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"As health care leaders, it’s essential that we ponder what the pandemic can teach us about how we can think differently about the future."
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Beyond COVID-19: What Else Should Health Care Policy Address?

By Kedar Mate | Tuesday, March 9, 2021
Beyond COVID-19 What Else Should Health Care Policy Address Photo by De an Sun | Unsplash

The US recently passed a grim milestone: Over half a million have people died from COVID-19. It’s a huge number to fathom. Think of it this way: This amounts to one COVID-19 death per minute, for almost an entire year.

There is no question that COVID-19 is the most important issue President Biden and his administration should tackle right now. From my perspective, they’re doing everything in their power to marshal a strong, coordinated federal response to the pandemic.

However, while COVID-19 is undeniably the most critical item on their agenda, the pandemic is far from the only health care issue we’re facing as a country.

As we learn from the lessons of COVID-19, it’s important to consider how this period has led to unprecedented creativity. What unleashed such innovation in our system operators, teams at the point of care, and clinicians? The clear and present danger of the virus — a very public “burning platform” — engendered focus from health system leaders like we’ve never seen. Gone — at least for a period — were the complex roadmaps and 200-project inventories. Suddenly we had one focus — beat back this virus. Government eased regulations to allow new models of delivery: large-scale COVID-19 field hospitals, mass vaccination sites in sports stadiums, and testing at pharmacy drive-thru windows. All these activities were unimaginable just a year ago.

Every health system leader I talk to right now has been inspired and motivated by the freedoms provided and afforded by their local, state, and federal authorities. It has allowed creativity and innovation to flourish. One of the few positive aspects of this pandemic has been seeing how much transformational change is possible.

What if the Biden administration and other policymakers were to use this opportunity to determine which regulations need to be in place and which we might do without post-pandemic? How might we change the operating model? How might we change the ways in which we work?

Here are a few recommendations I hope the Biden administration and other policymakers will consider:

  • Continue support for telehealth incentives. All evidence seems to indicate that support for telehealth will continue beyond the pandemic. But how might support for telehealth fundamentally improve care practices? Chronic care, for example, requires multiple, frequent, and typically brief touch points with our patients. It requires shared decision-making. Continual encouragement from friends and families, and genuine co-production help enable patients to live healthier lives. Tech can help support this kind of approach to chronic care but will require payment to match it.
  • Move care out of the hospital. More care should be provided closer to communities and in home-based settings. Providing acute care in the home or otherwise helping older adults safely “age in place” and avoid unnecessary emergency room visits and hospitalizations are examples of this. To help expand these options, we need a combination of incentivization, deregulation, and additional forms of support. This includes reimbursement for home-based hospital services and other ways to remove barriers to safe and effective alternatives to the hospital for managing chronic diseases.
  • Concentrate more on intersectoral work. Many community-based organizations know how to solve problems related to the social determinants of health that lead to poor health outcomes. We now have an opportunity to creatively move assets from health care to community-based organizations that understand best what their communities need most. If we move money to education, job creation, criminal justice reform, immigration support systems, and climate change, and increase coordination with health care, we could increase health in our populations and lower health care costs.
  • Focus on outcomes. My hope is that the new administration invests its energies in outcomes-based measurement and outcomes-based incentives. This will help ensure that value-based payments will be paying for the real changes in health outcomes that people value the most.

    It’s also worth noting that I mean real outcomes; I don’t just mean preventing readmissions and decreasing length of stay. I mean survival, reductions in morbidity, and ensuring people spend their days at home and with family when that is what matters most to them. “Days at home without disability” would be a measure we should consider using to track progress. In addition, while I welcome the support for Medicaid expansion that I expect to see from the Biden administration, beyond just increased access to care, I’d like to see increased access to high-quality

It’s been invigorating to watch as limitations on innovation in health care have become less restrictive during the pandemic. Creativity has mushroomed from every corner of our industry. As health care leaders, it’s essential that we ponder what the pandemic can teach us about how we can think differently about the future. We owe at least this much to the more than 525,000 people (as of this writing) whose lives have been lost to COVID-19, and the millions of family and community members who deeply feel their loss.

Editor’s note: Look for more each month from IHI President and CEO Kedar Mate, MD, (@KedarMate) on improvement science, social justice, leadership, and improving health and health care worldwide.

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