Simplifying Healthcare: 4 Lessons Learned from a Global Health Crisis

In my May newsletter, we looked at the Biden Admin’s Global Health Security Strategy and explained our government’s plan to partner with key players across the public and private sectors to develop global infrastructure to better identify, track and solve public health crises.???

As we continue to monitor the effects and outcomes from this strategy, I’ve also been reflecting on the lessons we learned in the healthcare industry during the 2020-2021 period. While there was certainly a lot of hardship that came from that time, I also think there were some valuable lessons we were able to take away – ones I hope we don’t lose sight of as we get back to “normal.” Whether it be healthcare payors, providers, policymakers or patients, these are the lessons I think we all learned across the pandemic beginning four years ago and should keep top-of-mind.?

What did we learn?

1. Maintaining accountable surveillance and reporting systems within and across states will help ensure we don’t end up in another COVID-level crisis.
2. Other areas and industries outside of healthcare will require the same level of preparedness and resiliency (supply chain, the economy, education, etc.).
3. Extending rules around telemedicine and hospital-at-home (and other transformative delivery models) shouldn’t only be implemented in response to crises.???
4. Removing barriers around treatments, availability, payment and coverage is key for improving access to care for all.

We made so many gains on the expansion of coverage during this time, which was accomplished through a variety of policy changes including the expansion of ACA subsidies and pausing Medicaid redetermination processes. Unfortunately, I see these policies being politicized more and more in the coming years, and when we look at who is most affected by losses of coverage, it is typically our most vulnerable communities, including those of color. Having individuals consistently cycle through loss of coverage leads our industry to have the same conversation around expanding coverage to the same groups with little consideration for addressing the root cause. One thing I hope we’ve learned is that it takes a great deal to get coverage expanded and get more folks into the system, but it’s much easier to lose them –?we should be doing everything possible to keep them in and widen the circle.??

In reflecting on our industry’s response to the pandemic, it was wonderful to see how people came together regardless of background in ways we’d never seen before. I fondly remember helping as we established the Charlotte Motor Speedway and the Charlotte Airport Parking Lot as drive-thru vaccine administration centers! During any other time, efforts like these would have felt impossible to accomplish quickly with all the regulatory considerations, federal/state database communication, and volunteer coordination –?but it happened many times and in many places all across the country.??

Once we got past the immediate impact of the pandemic, instead of a collective reflection on things we did well and how we continue to push those efforts forward (ex. Telehealth), we slid back into discussions on whether or not these services should continue and if they should be paid for.?The Hospital at home program is another example that comes to mind –?many organizations invested a great deal of time, energy and thought into building this innovative model, and now we’re having to go to Congress to argue for funding; whereas, a more productive conversation would be around the insights we’ve learned, the new people we reached and the outcomes we positively impacted through the delivery of services.??

I think this shift happened because healthcare is a highly regulated complicated system with a great deal of inertia. The overall regulatory, procedural and financial structure of our industry is what continues to push us back to status quo. We change payment models on the short-term and pull back regulations to let people be creative –?then the easing of regulations goes away, and we're put back in the boxes that we were in originally.??

For me, all of this can be summed up in trying to continue to push on the level of urgency and creativity in how we operate even when not in crisis mode.?This will allow us to provide innovative care to more people as we engage the broader community in new and different ways.??

The latest news –?Are we going backwards?

In case you missed it, the CDC recently announced they would be ending their free vaccine program earlier than anticipated in August for those who are uninsured (despite ironically, this month being recognized as National Immunization Awareness Month). The Bridge Access Program was a federal program aimed at providing free COVID-19 vaccinations through purchasing vaccines directly from manufacturers and distributing them across state health departments. It was set to last through December of this year before it ran out of funding. While the vaccine was and continues to be covered under most private insurance companies, this program helped increase access to care for uninsured populations who lacked health insurance due to cost or losing their jobs during the pandemic, including many who are already disproportionally impacted.??

The Congressional rescission of this funding and the end of this program were likely hastened by the ending of the Public Health Emergency in May 2023, which contained governmental measures regarding masking, distancing, travel, vaccination requirements, etc., to quickly address the spread. While COVID no longer poses the same threat as it once did, the need to intentionally address disparities for those who do not have coverage never went away. Unfortunately, shifts in or rescission of funding can happen, but at the same time, we need to ensure these do not undermine the accessibility gains and operational learnings we made during the pandemic. ?

Looking Ahead + Final Thoughts

The COVID-19 pandemic was undoubtedly a terrifying time in healthcare, and it is very fair to acknowledge that fear drove some of the adrenaline and energy we were feeling. However, I continue to advocate that our industry gained a sense of creativity and urgency in how it worked, delivered care and engaged patients that we shouldn’t lose.??

Multi-modal delivery of healthcare is ideally the best path forward, as that allows patients to engage in the ways that meet their needs (video, virtual, asynchronous, in-person, etc.). Looking ahead, we should be asking how we build models (including payment models) around those multi-modal approaches. Our instinct should always be to evolve forward –?not trench in and defend the parts of our system that are currently working for a few in our communities.??

I hope we do not return to the status quo, as it would be a shame to waste a crisis and not hardwire some of the meaningful things we learned. It was inspiring to see how whole communities connected to care for people and broadened that responsibility beyond only HCPs. The health of a community belongs to the community, and it will be imperative to keep that equitable, forward-leaning lens in future thinking, policy and action.??

As I was teaching my recent class on Population Health in the American Healthcare System , I always liked to bring similar public health crisis case studies for discussion. One of my favorite pieces of healthcare-focused media to review is the Act Up documentary . As a follow-up to this edition, I’ll plan to share my takeaways from that documentary and how patient activism and major policy decisions played a unique role in the AIDs epidemic and the lessons learned from that very important work.???

Until next time.?

- Ruth ???

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I’m curious – in the comments, let me know what you think are the biggest learnings we’ve had in healthcare over the last few years. Healthcare professional or not, I’d love to hear from you! ???