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Category: COVID-19

How to Pandemic-Proof Our Health Care Payment System

By AISHA PITTMAN and SETH EDWARDS

The pandemic has focused many policymakers’ attention  on strategies to make the healthcare system better. The obvious answer is one that we know is efficacious, if perhaps not the sexiest: value-based care.

The current healthcare payment system – built around the fee-for-service (FFS) model in which healthcare providers are reimbursed for the quantity versus quality of care – required $175 billion in bailouts and temporary modifications to remain whole during the crisis, a stance that’s unsustainable for both providers and payers.

The Centers for Medicare & Medicaid Services (CMS) admitted as much with its renewed national commitment to value-based care in late June: The movement to value is happening now.

The worth of value-based care models has long been detailed, from more coordinated care to lower costs. In fact, a recent survey conducted by our organization Premier Inc. found that healthcare providers in alternative payment models (APMs) were better positioned to respond to COVID-19 and support reopening plans through the rapid deployment of telehealth, care management and data analytics. These are the types of population health capabilities the industry must focus on spreading – and incenting – in the near future.

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Post Covid Healthcare is Becoming Like Buying from Amazon Instead of Going to the Mall or Reading an eBook Instead of a Paperback

By HANS DUVEFELT, MD

Now that we are seeing patients via telemedicine or even getting reimbursed for handling their issues over the phone, our existing healthcare institutions are more and more starting to look like shopping malls. 

They were once traffic magnets, so large that they created new developments far away from where people lived or worked and big and complex enough that going there became an all day affair for many people. 

What this pandemic has brought us is a shift in our view of where you have to be in order to get things done. If you can earn your wage remotely and still buy things online when offices and physical stores are shut down, it seemed logical to try to offer healthcare the same way. And most of us have found that it works surprisingly well. 

The analogy with Amazon runs deeper than that. Amazon isn’t just one megaprovider, but also a funnel for many small merchants who sell their products through Amazon. Consumers take advantage of the convenience of this centralized ordering or point of contact with a vast supply network of almost any product that money can buy. But they only give their credit card number to one central contact. 

I don’t follow business literature enough to know if Jeff Bezos chose the name Amazon partly (yes, I know he went through the dictionary) because of a vision of many small contributories coming together into the second largest river in the world. But that is certainly a visual representation of what his business looks like. And “Amazon” ranks higher in the alphabet and sounds a lot catchier than “The Nile”. 

Enter healthcare: Imagine the trusted brand names of our “industry” but without their traditional complete reliance on bricks and mortar places that patients have to visit. 

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COVID herd immunity: At hand or forever elusive?

By MICHEL ACCAD, MD

With cases of COVID-19 either disappeared or rapidly diminishing from places like Wuhan, Italy, New York, and Sweden, many voices are speculating that herd immunity may have been reached in those areas and that it may be at hand in the remaining parts of the world that are still struggling with the pandemic.  Lockdowns should end—or may not have been needed to begin with, they conclude. Adding plausibility to their speculation is the discovery of biological evidence suggesting that prior exposure to other coronaviruses may confer some degree of immunity against SARS-CoV2, an immunity not apparent on the basis of antibody seroprevalence studies.

Opposing those viewpoints are those who dismiss the recent immunological claims and insist that rates of infections are far below those expected to confer immunity on a community. They believe that the main reason for the declining numbers are the behavioral changes that have occurred either under force of government edict or, in the case of Sweden, more voluntarily. What’s more, they remind us that the Spanish flu pandemic of 1918-1919 occurred in 3 distinct waves. In the summer of 1918 influenza seemed overcome until a second wave hit in the fall. Herd immunity could not possibly have accounted for the end of the first wave.

The alarmists may have a point.  However, recent history offers a more instructive example.

Until early 2015, epidemiologists considered Mongolia to be exemplary in how it kept measles under control. In the mid-1990s, the country instituted a robust vaccination program with low incidences of outbreaks, even by the standards of developed countries. In the early 2000s, it adopted a 2-step MMR immunization schedule and, after 2005, its vaccination rates were upwards of 95%. From 2011 through 2014, not a single case of the virus was recorded, leading the WHO to declare measles “eradicated” from Mongolia in November 2014.  

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Robert Wood Johnson Foundation Innovation Challenges Blog Post Announcing Semi-Finalists

SPONSORED POST

By CATALYST @ HEALTH 2.0

The novel coronavirus (COVID-19) has underscored the need for efficient and innovative emergency response. Major health organizations, such as the American Hospital Association, have provided resources that can be utilized for organizational preparedness, caring for patients, and enabling the workforce during the pandemic.

As COVID-19 brought to light the lack of emergency response preparedness in the health care system, the Robert Wood Johnson Foundation (RWJF) and Catalyst saw an opportunity to highlight digital health’s potential to support health care stakeholders and the general public. RWJF and Catalyst partnered to launch two Innovation Challenges on Emergency Response for the General Public and Emergency Response for the Health Care System. 

