Projected long-term impacts from COVID-19-initiated behavior changes that will drive fundamental shifts to where care is delivered and how chronic conditions are managed. A recent Sg2 analysis predicts a seismic disruption to the healthcare system as outpatient demand surpasses 2019 levels and inpatient volumes stagnate. Physician offices and clinics are projected to see an 18 percent increase in demand by 2029. However, inpatient volumes are likely to remain at or below the 2019 baseline. Those patients admitted to the hospital will likely suffer from more complex conditions and require higher levels of care, with projected inpatient days jumping by almost ten percent by 2029. Exacerbated by COVID-19-related conditions, chronic diseases are expected to surpass overall projections and put higher demand on specific specialties such as behavioral health, neurology, and pulmonology.
Sg2, a Vizient company, sees care delivery increasingly moving away from hospitals and high-cost skilled nursing facilities (SNFs) to lower-cost care sites. Driven in part of COVID-19 and accelerated by policy initiatives from the Centers for Medicare & Medicaid Services (CMS), Sg2 projects that hospital outpatient departments will see a 19 percent increase, ambulatory surgical centers will see a 25 percent increase, physicians’ offices and clinics will see an 18 percent increase, and in-home care will see a 15 percent increase in patient volumes over the next ten years. Virtualization will solidify its role in evaluation and care management, while diagnostic and procedural volumes are projected to grow by more than ten percent over the next five years.
These essential, enduring changes are driving health systems to make significant investments in care navigation, remote patient monitoring (RPM), and more effective forms of deeper, richer patient communication. Changes to care delivery, catalyzed by COVID-19, are forcing the shift from fee-for-service thinking to value-based care. As this new reality takes hold, the failures of the existing reimbursement model to bring about deep change, and the penalty structures that have been the mainstays of at-risk reimbursement, will cause payers and providers both to explore fundamental changes in patient expectations, care delivery processes, care needs—and how to pay for all of this.
To thrive in this new environment, providers have to think beyond the hospital walls to a systems approach that puts the guardrails and processes in place to ensure a patient’s movement in the right trajectory along the care path. A systems thinking approach requires the right mix of technology, people, and clinical and non-clinical protocols to proactively identify when a patient is off-track or non-compliant with a care plan; address the practical and clinical barriers that are impeding a patient’s motivation and ability; and empower clinical resources with the right information and the right time to drive escalation to the most appropriate care setting. This kind of systems approach lowers non-clinical demands on nursing staff so that they can operate at the top of their licensure, strengthens the connection to the patient and communication pathways, and drives patients to the best possible health outcome.
RPM investments take on a more central and critical role in post-COVID-19 care delivery. Because so much of evaluation and care management will occur in the home or remote care settings, RPM will serve as a critical clinical lifeline to the patient. But RPM requires more than devices and integration. Effective RPM necessitates onboarding, ongoing monitoring, continuous outreach, and an escalation process that communicates clinical and non-clinical variables to a clinician in an actionable, integrated way. Without this complete, end-to-end approach, the value of the RPM connection is undermined by patient non-compliance and clinician fatigue. The revenue generating allure of RPM can be tarnished by overburdened clinicians and patients who lose the motivation to continue using the device.
Addressing Practical Concerns
Patients live in a world full of practical barriers. Within the University of Alabama at Birmingham (UAB) Health System, an analysis of patient barriers identified and mitigated between May 2020 and April 2021 found that more than 60% of the barriers were related to practical concerns. Additional barrier categories included physical symptoms, emotional concerns, information gaps, family concerns, and spiritual concerns. Leveraging non-clinical care guides and an AI-enabled communication engine, 98.39% of the barriers identified were resolved within the studied timeframe. As care delivery moves farther away from the acute care setting, the practical barriers that impede a patient’s outcome become key variables that have to be incorporated into care delivery. And the investment in solutions that will lower these barriers without overwhelming nursing staff will become more central to the system’s overall performance.
Realizing System-wide Performance
Fee-for-service reimbursement models overemphasized the individual episode of care. A systems thinking approach forces a focus on the patient’s health trajectory and the potential points of failure across the care path. This means that healthcare providers have to go beyond the appointment to the complete care journey. Enabling deeper, enriched communication, ensuring that patients are routed to the right care setting, personalizing the care experience, and leveraging technology as an effective care enabler requires a deep understanding of the entire system in which the patient exists. If done incorrectly, providers will exacerbate existing siloes, bureaucracy, financial loss, and patient leakage. When right-sized with the right level of resources engaged in addressing different levels of need, a provider can realize performance delivered at the lowest total cost across the enterprise.
COVID-19 will have lasting impacts on the way we deliver, perceive, and measure care. As care delivery shifts to the home and lower-cost care sites, providers will have to think about patient health outcomes from a system level. This goes beyond the provider to include the environment, behaviors, and social factors that influence a patient’s motivation and ability to adhere to a care plan. But this thinking demands more than technology investments. The best resources, aligned to need, have to be engaged across the patient’s journey. And this has to be continuous, tailored to the disease or condition, and scalable to adjust to changing demands and patient needs quickly. We have as an industry talked about patient care in the context of outcomes; COVID-19 is forcing us to put action behind our words and think about the patient, the setting, and the social factors that impact health as one system that must be linked together and managed to drive to the best health outcome.