The Covid-19 pandemic has highlighted numerous shortcomings within the U.S. health care system, Intermountain Healthcare President and CEO Marc Harrison writes for the Harvard Business Review. He shares five key priorities to help fix the system.
1. Improve health, largely through prevention
Perhaps one of the most surprising characteristics of the coronavirus is that it often exacerbates underlying chronic conditions like diabetes, heart disease, and obesity, Harrison writes.
"With these chronic conditions already at epidemic levels in America, the U.S. population has been ripe to be ravaged by Covid-19. … Covid-19 would have been deadly even without the presence of chronic diseases, but their presence increased [Americans'] vulnerability. Disease prevention must become a top national health care priority," he adds.
Harrison acknowledges that disease prevention is partially behavioral and can often be achieved through personal choices. However, Harrison argues that prevention needs to be facilitated by health care providers on a larger scale. According to Harrison, focusing on preventive care would give physicians the ability to spend more time with their high-risk patients because they would have fewer patients to care for.
Harrison writes that a program at Intermountain where physicians help patients proactively improve their health has led to a "20% improvement in controlling high blood pressure, diabetes, osteoporosis, colorectal cancer, and other health problems" among program participants. "Better health has, in turn, reduced costs by $648 per patient each year ($1,908 a year for patients 65 and older) compared to standard clinics," Harrison writes.
2. Address racial disparities
"The Covid-19 pandemic has starkly illuminated the profound racial disparities in health care, and these must be rapidly addressed to achieve health equity," Harrison writes.
According to Harrison, the key to overcoming these health disparities is tackling the social determinants of health outlined by CDC—including neighborhood and physical environment, health and health care, occupation and job conditions, income and wealth, and education.
At Intermountain, Harrison says they are working with multiple nonprofit agencies to help address these issues. "We are contributing $12 million and staffing to a three-year pilot project in Utah to address the social factors that influence health in low-income zip codes," he adds.
As the project approaches the end of its third year, Harrison says the pilot aided in a 12.7% reduction in ED visits among participating patients. In fact, Harrison writes, the pilot project was so successful that the Utah legislature has decided to take the model statewide.
3. Increase telehealth and in-home hospital offerings
Harrison writes that instead of making patients come to the office to receive care, the health care industry needs to "become more consumer-centric" and "care for people closer to their home." To achieve this goal, Harrison says, "we need to meet people where they are as much as possible when delivering care." And this, he writes, can be achieved through a greater use of telehealth, which can increase access to care and make specialists.
"[Patients] can remain in their communities, surrounded by their support systems, with the local hospital retaining most of the compensation. That strengthens not only rural hospitals but also rural communities where the hospitals are often the largest employers," Harrison writes.
4. Integrate health systems
Another key takeaway from the pandemic is that integrated health care delivery systems can more easily adapt and align incentives to rapidly changing circumstances, Harrison writes. In fact, a PwC Health Research Institute study confirmed that integrated health systems with their own health plan were able to handle the financial strain of the pandemic better than non-integrated systems.
According to Harrison, "Integrated systems can 'balance the load' by transferring patients between facilities, across space, and among caregivers—and, perhaps most importantly, between care providers and insurers. They can quickly share learnings and best practices."
Integrated care models allow "the cost of providing care and the cost of insuring care to be aligned in ways that benefit the insurer and the provider. That's because both share the benefits when health care costs are reduced," he writes.
5. Implement value-based care
"Value-based care improves quality of life and corrects misaligned incentives," Harrison writes. He writes many of the current fee-for-service system's flaws were "highlighted by the pandemic."
Harris cites Ceci Connolly, president and CEO of the Alliance of Community Health Plans, who said, "The pandemic opened the eyes of a lot of providers that make their money through volume." Connolly added, "Suddenly they had no volume and no revenue. Providers with value-based arrangements with health plans kept getting a check every month, regardless of the volume. They were able to focus immediately on telehealth and other creative ways of caring for patients, because they weren't as worried about volume or reimbursement."
"Accelerating the move to value-based care right requires significant investment, commitment, flexibility across organizations, and, for some, a leap of faith away from tradition," Harrison writes. He recommends organizations reorganize provider panels, restructure teams and workflows, educate providers and teams, deploy novel technologies, use real-time insights, and align financial incentives to shift to value-based care. (Harrison, Harvard Business Review, 12/15)