The coronavirus crisis forced health care providers to mobilize in ways few could have predicted six months ago, revealing not only the system’s weaknesses but its profound ingenuity.
Within weeks, providers worldwide set up drive-through testing sites, makeshift treatment centers, and screening apps for frontline employees to contain the pandemic. The experience will like reshape the entire health care industry for years to come.
We asked faculty members affiliated with the Health Care Initiative at Harvard Business School how the COVID-19 crisis will likely change health care. Here’s what they said:
Hospitals will rethink payment and operating models
Leemore S. Dafny: Physician organizations will expand
The decline in independent physician practices will accelerate, leading to larger physician organizations and more physician-hospital affiliations. If these organizations shift toward shared savings and capitated arrangements and away from fee-for-service, they will be better positioned not only to withstand any COVID aftershocks but also to gain patients during the recession.
Leemore S. Dafny (@LeemoreDafny) is the Bruce V. Rauner Professor of Business Administration.
Susanna Gallani: Physician pay will get a closer look
The COVID-19 crisis has highlighted the problems of compensation based on relative value unit (RVU) as never before. Hospitals have been overwhelmed with COVID-related cases and, at the same time, they have had to cancel elective procedures, including high-paying ones. Wherever possible, health care professionals have shifted from their normal service lines to serve COVID patients. Primary care provider offices and outpatient services are empty.
As a result, health care provider organizations are finding creative ways to pay their physicians, from lump sums to estimations of RVU volumes if the crisis didn’t happen.
My hope is that this crisis will provide the opportunity to rethink physician compensation in a way that maps physician incentives to the behaviors that generate value for the organization and for the patients.
Susanna Gallani (@sgallani) is an assistant professor of business administration.
Regina E. Herzlinger: Patients will choose ambulatory care more often
There will be a radical shift in the role of hospitals in the health care sector. The diminution in admissions that had already begun due to minimally invasive surgical techniques, the changes in reimbursement for free-standing ambulatory surgery centers, the rise of telemedicine, and consumers’ preferences for surgery outside of the hospitals, will be accelerated by the closing of hospitals for “elective” surgery.
Consumers will increasingly opt for ambulatory service centers, which are primarily owned by physicians.
Regina E. Herzlinger is the Nancy R. McPherson Professor of Business Administration.
Amy C. Edmonson: New ways to balance prevention and sick care
Those on the front lines of COVID care, working impossibly long hours, taking on tasks and roles for which they lack formal training, and facing painful uncertainty about what happens next, deserve our admiration and gratitude. But that is not enough.
At some point (and none of us know exactly when), exhaustion will overwhelm duty. It’s time to figure out how to get from unsustainable improvisation to viable ways of operating that can function indefinitely.Neither management scholars nor health care providers have access to an off-the-shelf solution for how to do this. But through a collaborative approach, we may be able to team up to midwife necessity as she once again becomes the mother of (systemic) invention. The opportunity, therefore, is to start reinventing the future health care delivery system that will sustainably deliver prevention and sick care in a post-COVID world.
Amy C. Edmondson (@AmyCEdmondson) is the Novartis Professor of Leadership and Management.
Debate about employer-based insurance will return
Amitabh Chandra: More demand for insurance exchanges
Recessions and pandemics create job losses that highlight the problems of tying health insurance to employment. Cleaving insurance from employment is often viewed as a path to more government control of health care, but this does not have to be true if employees can purchase private insurance on exchanges. I believe that we will start to see more demand for this kind of policy in the coming months.
Amitabh Chandra (@amitabhchandra2) is the Henry and Allison McCance Professor of Business Administration
Trevor Fetter: Serious questions about employment-based insurance
People are appreciating our frontline health care workers more and recognizing the critical role hospitals play in our health care system. I hope this will lead to investments in a more secure future for our providers after decades of being squeezed.
In a month’s time we went from the lowest level of unemployment in 50 years to the highest unemployment in 80 years. I expect this dislocation to reignite a serious debate about our employment-based insurance system and whether a more comprehensive model would make more sense.
Trevor Fetter, a senior lecturer, is former CEO of Tenet Healthcare.
Regulations that limit care might be loosened
Richard Hamermesh: Cutting the red tape in diagnostic testing
The crisis has revealed the weakest part of our medical system—the lack of rewards for diagnostics. Precision medicine requires precision diagnostics. It is a travesty that we don’t have simple tests that can distinguish between the common cold, seasonal allergies, and various strains of the flu, let alone the sophisticated diagnostics needed to guide the treatment of cancer subtypes.
This is the result of archaic structures both at the US Food and Drug Administration and the Centers for Medicare and Medicaid Services. The pandemic has made it clear that this must change.
Richard Hamermesh (@RHamermesh) is a Baker Foundation Professor of Management Practice and MBA Class of 1961 Professor of Management Practice, Retired.
Robert S. Huckman: Breaking down barriers to care—for good
The urgency of the pandemic has brought on a pervasive easing of formal and informal regulation in health care.
