Thinking Ahead: Preparing for a Post-COVID World

By Allen Miller
Principal, COPE Health Solutions
By Sarin Khachatourians
Senior Consultant, COPE Health Solutions

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Original Publish Date: May 5, 2020

As we begin to see the light at the end of the tunnel amidst what will likely be only the first wave of Covid-19 infections and economic impacts, it becomes clearer that health care will be forever changed and that many strategies that had not been universally accepted will now be critical success factors going forward.

Over the last decade, health care in this country has glacially been moving away from fee-for-service to payment for value and capitation; from in-person medical office visits to telehealth, home and community based care; and from a traditional definition of health care providers to a broadened understanding of how social determinants impact health and how social services play a key role in improving outcomes and reducing the total cost of care. Summarized below are five categories for consideration around what the health care world will most likely look like post-Covid:

Hospitals will still be needed, and the ability to expand and contract hospitals, particularly intensive care unit (ICU) space, rapidly in an emergency will be a required skillset for hospital and health system leaders. Hospitals that are not part of a well-integrated network of physicians, federally qualified health centers (FQHCs), behavioral health, home care and other key providers within a region may not survive.
In the face of a pandemic, surge impacts were not equally distributed. Whereas all of health care was required to substantially curtail the crisis, elective procedures and ambulatory visits dropped dramatically, reducing revenues by 35% or more in many cases. Medical groups, IPAs, hospitals and health systems in capitation or other global risk arrangements with well-designed re-insurance were best equipped for this latest disaster will be best able to weather crises going forward.
Social determinants of health (SDOH) is no longer a catchy marketing phrase but the basis for a foundational set of drivers of cost and health outcomes that complement and often outweigh medical needs. As the economy continues to struggle for the next 12 to 18 months, tens of millions of commercially insured people will have transitioned to Medicaid, subsidized exchange or lost coverage completely in non-Medicaid expansion states. To successfully overcome this new reality, hospitals and health systems must integrate with community-based organizations (CBOs) with well-defined services and key performance indicators (KPIs) as paid components of a clinically integrated network in global risk value-based payment (VBP) arrangements.
Regulatory relief that encouraged both telehealth expansion and enhanced financial and clinical alignment between hospitals, physicians, FQHCs and other providers during the Covid crisis will not disappear, nor will the resultant new networks and referral patterns. Those who are aggressive now in supporting and integrating with independent physicians, smaller medical groups, FQHCs, behavioral health and high quality CBOs with the right KPIs and value-based agreements will be best positioned for success with payers in 2021 and 2022.
The number of people dually eligible for Medicare and Medicaid has been growing and will continue to grow after this initial Covid-19 surge. Success will require the ability to coordinate benefits for dual eligible members, generally through PACE or DSNP payer models, and with highly integrated care networks that include both CBOs and remote home based patient monitoring and care management platforms that can engage even remote caregivers and family in the care process.

The road to recovery from Covid-19 will be long and challenging. The partnerships that are initiated to address the immediate concerns of saving the most number of lives and limiting spread could transition into long term opportunities for integration. Preparing for the road ahead will be critical to ensure success in reopening healthcare in a post-COVID world.

Allen Miller is Principal and CEO of COPE Health Solutions and can be reached at amiller@copehealthsolutions.com and 310-386-5812. Sarin Khachatourians is Senior Consultant with COPE Health Solutions and can be reached at skhachatourians@copehealthsolutions.com.