What Will Healthcare Look Like in a Publish-COVID-19 World?

Photograph from Dr. Feldman with permission from HLTH

This text examines the way forward for healthcare in a post-COVID-19 world as gleaned from the HLTH VRTL 2020 on-line mega-conference. It additionally explores the influence of the long run state on the care of power inflammatory illnesses, my space of focus. As I engaged in digital periods and networking, I considered them by my lenses as a monetary analyst, enterprise advisor, and affected person.

In line with my mission at Your Autoimmunity Connection, I continuously saved one query in thoughts. How may these post-COVID modifications assist sufferers with autoimmune and autoinflammatory situations?

How did HLTH VRTL work out?

I really like going to conferences, from the anticipation of journey with my well-worn suitcase and beloved journey garments. Plus the thrill of assembly new folks in essentially the most unlikely areas: bogs, hallways, and elevators. For me, conferences have been intermittent alternatives to take the heartbeat of digital well being.

Prior to now, HLTH has been probably the greatest such adventures. In 2019, I shared a room with Mette Dyhrberg, founding father of Mymee, an effective way to collaborate on our joint missions to enhance analysis, prognosis, and take care of autoimmune sufferers.

This yr, 2020, the Yr of the COVID-19 pandemic, is totally different. With secure journey choices restricted, we’re all adjusting to digital conferences.

I’m pleased to report that the HLTH VRTL platform execution was excellent. Throughout a complete week of on-line displays and one-on-one digital conferences, the platform by no means crashed. In truth, that dreaded round buffering icon by no means as soon as appeared. Kudos to the HLTH VRTL tech staff for making a seamless digital convention expertise.

First impressions of HLTH VRTL 2020

First impressions are key. HLTH did an excellent job setting the stage. They began with an inspirational video and adopted with an informative statistics video.

Among the many myriad of tracks, I discovered the day by day recaps with Andy Slavitt, Leona Wen, and John Brownstein to be helpful and informative. These helped me to rapidly determine the healthcare supply developments that I feel may be necessary to power autoimmune and autoinflammatory sufferers.

Beneath are highlights of chosen periods, framed by my evaluation and commentary on how disruptive post-COVID drivers of change may assist create a brand new regular that may higher meet the present and future wants of autoimmune sufferers.

The disruptor: COVID-19 pressured speedy progress in telemedicine and distant affected person monitoring.

Within the “Way forward for Telehealth,” part of the HLTH Counterpoint Collection, Tina Reed, Govt Editor of Fierce Healthcare, moderated contrasting views on the way forward for telehealth from Roy Schoenberg, President, and CEO of Amwell (NYSE: AMWL), and Mario Schlosser, CEO of Oscar Well being.

  • graphic speakers at HLTH discussing health care in post-covid-19 world
    Graphic supplied by the creator

    Amwell – telehealth platform for all

Amwell is a number one telehealth platform supplier in america and globally. It connects and permits stakeholders to ship higher entry to extra reasonably priced, larger high quality care. These embrace:

      • suppliers,
      • insurers,
      • sufferers,
      • innovators.

With over a decade of expertise, Amwell powers telehealth options for over 2,000 hospitals and 55 well being plan companions with over 36,000 employers, masking over 80 million lives.

Roy Schoenberg, CEO of Amwell, stated,

“The coronavirus has proven those who delivering healthcare with expertise has a job to play. We have now a robust voice for the payer and supplier, perhaps we’re starting to see the arrival of the affected person voice…If we are able to create a gratifying expertise for the those who we serve over the long run that could be a successful technique.”

He continued,

“There is a crucial query as as to if these applied sciences are a part of the supply or the payer aspect of care.”

He sees a future the place group practices are enabled by expertise to be extra simply accessible to sufferers whereas offering nice customer support and communication. Quite than viewing telehealth as simply one other “software”, he believes {that a} “dwelling run” can be when:

”Telehealth is a care setting during which conventional drugs is delivered and the house entrance would be the most coveted care setting.”

How does this apply to autoimmune care?

Persistent illness sufferers, particularly autoimmune and autoinflammatory problems sufferers, want ongoing assist between commonly scheduled appointments. The increasing use of telehealth could profit them.

Telehealth can allow extra frequent, handy, but more cost effective encounters from sufferers’ properties. That is much more true if telehealth is not only changing PCP encounters however augmenting them with teaching and different employees. Coordinating with specialists is one other necessary characteristic for power and autoimmune illness sufferers, however that doesn’t appear to be as far superior.