The Emergency Response Innovation Challenges asked innovators to develop a health technology tool to support the needs of individuals as well as health care systems affected by a large-scale health crisis, such as a pandemic or natural disaster. The Challenges saw a record number of applications— nearly 125 applications were submitted to the General Public Challenge and over 130 applications were submitted to the Health Care System Challenge. 

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Too Many Small Steps, Not Enough Leaps

By KIM BELLARD

I was driving home the other day, noticed all the above-ground telephone/power lines, and thought to myself: this is not the 21st century I thought I’d be living in.  

When I was growing up, the 21st century was the distant future, the stuff of science fiction.  We’d have flying cars, personal robots, interstellar travel, artificial food, and, of course, tricorders.  There’d be computers, although not PCs.  Still, we’d have been baffled by smartphones, GPS, or the Internet.  We’d have been even more flummoxed by women in the workforce or #BlackLivesMatter.  

We’re living in the future, but we’re also hanging on to the past, and that applies especially to healthcare.  We all poke fun at the persistence of the fax, but I’d also point out that currently our best advice for dealing with the COVID-19 pandemic is pretty much what it was for the 1918 Spanish Flu pandemic: masks and distancing (and we’re facing similar resistance).  One would have hoped the 21st century would have found us better equipped.

So I was heartened to read an op-ed in The Washington Post by ReginaDugan, PhD.  Dr. Dugan calls for a “Health Age,” akin to how Sputnik set off the Space Age.  The pandemic, she says, “is the kind of event that alters the course of history so much that we measure time by it: before the pandemic — and after.”  

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Stop Rolling Back Expanded Practice Licenses for Nurse Practitioners

Dallas Ducar
Katie Wolf

By DALLAS M. DUCAR, MSN, PMHNP-BC, RN, CNL and KATIE WOLF, MBA

We’re not in Kansas anymore. Kansas has rescinded an executive order that dramatically empowered and expanded its healthcare workforce as COVID-19 cases soared.  In the best interest of patients now and in the future, other states must not follow Kansas’ example.

The story of coronavirus is far from over in the United States and the impacts to our healthcare systems continue.  America’s clinical workforce began this battle at a deficit and, in certain states, continues under those conditions. For years, studies outlined shortages of medical doctors and predicted gaps to worsen over time. Prior to the presence of COVID-19, a contentious debate emerged as to how to address the deficit of physicians. Nurse practitioners (NPs) lobbied for broader clinical autonomy to help bridge this gap. At present, rapid influxes of critically ill patients have strained our healthcare systems to a breaking point laying bare the resource constraints in our healthcare system. 

Alex Azar, the Secretary of Health and Human Services responded to this need by sending a letter to governors to expand the 290,000 NPs in the United States, bolstering our provider workforce during this time of crisis. Empowering NPs to independently treat patients  has needlessly been a long-standing point of contention in healthcare. Increasing the breadth of NP autonomy makes sense in the face of COVID-19.  Wisely, since the start of the pandemic, the number of states allowing NP autonomy jumped from 22 states to 48.  This structural change to healthcare is long overdue and should remain in perpetuity.  However, at the end of May, Kansas became the first state to expire this expansion of NP authority.  

NPs are independently licensed and trained to diagnose and prescribe medications and treatments. This role grew organically out of the field of nursing, to provide holistic and patient-centered care to their communities. Nurses become nurse practitioners by choice, honing their skills through years of training at patients’ bedsides, and are part of the most trusted profession in the United States

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Collective State Action Is Needed to Fight This Pandemic Right Now

By KEN TERRY

As COVID-19 cases soar across the country, the federal government has lost control of the situation. Amid the Trump Administration’s happy talk and outright dismissal of the crisis, the U.S. is experiencing a forest fire of contagion and hospitalizations, and an upsurge in COVID-related deaths has already begun.

Other countries like Taiwan, South Korea, Germany, Australia and New Zealand have controlled their outbreaks, which is why their COVID-19 infections and deaths have been minimal or trending downward in recent months. To replicate those nations’ strategies of testing, contact tracing and quarantining, the U.S. Congress would have to appropriate about $43.5 billion, according to one estimate. But as we know, Senate Republicans won’t pass such a bill without Donald Trump’s prior approval—and that’s unlikely as long as his main focus is on reopening the economy.

We can hope that electoral victory by the Democrats in November will change this equation, but Joe Biden won’t take office until January if he wins. Meanwhile, the coronavirus is chewing up America. We can’t afford to wait six months to blunt the impact of this horrible disease. However, there is a solution that doesn’t depend on federal leadership: states can form compacts that would form the basis for collective action to get us out of the trap we’re in.

