The COVID-19 pandemic has forced healthcare providers and payers to adopt new ways of working. Simultaneously, a historic drop in healthcare service consumption is stressing many institutions (providers may have lost over $200 billion in the first half of 2020), and consumers are embracing new tools that support virtual and in-home care delivery. Together, these forces are creating unparalleled opportunities for the U.S. healthcare industry to reimagine its current operating model to reduce systemic inefficiencies and catch up with other industries regarding digital transformation.
But providers and payers must also deal with the unfolding crisis in the short term. They’ll be contending with the pandemic well into 2021 — determining the usage, efficacy and side effects of vaccines, to take just one example.
We believe the industry can (and must) address these immediate needs while simultaneously investing in the capabilities required to emerge from the pandemic with new, more efficient models of care and better engagement with patients and members. The key is selecting the right areas in which to invest.
To that end, we’ve created checklists for healthcare providers and payers around what we view as five imperatives:
The perennial industry challenge is reducing the cost of care while improving the quality of outcomes and patient experiences. As the figure below demonstrates, the pandemic has not helped. For this and other reasons, providers may need short-term cash-flow improvement to address immediate pressures.
COVID-19 has forced the high-scale adoption of telehealth. Care-at-home is the next evolution of virtual care in which healthcare providers offer a wider range of services virtually. Implementing this imperative will give providers greater freedom to serve patients, optimize total cost of care, and improve patient engagement.
The continued risk of COVID-19 infection is forcing providers to reduce physical contact during care delivery and administrative processes. A critical challenge is delivering a personalized, human experience while practicing social distancing and contactless processes. Naturally, our checklist here applies only to providers.
Shifts in consumer behavior, combined with regulatory easing and powerful new technologies and their accelerated global adoption, create a perfect environment for change.
Payers and providers have an opportunity to work together to engage patients to control costs. They can create a model of joint operations to maximize operating efficiency; reduce waste and duplicated effort; maximize information delivery speed; and improve patient care.
Create a financial recovery roadmap by each payer contract to sustain operations.