July 22, 2020

"Covid-19 is a wake-up call that tells us we need to change what we're doing, do it better, and make it more affordable," writes Intermountain Healthcare CEO and President Marc Harrison in Harvard Business Review. Here are the seven key lessons Intermountain has learned from that wake-up call, according to Harrison.

Marc Harrison promised to turn Intermountain into a 'Tesla.' He wasn't kidding.

The 7 lessons Intermountain has learned

1. Leverage technology aggressively

Since the start of America's Covid-19 epidemic, telehealth visits have increased exponentially, Harrison writes.

According to a report from the Kaiser Family Foundation, 23% of enrollees in large-employer health plans have utilized telehealth during the epidemic, compared with 2.4% during the same time period in 2018 and 0.8% in 2016. Moreover, according to a Harris Poll survey, of the 42% of Americans who say they've used telehealth during the epidemic, 65% said they liked the convenience, while 63% said they believed telehealth services are a good way to avoid exposure to sick patients.

The lesson, according to Harrison? "Now that people are used to getting more services at home, they're not going to want to go back to the way things used to be."

And Intermountain is leaning into that notion: In April alone, Intermountain hosted 63,000 virtual patient visits—up from 7,000 virtual visits in March. In addition, the health system—which has pursued telehealth since 2012—has digital platforms enabling providers to connect with specialists located in different Intermountain facilities, as well as a digital front door app, which lets patients find, manage, and pay for their care.

2. Focus on preventive health

The Covid-19 epidemic has also underscored Harrison's conviction that "[k]eeping people healthy—and keeping them out of clinics and hospitals—is the best and least expensive way to improve people's health."

That means providers have to "treat the whole person, not just their problem," Harrison writes, such as by connecting them "with the resources they need outside of the clinic" to maintain their health and stay out of the health care environment. That approach runs counter to "how medicine is usually delivered in the United States today," where "the more services you provide, the more money you make," according to Harrison.

Ultimately, Harrison writes, "Preventive care is the epitome of a consumer-focused priority."

3. Address and eliminate racial health disparities

According to data from the Covid Tracking Project, Black people make up 13% of the U.S. population but 23% of all U.S. deaths related to the coronavirus so far—and racial health disparities don't end there, Harrison writes.

Harrison cites a 2018 report from the Commonwealth Fund showing that Black women with breast cancer have an 80% five-year survival rate, compared with 91% among their white peers. In addition, Black Americans have a heart disease mortality rate of 308.2 per 100,000 people, compared with 241.9 per 100,000 among white people, Harrison writes.

To start addressing these disparities, Intermountain has expanded its hiring and governance practices to ensure its team represents the community it serves, Harrison writes. Intermountain also expanded training for staff and joined the Health Anchor Network, an organization of 45 health systems that aims to improve long-term health and well-being at a local level, according to Harrison.

4. Combine mental health care with primary health care

The division between mental health and primary care is yet "another problem that was bad before and now is worse" because of the Covid-19 epidemic, Harrison writes. Citing research showing the United States has higher rates of deaths from substance misuse and suicide than other high-income countries, Harrison notes that experts predict the epidemic will likely exacerbate those and other mental health trends, such as stress, depression, domestic violence, and more.

According to Harrison, Intermountain has been integrating mental health care with primary care since 2000 to facilitate early diagnosis and access to treatment for mental health conditions. In fact, a study published in JAMA found that, as a result of its efforts, Intermountain has seen better rates of mental health screenings, better adherence to care protocols, greater use of self-care plans, better clinical outcomes, and lower costs.

5. Run towards innovation

Providers need to drive innovation and adaption if we're going to keep up with the epidemic, Harrison writes.

One case in point is working from home, he writes. At Intermountain, for instance, the number of Intermountain' s 41,000 employees working at home has increased from about 1,000 at the start of the year to 10,000 now—and a survey has found that 89% of Intermountain employees enjoy it, 78% want to continue working from home after the Covid-19 epidemic ends, and a majority said they're more or equally as productive as before they began working from home.

The epidemic also led Intermountain to develop a new disinfection protocol to make N95 respirators last longer and to partner with nonprofit organizations to work with volunteers producing personal protective equipment, Harrison writes.

6. Partner

Which leads Harrison to his next lesson: the Covid-19 epidemic "is too big to fight by yourself," he writes. Partnerships are necessary, and the "[n]ew and nontraditional partnerships formed during the [epidemic] are helping providers deliver the kind of help people need, when and where they need it," Harrison notes.

Intermountain, for example, has partnered with state and local governments, as well as University of Utah Health, which is typically a competitor, Harrison writes. Intermountain also has joined the Covid-19 Healthcare Coalition—a group of health care organizations, technology firms, nonprofit organizations, academic organizations, and startups. And because the epidemic could have a major impact on rural America, Intermountain has partnered with 15 rural hospitals in Colorado, Idaho, Nevada, Wyoming, and Utah to provide telehealth consultation services for their providers.

According to Harrison, partnerships are also vital to efforts beyond the epidemic, such as increasing the availability of generic drugs. That's why Intermountain helped develop CivicaRX, a collaborative of more than 1,200 hospitals and 50 health systems that has produced and shipped over 30 generic medications.

7. Address the 'untenabl[y]' high cost of health care

The Covid-19 epidemic has led to a significant economic downturn and high unemployment, which, when compounded with "a health care model that was previously unsustainable," means "providers and our patients are facing a disaster unless we can drastically improve affordability," Harrison writes.

To do this, Harrison emphasizes the importance of all the priorities he's highlighted—especially looking beyond the traditional confines of health care to social determinants of health. Citing research showing that 60% of an individual's health is determined by lifestyle factors, 30% by genetics, and around 10% by medical care, Harrison writes, "That means the best way to improve people's health and the affordability of health care is to go upstream." He adds, "That kind of care is not only better for the people we serve, it's much cheaper."

Ultimately, Harrison concludes, "Covid-19 is a wake-up call that tells us we need to change what we're doing, do it better, and make it more affordable. Businesses across the country are getting that message. Why can't health care?" (Harrison, Harvard Business Review, 7/20).

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