Pandemic or not, December always comes around too quickly.
I can't help but reflect on the numerous conversations I've had with health care chief executives and their boards. I'm struck by how we're all facing the same set of thorny strategy questions. Now, with the benefit of hindsight, I'd like to take another run at the three most challenging questions I've gotten since the pandemic started:
1. How ambitious should we, as providers, be during all this upheaval and disruption?
When I first tried to answer this question, I said, 'It depends'—which is the catch-all researcher answer. My thinking at the time was that organisations needed to take stock of how much institutional latitude they had to drive change and how they could message that to a workforce that was under daily pressure—all while hoping to go back to the way things were in January, at least to some degree.
Now, my answer would be more bullish. I'd say that if you're in health care and you're not trying to take advantage of the fluidity in our operating environment then you're missing a huge opportunity. That's not to say that organisational inertia isn't at an all-time high. Instead, it's a call to be very targeted in what changes you try to drive. The sweet spot is the overlap between 'changes we need to make because of the pandemic' and 'changes we need to make to succeed in the future of health care.'
2. How much of our focus on integration and population health management will persist into the future?
Before the pandemic, we were tracking more than five jurisdictions that were pushing providers to become integrated population health managers (PHM). Although most could agree that the direction of travel made sense, the work was arduous, painstaking, and political.
The question behind this question is: 'Have we wasted all this time focusing on integration and PHM?' At the time I said no, and today I'm even more confident in that answer.
What I believe will play out is that, in the near term, network design and PHM work will slow down. Our major focus into 2021 will be on community vaccination. A few entrepreneurial systems will move forward on greater integration, but, for the most part, 2021 will hopefully be the bookend to the pandemic.
From there, policy makers are going to take stock of the health system. The fundamentals that drove many health systems to this work—long-term conditions and health care affordability—will be even more powerful drivers than they were before the pandemic. And my gut is that, when PHM comes back, it will return at a pace and breadth greater than when we started.
3. Is the priority on health equity real?
The pandemic is a stress test for health systems. And one of the most common pain points is that under-served communities are at highest risk.
Given that many jurisdictions have known this for years, it's fair to ask whether we will do anything about it. When I first responded to this question, I hoped that we would see drive toward meaningful and systematic improvement for deprived and vulnerable communities, but I know that structural change is wildly difficult.
I'm not yet willing to put all my chips into the 'this time will be different' pot. But I will say that the commitment and case studies we're uncovering in this space look and feel different. Governments are discussing ways to 'un-earmark' funds to support work on social determinants of health, and I'm experiencing a receptiveness to non-clinical health for health outcomes different than when we first started talking about it in research two years ago. The reality that health inequity is a pandemic vulnerability could also hardwire this work.
When we look back at Covid-19 and the near misses that preceded it, it's hard to argue that pandemic preparedness—and therefore protection of the most vulnerable parts of society—is not simply nice but a need to have.
How did we do? Did I miss your most challenging question of 2020? If so email me and share your thoughts. I'd love to hear more.