  • Oscar Well being – Past insurance coverage

Oscar Well being is a hybrid insurance coverage firm, telemedicine platform, and first care supplier, based mostly within the Pacific Northwest. Based in 2012, Oscar Well being was the primary direct-to-consumer (DTC) well being insurer. It facilitates member engagement with their very own full-stack expertise platform that handles each the insurance coverage aspect and the care supply aspect of the enterprise. This contains:

      • claims processing workflows,
      • advantages adjudication,
      • prior authorizations,
      • options to assist telemedicine, distant affected person monitoring, and care collaboration and coordination.

Oscar is one in every of many firms constructing variations on care groups to enhance coordination, supply, and customer support whereas controlling prices. These groups, which Oscar calls concierge care guides, will help sufferers do the next:

      • discover a doctor or specialist,
      • coordinate their care,
      • navigate billing and advantages.

This method: digitally supported personalised care groups led by nurses, coordinated by guides (aka coaches), and physicians. The personalised care groups present a spread of care, together with power illness plans, which is analogous to concepts we’ve proposed from 2014 on to assist CID sufferers navigate their complicated ongoing care.

Mario Schlosser, CEO of Oscar Well being, informed HLTH that the COVID increase to telehealth is a

“large alternative to bend the associated fee curve and improve the variety of touchpoints (visits) and subsequently scale back the variation in care.”

For autoimmune and autoinflammatory problems sufferers, extra telehealth visits and distant monitoring of signs, medicines, and so on. between appointments may assist them scale back flares, higher handle unwanted side effects, and keep away from expensive emergency care and hospitalizations.

Schlosser sees a future the place there will probably be extra remotely enabled doctor practices that tackle the monetary danger themselves in order that

“the variety of doctor visits go up, however the worth goes down.”

Implications for autoimmune sufferers

In conclusion, telemedicine and distant affected person monitoring are enabling applied sciences, a lot wanted. Nevertheless, they haven’t but immediately centered on autoimmune or autoinflammatory illness care.

Utilizing telehealth to develop entry, pace, and the variety of encounters, together with the expanded use of care-based staff fashions that embrace specialists, may probably profit autoimmune sufferers.

Likewise, distant affected person monitoring can allow higher power autoimmune illness care. Nevertheless, this may solely happen if payers, suppliers, and platform firms lastly concentrate on this invisible alternative, as expensive and sophisticated as most cancers.

The motive force: quicker migration from FFS to VBC permits new fee & reimbursement fashions

Worth-based care (VBC) gives a brand new monetary basis for healthcare supply enterprise mannequin experiments. From the angle of autoimmune sufferers, I’m wondering if the VBC fee fashions higher assist the long-term, multiple-modality care coordination that such sufferers want, however have usually not obtained from FFS supply fashions?

graphic of speakers at HLTH talking about healthcare in a post-COVID-19 world
Graphic supplied by the creator

Bryony Winn did an excellent job setting the stage, asking why this can be a good time to debate “A Push Into Worth-Primarily based Care”, as she asserted that:

    1. The COVID pandemic exhibits that perverse incentives make FFS unsustainable for suppliers. Nevertheless, VBC’s regular income fashions could higher align payers, suppliers, and sufferers.
    2. We now have proof from applications that had been launched and examined primarily by the federal government over a decade in the past, that VBC can work to cut back prices and enhance outcomes.
    3. An open query: what sort of supplier networks work finest below VBC?

From my perspective, FFS has not been a superb mannequin for power illness administration, not to mention, power antiinflammatory, and autoimmune illnesses. The important thing query is, will VBC fee fashions assist suppliers and practices to supply higher take care of lifelong power inflammatory sufferers?

  • Hospital-led ACO – Mass Normal Physicians Group

The Massachusetts Normal Physicians Group (MGPO) is the biggest multi-specialty medical group in New England and one of many largest within the U.S.

Dr. Timothy Ferris- CEO of Mass Normal Doctor Group, stated,

“I don’t see [hospital-led ACOs vs independent physician practice-led ACOs]as an either-or? [Hospital-led ACOs] have capital that may be redeployed in ways in which generate advantages for the system and sufferers…The important thing factor is investing within the infrastructure and providers that the FFS mannequin doesn’t pay for.”

These embrace:

      • high-risk care managers,
      • monitoring hypertension sufferers,
      • embedded psychological well being providers.
      • different proactive preventive methods.

How can massive ACOs compete with new, cheap retail FFS choices? For instance, DTC apps reminiscent of HIMS, HERS, Retains, and so on. supply one-stop, doc-in-a-box purchasing for fashionable prescribed drugs. Different opponents embrace massive point-of-care retailers, like CVS and Walgreens, for acute care, vaccinations, prescriptions, and so on.

