Early lessons from COVID-19 we already should have learned | American Enterprise Institute
The spread of COVID-19 has exposed real structural
deficiencies in our healthcare delivery system. As Congress completes its
latest rescue package, it should apply lessons learned and pursue long-needed
healthcare reforms that would benefit all Americans even further into the
future. Some responses to the COVID-19 outbreak, if implemented widely, could improve
healthcare delivery for many conditions.
First, consider recent speedy adoptions of telemedicine. Insurers, physicians, and hospitals have scrambled to make sure that those who might have the coronavirus do not bring their infection into healthcare facilities. The virus’ spread has illustrated the dangers of requiring patients to visit physician offices as a first line of defense.
We do not want people battling infections of any kind to congregate in areas populated by patients with compromised immune systems. For many conditions, virtual care is cheaper and more convenient without meaningfully sacrificing quality. More important, it is safer for both patients and providers, many of whom have put themselves at risk while heroically treating coronavirus patients. Virtual visits should be the norm, rather than the exception. Facilitating necessary reimbursement mechanisms and clearing away anti-competitive regulatory barriers to telemedicine across different states were on the overdue policy reform list even before COVID-19 started spreading. The latest virus-related bills start to do this, primarily through Medicare and other public programs. We need to do more, on a permanent basis.
Second, how many people with elderly parents and friends are now regretting the shortcomings of elder care? We have long known of the dangers of infection spreading in nursing homes and other elder care homes. We have also known that our seniors often lose their friendship networks and their pride of self-sufficiency when they are left isolated in assisted living facilities. Such moves would be less necessary if we can make in-home care more affordable and flexible.
Virtual technologies could help reorient elder care. Video conversations (about which those of us of a certain age are all learning much more) could replace or supplement in-person caretaker visits. Voice and motion monitors can detect falls or erratic behaviors and, when necessary, summon emergency responders. Biometric devices could even monitor oxygen levels or other physiological abnormalities that might anticipate the need for anything from urgent care to correcting medication doses to more exercise. Many of these interventions could forestall institutionalization, while sustaining and extending healthier individual living.
And third, the COVID-19 outbreak starkly illustrates the need to disseminate accurate medical information to the population. Currently, most patients only obtain meaningful health information by visiting the physician. Others rely on web searches, where information can be useful but is neither tailored nor consistently accurate.
There are better ways to inform patients and welcome them as partners in their own care. Medical providers could tailor medical instructions and healthcare advice to their patients through digital apps or other at-home mechanisms. Electronic health records could finally have a meaningful use if more interoperative platforms supported a wealth of analytics that would generate efficient and accurate medical guidance. These digital linkages would connect patients directly with providers, who in turn would be directly connected to troves of analyzed data. This infrastructure would, of course, be especially useful for a public health crisis.
Instituting these changes to the delivery
system requires only minimal technological advances. But it does require a
significant reorganization of our delivery system, as well as the willpower of
both health sector interests and political intermediaries to implement meaningful
changes in how we regulate care and how we pay providers.
Our current reliance on physician visits is driven by the lingering grip of our fee-for-service system, which still pays physicians primarily for the volume and service intensity of the patients they see individually. Payment reforms can compensate physicians instead for the overall health outcomes they help achieve and maintain in the patient populations they serve. If we pay providers more for keeping people from needing to enter the hospital, rather than compensating them for what patients consume inside hospitals and other facilities, we will stimulate investments toward keeping people healthy in their homes.
As we confront the painful limits of our health care system during a public health crisis, we are learning, too, that our regulatory system remains inadequate for the modern digital economy. We improperly regulate devices that transmit health information, and we require unnecessary credentials from individuals that use these devices to monitor patient health. Barriers to accessing and analyzing health information prevent the formation of an effective health information ecosystem.
Congress belatedly is scrambling to support
the nation’s health system as it buckles under the strains of the COVID-19
outbreak. Initial rescue packages necessarily focus first on assembling massive
resources (both real and elastically virtual) to address urgent needs. The next
ones ahead must offer further needed relief that invests more strategically in improving
the nation’s health system, not just for the next pandemic but for our handling
of most illnesses.
Rather than just shoring up legacy
institutions and delivery systems, Congress should invest in the physical and
regulatory infrastructure to support in-home acute and long-term care. That
means instituting payment reform that encourages providers to invest in health,
not volume, and in systems that provide accurate and helpful health information
to their population of patients.
Barak Richman is a Professor of Law & Business Administration at Duke University and a Visiting Scholar at the Stanford School of Medicine.