Destruction or Disruption — COVID-19 Forces Overdue Health-Sector Change
July 10, 2020
As the current public health crisis grinds on, it has revealed serious vulnerabilities throughout the health sector. We’re seeing inequitable access to healthcare and lopsided disease and mortality burden among diverse communities play out as yet another tragic manifestation of racial injustice. We read about the fragility of supply chains from raw materials to manufacturing to delivery; and an already fragmented care-delivery system splintering even further as those with pressing health challenges actively avoid hospitals and providers.
At the same time, the COVID-19 pandemic is throwing into relief great opportunities for providers and product innovators to connect with consumers in ways never before thought possible. Technologies that consumers requested, and which they were often denied — such as telehealth, digital therapeutics and clinical-trial design influence — are now accessible. We cannot go back.
However, if past history is any indicator for future performance, the health ecosystem rarely misses an opportunity to miss an opportunity.
Twenty-five years ago, I wrote these words as part of epidemiolocal report on how the advent of online information might impact people with 12 different illnesses:
“Pharmaceutical companies take note. Whether as individuals or as members of organized patient support groups, ‘cybersurfers’ with illnesses are cutting out the middlemen in the question for truth, hope, pain mitigation and magic bullets. The phenomenon comes as trust in experts in general, and in drug companies in particular, is falling — quickened by the bruising health care battles in Congress last year.”
“Pharmaceutical companies are in a position to help patients in the most important quest of their lives. Drug makers can influence, for the better, the accessing by laypeople of information meant for experts. Patients not only have rights, but obligations. By stressing the need for them to be part of the process of research and development, the industry can keep potentially lifesaving protocols on track.”
It appears that despite the seeming singularity of our present circumstances, they give affirmation to the adage: “The more things change, the more they stay the same.”
Back in 1995, people with health concerns faced a herculean struggle to find information about their conditions. The “World-Wide Web” was fragmented. Few (<25%) had home computers. Those who had computers and were Web-savvy used paid dial-up services such as America Online, Prodigy, and CompuServe. That’s all changed thanks to Dr. Google and WebMD, which enable more than 60 million unique users monthly to access medically vetted information at no charge.
But consumers still lack uniform access to their own medical records across health systems and still struggle to find the answers and guidance they need. New technologies have emerged and have been validated clinically, yet integrating these innovations into decades-old systems and protocols is excruciatingly difficult and costly. These systemic obstacles are magnified by challenges to monetize advances within private and public reimbursement systems. If doctor’s know insurers will not reimburse for new services, and consumers will be left with the shocking bill, medical advances will not fulfill their potential.
Healers delivering care and those in search of healing understand the system isn’t working, but they don’t have the power to make sorely needed changes unilaterally. Old habits die hard.
Today, we are again experiencing massive change — this time, a viral force of nature, not a technological force where information “goes viral.” The pandemic has created medical tragedies and economic hardships. It is forcing us to look anew at health disparities and recognize that racism leads to poverty and that poverty results in illness and death. It is driving chiefs of companies, hospitals, contract research groups and advocacy organizations to revisit structures, procedures and economic approaches that seemed to work, and which now clearly don’t.
The deficiencies that coronavirus reveals require bold action; it is not a time for incrementalism in medicine, care delivery, or research advances.
My words quoted above were part of a pioneering 1995 study, conducted through 16,000 two-hour, in-home interviews, which explored the attitudes, values, lifestyles, and marketplace behaviors of people with 12 prominent illnesses. These conditions included some of the more pressing noncommunicable illnesses including arthritis, autoimmune disease, cancer, diabetes, digestive disease, heart disease, urinary conditions, neurological disorders, osteoporosis, respiratory conditions, skin conditions, and vascular disease. The results were evident then and now; people want to be involved and considered individual customers of a personalized health system. Instead, today, the system is focused on consumerism of care — built around fee-for-service (i.e., doing things) rather than fee-for-value (i.e., achieving outcomes).
The sad reality is that we remain stuck in the gravitational pull of a suffering health system. We must change orbit. Our problem has never been lack of innovation. Our challenge is changing mindsets, finding courageous leadership to embrace saner, smarter processes and delivery mechanisms that can improve the human condition.
Digital technologies, artificial intelligence, and decentralized clinical trials are part of the bigger picture that have the capacity to revolutionize healthcare when coupled with common sense. COVID-19 is the great disruptor that has clearly shown that it’s time for the health system to take stock and, cutting loose the deadweight protocols set decades ago, best determine how to integrate ever-evolving ideas and insights. Our fragmented system must find new ways to collaborate because people with health urgencies desperately need that change and quickly.
Payer, product innovators and provider leaders will need to think differently going forward. Collaboration is imperative to shared success in order to improve care and reduce cost — and mean it! Instead of setting up road blocks to new ways, leaders will need to appoint internal champions to guide innovators and integrate ideas into their systems faster. It’s a two-way street. It also requires health pioneers to learn more about their customers and recognize the old ways do not change quickly and decision makers cannot make a “leap of faith.” They need to think through implementation and ongoing service support.
Twenty-five years ago, I ended my demographic research article with these words:
“The sponsorship of on-line forum is therefore more than a customer service tool. It is a leadership tool. Still it should not blind us to the real objectives. The objective of educating patients. The objective relating to them as customers. The objectives of reaching out to them as human beings.”
Both an agent of destruction and a disruptor, COVID-19 is forcing needed health-sector change. The stakes are high. Let’s seize this opportunity to move forward and get this right.
[My thanks to FINN Partners colleagues for their thoughts and recommendations – Arielle Bernstein Pinsof, MPP, John Bianchi and Kristie Kuhl, JD]