Today’s health care institutions are stretched to capacity and beyond by the COVID-19 crisis. But like physical exercise, it’s possible that this stress can lead us to a stronger system longer-term. This depends, of course, on how we respond to the shortcomings revealed by our slow responses to the pandemic.
From my decades in health policy, here are my top ten lessons from COVID-19 that should change the future of health care in America:
- Emergency Preparedness. Perhaps the most obvious need for improvement is in our preparations for future health care emergencies. A more adequate strategic reserve of key equipment and medications, especially personal protective equipment, and more responsive means for national distribution, would be a positive step to strengthen our ability to respond more effectively to future threats. This includes more adequate surge capacity, better planning to address new methods of care delivery (like home-based care), and closer cooperation between public and private sector entities that can contribute to emergency medical needs. Examination of why existing stockpiles have proven insufficient will also be important.
- Testing and Diagnosis. The failure of the United States to quickly test large numbers of people greatly contributed to the spread of the virus and subsequent loss of life. Other countries addressed this need more effectively. A stronger health care system going forward will include a more responsive testing capacity which can then inform population health measures to limit the spread of infections. We need data. Also, we will need to retain the more flexible and responsive regulatory oversight at the FDA that was finally permitted during the COVID-19 crisis. The provisions waiving cost-sharing for testing should continue as we recognize the urgency and benefit of widespread testing – the spread of infectious disease highlights the critical positive externalities of low barriers to high-value care.
- Telehealth Flexibilities. Telehealth has the potential to free up our system to incorporate more efficient and responsive alternatives to face-to-face medical appointments. Barriers to telehealth use have been lifted at break-neck speed by the administration and Congress in light of this disaster. Many of these new measures should be made permanent so that patients and physicians can take advantage of new ways to interact and forego outdated methods of care.
- Workforce. The emergency has forced the suspension of restrictions on physician and nurse practices that are no longer appropriate. Allowing physicians to practice across state lines, allowing nurse practitioners and physician assistants to practice to the full scope of their licenses are overdue reforms that need to continue beyond the current crisis.
- Public Health Infrastructure. Our underfunded public health infrastructure has been overwhelmed. Community Health Centers, for example, are at the front lines of reaching millions of Americans, particularly those lacking insurance or the means to get treatment. That lack of capacity resulted in greater infection for the general population. The foundations of our modern economy no longer
allow us to isolate infectious disease to one part of our society. Other key public health institutions such as the Centers for Disease Control (CDC) are now receiving badly needed supplemental resources that need to continue. - Insurance Coverage. If the current crisis demonstrates anything, it’s that everyone should have insurance coverage – not just for their own protection but for the community’s. Any delays in seeking treatment, even if just a phone call to a family physician, due to lack of insurance coverage simply put everyone else at risk and could drive up total costs. This crisis is forcing a relaxation of enrollment restrictions along with a reexamination of cost-sharing requirements for critical treatment. Congress has the opportunity to build on this change by moving our system toward value-based coverage provisions that reduce costs for prevention and high value medical interventions, especially during an emergency. States that have not expanded Medicaid have the opportunity and responsibility to expand Medicaid coverage as a step to protecting the general population. Insurers may need financial support for these changes to continue, but the more generous targeted coverage provisions recently adopted need to be extended in ways that enhance access to important diagnostic services in future public health emergencies.
- Outreach to Those Most Vulnerable. COVID-19 has shown how much higher risk some people are to hospitalization, disease, and death than others. The underlying causes of these vulnerabilities can often be addressed through continuation of expanded support for social service agencies. The health care system also has a role in investing upstream in social determinants of health, in order to avoid over-hospitalization. Health plan investments in nutrition, housing, and transportation, for targeted at-risk populations can be cost effective and need to be expanded. Nursing home and other senior living facilities have been particularly at risk to COVID-19. Containment strategies based on testing, isolation, and treatment could limit the spread of infection. Greater support for nursing staff and home care options are also measures that need to continue.
- Mental Health. Depression, anxiety, and stress are understandable reactions to our current crisis. Social isolation is particularly difficult for many who live alone. Outreach to those people is so far inadequate, but could be expanded to build on the explosion of online efforts to engage isolated individuals who are lonely, anxious, or depressed with helpful resources. Video outreach may turn out to be a partial substitute for face to face interactions, even by individuals with minimal training. There will be a surge in demand for mental health services during and in the wake of COVID-19, as isolation extends and losses grow, in addition to those underserved already. Federal and state partnerships to expand mental health programs will be essential to a healthy future.
- Stronger Public Communication and Education. One of the most important lessons from our current experience is the crucial role that timely, clear, authoritative, and credible information plays to support public understanding and behavior during a rapidly evolving epidemic. Political leaders, governors and presidents alike, need to regularly communicate with the public and provide access to public health experts who can communicate complex science and uncertainty without generating panic. We need stronger norms and better models of communication for future crises, free from political agendas.
- Cost-containment. All these ongoing changes will be expensive but worthwhile. If we are to keep our health care system at all affordable, Congress has now the responsibility to enact cost-saving measures that can offset these needed investments. Two areas stand out because they are widely understood to embody unnecessary health care expenses: specialty prescription drugs and so called
“surprise bills” for out of network care, often in emergency rooms.
High-cost specialty drugs are driving higher costs that are unaffordable to families, employers, and taxpayers. Bipartisan proposals have been introduced to bring drug prices more in line with their value – Congress should no longer delay them. Surprise bills burden unsuspecting patients with extraordinary charges for in-hospital care by physicians not a part of the patient’s insurance network. Many states have already tried to limit this practice, but federal action is still necessary. Both situations are abusive and result in unjustified costs to patients, insurers, employers, and taxpayers. Congress needs to act to reallocate health care dollars where we really need it.
The current crisis presents some opportunities for strengthening our health care system going forward, but only if we build on what we are learning from the current stress.