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No industry has been impacted more by the COVID-19 pandemic than health care. No industry is likely to change as much after the pandemic eases than health care.

Potential changes range from recreating domestic supply chains for equipment and drug agents to rethinking employer-provided health insurance to managing more patient care online. Medical practices from waiting rooms to research labs could see major changes. Gaps in the public health system could be plugged, hospital business models could be revised, a Nurse Corps could be created and masks could become the norm.

Elizabeth Hayes explored the future of post-pandemic health care in a major story published last week by the Portland Business Journal, which was based on extensive interviews with health industry thought leaders. “The COVID-19 pandemic not only has killed more than 100,000 Americans and 154 Oregonians, but also exposed cracks in the health care system that were always just under the surface,” she wrote. “Changes have already come to a notoriously resistant industry.”

“Most visibly,” Hayes said, “providers pivoted to telehealth from in-person visits, accomplishing in a matter of days what in normal times would have taken months. Providence Health & Services is now providing 10,000 telehealth visits daily. Pre-COVID, that was the yearly goal, Chief Financial Officer Melissa Damm said at a recent legislative hearing.”

Here are some quick takes from Hayes’ story:

Preparedness  Shortages of masks, gowns, gloves, eye shields and personal protective equipment quickly emerged as stockpiles were exhausted almost overnight as the virus surged. The source of the problem was offshore suppliers and an international free-for-all to buy what equipment was available. Oregon Health Authority Director Patrick Allen told state lawmakers, “We need to be more self-reliant as a state for PPE and other medical stockpiles than we originally thought and planned for.”

New Amsterdam Reality TV
Several episodes of the TV medical drama pivoted on gaps in the health care system, ranging from unaffordable insulin prescriptions, high health insurance deductibles and treating underserved at-risk patients.

Employer-based insurance  Before the pandemic, 1.9 million Oregonians were covered by employer-based insurance. When businesses closed and layoffs mounted, many families felt at risk of losing their health insurance, too. According to Hayes, a Kaiser Family Foundation analysis found 26.8 million American households were potentially at risk. Access to health insurance was already a hotly contested political issue in the 2020 presidential election, and stands to be even more so with newfound middle America question marks and possible openness to voluntary access to health insurance with a Medicare public option.

Workforce  Hospitals faced workforce shortages even as they furloughed nurses and other staff when elective surgeries were postponed. Nursing officials said the incongruous situation suggests more cross-training of personnel to meet unexpected health care demands. A more integrated public health care network might help, too. Oregon Nursing Association Executive Director Sarah Laslett mused, “Could we imagine a nurse corps, like the Peace Corps, where you have opportunities for nurses and other providers to plug into a well-designed system that’s ready to go, where we can be doing care in settings other than an acute care facility? A lot of roles can be played, and the nursing workforce is a well of expertise.”

Telemedicine  Telehealth has been around for years, but took off during the lockdown. “Reluctant clinicians have seen that they can often provide the same quality of care remotely for many, though not all, services. Patients like the convenience. Insurers have agreed, at least during the pandemic, to reimburse at comparable rates to in-person care,” Hayes notes. As technology improves, telemedicine can advance beyond a simple interface to transmit diagnostic information and conduct remote screenings, especially for patients with chronic illnesses. Patient avoidance of waiting rooms may perpetuate the trend, even if insurers are reluctant to continue reimbursement.

Research  The pandemic severely disrupted medical research, pushing aside projects and undertaking COVID-related investigations. Some medical labs may not survive. Whether disrupted research projects resume will depend on new priorities established by the National Institutes of Health, which is a major funder. “The track record for us as a society is not terribly good,” says OHSU Chief Research Officer Peter Barr-Gillespie.” When various pandemics come through that have been threatening, we increase funding and then cut back significantly.” It’s likely the priority will remain for some time on virology, infectious disease and epidemiology.

Business Model  The pandemic revealed how hospitals make money – and what happens when volume services are halted. “I do think the pandemic has forced the hospital systems, and even large specialty groups, to reimagine how they’re paid in the future and how the business model has worked,” says Jack Friedman, former CEO of Providence Health Plan. “I don’t know if the payer market is completely ready to move in that way, but I do think health systems are talking about that.” Global budgeting, where insurers charge a set amount per member, would provide more financial stability. Coordinated care organizations in Oregon already use a similar model, as does Medicare for primary care.

Don’t be surprised if masks and omnipresent hand sanitizers become standard fare in public places well after the pandemic passes. Intensified personal hygiene has been welded to our health care system.