Payment for telemedicine has expanded and, accordingly, physicians have been allowed to practice more freely across state lines. Non-physician providers, such as nurse practitioners and medical assistants, have been given greater latitude to practice independently. And those individuals who are actually able to get tested for COVID-19 can do so by driving through a field testing site in the parking lot of a local store.
Though the official stance regarding this broad easing of regulation is that it is “for the duration of the current crisis,” I suspect that patients and providers—having seen what is possible in a time of great need—may resist efforts to reinstate many prior regulations once things have approached their new normal.
Robert S. Huckman (@robert_huckman) is the Albert J. Weatherhead III Professor of Business Administration at Harvard Business School and the faculty chair of the HBS Health Care Initiative.
Virtual medicine will become a standard option
Peter Barrett: Remote sensors will collect patients' vitals
The pandemic has forced health care workers into much broader use of virtual visits. I believe that the use of these virtual sessions will become standard in many cases. This change will also give rise to remote health sensors that give physicians vital information during the virtual visits.
Peter Barrett is a senior fellow.
Laura Huang: Startups will flock to virtual care
Health care is going to change in delivery modes. COVID-19 is showing us that telehealth, virtual appointments, and phone call consultations are replacing the traditional in-person appointments. This will continue in the world after COVID-19 and will perhaps expand further.I believe that startups that offer technology and software that enable physicians to confidently practice medicine from afar will become more valuable. My sense is that this trend will likely continue in entrepreneurship with new ventures that address the need for virtual health care.
Laura Huang (@LauraHuangLA) is the MBA Class of 1954 Associate Professor of Business Administration.
Robert S. Kaplan: Physician time will be used more efficiently
Telehealth and telemedicine will be permanently integrated into care pathways. Clinicians can now use familiar and ubiquitous platforms, such as Zoom, to assess and monitor their patients’ health status and their compliance with treatment protocols.
Patients will be able to conveniently access clinical services that use physicians’ time more efficiently. Clinicians, previously constrained by rigid state licensure requirements, will be able to practice telemedicine for all patients in their regions.
Replacing fee-for-service payments with value-based ones will remove the final barrier to delivering such integrated care.
Robert S. Kaplan is the Senior Fellow and Marvin Bower Professor of Leadership Development, Emeritus.
Ariel D. Stern: Remote monitoring will create more value
We have already seen a rapid wave of digital transformation in health care and that is likely to continue. The explosion of telemedicine and remote monitoring technologies are great examples of this. These interventions are now creating more value than ever as clinicians work to provide care for patients outside of the physical walls of a clinic or hospital.
Ariel D. Stern (@arieldora) is the Poronui Associate Professor of Business Administration.
New data approaches and therapies for infectious disease
William A. Sahlman: New treatment options for the next pandemic
The crisis reveals the remarkable progress over the past 20 years in health science. There are hundreds of companies, big and small, working on better tests, better therapies, and effective vaccines. These advances will change the world for the better over the next two years, and will prepare us for the inevitable pandemics that follow.
William A. Sahlman is a Baker Foundation Professor and the Dimitri V. D'Arbeloff - MBA Class of 1955 Professor of Business Administration, Emeritus.
John Beshears: New data sources for targeted intervention
The COVID-19 crisis has exposed major shortcomings in the US public health infrastructure, and when we come out of the crisis, I think the US will be ready to invest much more in the systems that help us prevent and fight infectious disease.
I expect to see more attention and resources devoted to linking health data sources and creating new data sources that facilitate monitoring and targeted intervention. This ecosystem will also involve innovation in diagnostics and analytics, with spillovers into areas of application beyond infectious disease.
John Beshears (@johnbeshears) is the Terrie F. and Bradley M. Bloom Associate Professor of Business Administration.
Public health will become a mainstream concern
Leslie K. John: Healthy hygience habits will finally stick
One consistent finding from our research on health behavior change is just how hard it is to achieve sustained behavior change. This might be because you need to engage in the desired behavior many times before it sticks as habit.
With COVID-19, we’re going through an extended period of heightened adherence to healthy hygiene behaviors such as frequent handwashing and abstention from handshaking. Though this pandemic has had many tragic consequences, one potential positive side effect is that it may lead to lasting improvements in these healthy hygiene behaviors.
Leslie K. John (@lesliekjohn) is a Marvin Bower Associate Professor of Business Administration.
Rosabeth Moss Kanter: Organizations will band together to support community health
There will be more recognition of the interconnected systems that account for the need for care, access to care, and care outcomes. The availability of jobs and their safety, housing density and quality, education and the health contributions of public schools, green space and recreation, air quality, extreme weather events.
Public health coalitions that cross sectors and the need to “think outside the building” will combine the efforts of many distinct organizations toward ensuring community health.
Rosabeth Moss Kanter (@RosabethKanter) is the Ernest L. Arbuckle Professor of Business Administration.
About the Author
Danielle Kost is a senior editor at Harvard Business School Working Knowledge.
[Image: vm]
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What changes do you hope to see in health care in the wake of COVID-19?
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