Ferris continued,

“I feel that built-in supply methods of the long run should discover a mannequin to ship low-end providers.” (flu pictures, and so on.) as cheaply as their new opponents. “However most of our spend is just not on low-value care, however relatively on of us who’re very sick.”

Partially as a result of many very sick sufferers current with a number of comorbidities, any supplier’s capacity to cut back the spending on these sick of us is proscribed.

“We are able to present that enormous built-in supply methods had been capable of scale back total system prices by 2%”.

How may massive hospital methods apply this to autoimmune sufferers?

Devoted care managers (just like these monitoring hypertension sufferers) may assist autoimmune sufferers with remedy assist wants between common appointments. They may additionally assist foster extra proactive flare-prevention methods.

Autoimmune and autoinflammatory situations are expensive to handle and never simply due to specialty medicines. Nevertheless, avoiding flares and thus much more costly episodes of emergency care and hospitalization strike me as low-hanging fruit, high-return investments for large hospital methods.

But this unmet want is a chance that appears usually to have been ignored. Possibly the emergence of post-COVID syndromes, which look very very similar to autoimmune reactions, will drive massive supplier methods to return to grips with the unseen epidemic of immunological and inflammatory illnesses.

Extra Content material by the creator: 
HLTH: Uncovering Improvements to Assist Sufferers with Immune-Mediated Illnesses

  • Doctor-led ACO – Aledade

Aledade is a platform firm that companions with major care physicians to assist them construct and lead their very own Accountable Care Organizations (ACOs).

Farzad Mostashari, the co-founder and CEO of Aledade, informed us that 6 years in the past they wager that impartial PCP ACOs would win over hospital-led ACOs. The independents weren’t burdened with the massive monetary overhead of hospital methods. Subsequently, Aledade noticed a chance to

“Go together with these with essentially the most to achieve and the least to lose from VBC.”

As of 2020, Aledade serves 550 practices and 7000 clinicians with $10 billion below administration.

“It’s working and it’s rising.”

Aledade gives regulatory experience, expertise, information analytics, enterprise transformation providers, and upfront capital. Along with all the opposite components, impartial practitioners want to achieve value-based care.

Sufferers usually are not seeing decreased care. Mostashari stated we are able to supply “extra screening, extra immunizations, higher blood strain management.”  Sufferers are getting major care that’s “extra accessible, extra knowledgeable, and extra engaged.”

Total, they declare an 8-13% discount within the whole price of care. Financial savings differ by state.

Will this enhance autoimmune care?

Offering reasonably priced, straightforward to combine, off-the-shelf IT infrastructure and different enterprise course of assist instruments in addition to information administration for major care docs may allow them to higher compete with giant hospital methods. This may additionally allow them to supply extra well timed, accessible care to power illness sufferers, together with autoimmune sufferers.

This leaves open the query of how specialists, a lot utilized by autoimmune and power inflammatory sufferers, slot in. Specialist practices have thrived below supply-restricted, high-demand FFS fashions. And thus far haven’t been desirous to take part in digitally-enabled care staff practices.

As soon as extra, perhaps the pandemic disruption to money cows like colonoscopy will speed up the beforehand sluggish migration of specialists to VBC fashions.

Conclusion of Half 1 of Healthcare in a Publish-COVID-19 World

Telemedicine and distant affected person monitoring are two essential however not adequate enabling applied sciences for higher autoimmune care supply. Making care extra accessible from sufferers’ properties by telemedicine, apps and the expanded use of care-based staff fashions may probably profit these with power immune situations, who want extra frequent touchpoints on their care journeys.

The altering reimbursement panorama, from fragmented, uncoordinated FFS to patient-centered (or at the least capitation or episode-of-care protection) VBC may higher financially assist care supply for autoimmune sufferers. Particularly these sufferers on specialty meds who want monitoring, administration, and assist between common doctor and specialist visits.

Such care must also embrace non-pharmacological modes like bodily remedy, train teaching, eating regimen administration, sleep, and psychological well being assist. A few of these items are being included into a number of the new care supply fashions. Nevertheless, the power illness focus has been on most cancers, diabetes, and cardiopulmonary illness, not inflammatory, immunological, autoimmune or autoinflammatory situations.

The convention centered on bringing digital major care into the house or at the least to the smartphone. Nevertheless, I’ve unanswered questions in regards to the function of specialists in these new fashions. How will team-based care coordination combine the a number of specialists (e.g. rheumatologist, gastroenterologist, dermatologist, neurologist) many autoimmune sufferers must information power care?

Half 2 focuses on new supply fashions and the competitors for the digital entrance door from inside and out of doors conventional healthcare. 

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