimbursement models that are focused on positive consumer experience and reduced use of emergency room and inpatient services. Our recent sessions with health plan executives (see Innovation By Design: Capturing Value In Health Care and One Foot In Two Canoes: Managing Service Lines For Value-Based Reimbursement & Fee-For-Service At The Same Time!) have reinforced my thinking that the post-crisis period will see increased adoption of non-FFS reimbursement models—and an advantage to the provider organizations that can demonstrate value and manage value-based contracts.
So, what is the big takeaway from this issue for provider organizations serving consumers with chronic conditions? As we look ahead to continued rocky economic times, this pandemic-era period of health care utilization is going to be used to justify reductions in health care spending. Provider organization management teams need to go “long” on developing the ability to demonstrate value using customer-facing metrics—payers and the health plans will be asking. For more on how to develop a customer-facing value story, see these resources in The OPEN MINDS Industry Library:
- Defining ‘Value’ Is Key To Provider/Health Plan Conversations
- Value-Based Reimbursement: 3 Steps To Go From Idea To Action
- What To Say When You Want More
- Negotiate Those Contracts
- Identifying Strategic Opportunities: Cultivating, Negotiating & Decision-Making
- The OPEN MINDS Health Plan Partnership Summit: A Guide To Developing & Negotiating Partnership Agreements With Health Plans
- Identifying Strategic Opportunities: Cultivating, Negotiating & Decision-Making – Sponsored By Credible Behavioral Health Software
- Executive Compensation: How To Negotiate & Manage The Compensation Process
- Are You Ready For Risk-Based Reimbursement? How To Assess Readiness & Negotiate Contracts
- Developing Case Rates? Better Find Your ‘Single Source Of Truth’
And don’t miss our July 16 web briefing in our weekly “recovery” series for our Elite members, Strategic Planning For Post-Disruption Recovery & Sustainability, led by OPEN MINDS Senior Associate Joe Naughton-Travers, Ed.M.