Interstate compacts are very common in the U.S. Various pacts cover everything from clean water and clean air to medical licensure, mental health and interstate transportation. For example, under the Middle-Atlantic Forest Fire Protection Compact, which includes Ohio, West Virginia, Virginia, Pennsylvania, New Jersey, Delaware, and Maryland, member states assist one another in fire prevention and suppression and firefighter training.

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Repurposing a Universally Installed EHR App Into an Effective COVID-19 Early Detection System

By SCOTT WEINGARTEN, MD

COVID-19 exposed our country’s lack of centralized coordination when it comes to managing and preventing disease spread. Today, our public health system relies on flawed data and obsolete technology that fails to accurately track current and suspected cases, risk stratify patients, monitor disease progression or predict future spread. Not only do these blind spots create opportunities for the disease to spread, they also undermine the ability to safely plan for economic recovery.

What may surprise some, though, is the fact that we don’t have to start from scratch in order to build an effective system that stems the spread of COVID-19. In large part, the infrastructure we need is already here.

In 2009, Congress passed the HITECH Act, which allocated roughly $30 billion for providers to purchase electronic health records (EHRs). As a result of this stimulus, EHRs went from relative obscurity to ubiquity, and today about 96 percent of all providers are users of EHRs. Five years later, Congress passed the Protecting Access to Medicare Act (PAMA), which requires healthcare providers to consult with an approved Clinical Decision Support Mechanism (CDSM) in order to receive reimbursement for advanced imaging procedures for Medicare beneficiaries. 

The net result of these two laws is that there is now visibility into nearly every patient-provider interaction in the United States at the moment that care is delivered, through more than a dozen CDSMs that have been certified by CMS. Although PAMA was intended for use with imaging, it’s not difficult to add on and repurpose decision support apps to conduct symptom surveillance for COVID, enabling healthcare workers to spot cases more reliably and earlier in the disease progression for prompt action.

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The Trump COVID Legacy: Bad Timing. Lots of Questions. Few Answers.

By MIKE MAGEE, MD

What a strange irony. Trump decides, full-bravado, to challenge China to a trade war just months before China unwittingly hatches a virulent pandemic that collapses our deeply segmented health care system and our economy simultaneously. And rather than cry “Uncle”, our President then fires the WHO just as their experts are heading to China to attempt to unravel the mystery of COVID-19.

With the ongoing, cascading catastrophe of Trump’s mishandling of COVID-19, it is easy to lose sight that the next pandemic (fueled by global warming, global trade, and human and animal migration) is just around the corner. And we haven’t even begun to nail down the origin story of this one.

Unraveling the transmission trail requires international cooperation. As one expert recently noted, “Origin riddles for other new infectious diseases often took years to solve, and the route to answers has involved wrong turns, surprising twists, technological advances, lawsuits, allegations of cover-ups, and high-level politics.”

What we do know is that there are originators, intermediate hosts, and human super-spreaders….and COVID-19 appears to have begun in China.  These are not new insights. We’ve seen this playbook before.

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The 2020 Pandemic Election

The 2020 US election will be vicious, with a nasty pandemonium following a nasty pandemic.

By SAURABH JHA, MD

When the COVID-19 pandemic is dissected in the 2020 presidential election debates, Donald Trump will be at a disadvantage. The coronavirus has killed over 100,000 Americans and maimed thousands more. The caveat is that deaths per capita, rather than total deaths, better measure national failure, and by that metric the US fares better than Belgium, Italy and the United Kingdom. New York City owns a disproportionate share of the deaths, but this hyperconnected megapolis is an outlier whose misfortunes can’t be used to draw conclusions about administrative competence for the country as a whole.

Nevertheless, even after introducing nuance, the numbers aren’t flattering. President Donald Trump may claim that the US dodged the calamity predicted by the epidemiological models, which foretold millions of deaths. To be fair, we don’t know the counterfactual — Jeremiads aren’t verifiable. The paradox of successful mitigation is that we can’t see the future we dodged, precisely because we avoided it.

Reducing the death count logarithmically, rather than merely arithmetically, won’t be celebrated because as bad as the worst case scenario could have been, the situation still looks awfully bad. Many still disbelieve the high death toll predicted by epidemiologists early on, particularly Trump supporters who believe the response to the virus, specifically the economic shutdown, has been criminally disproportionate. One can’t simultaneously believe that COVID-19 is no more dangerous than the seasonal flu and that Trump saved millions from the coronavirus. The constituency that acknowledges the lethality of COVID-19 and credits Trump for decisive action against it is small.

Triangle of Incompetence

Trump’s challenger, former Vice President Joe Biden, will charge that fewer Americans would have died had the Trump administration acted earlier. Trump may be accused of having blood on his hands, but such rhetoric is unnecessary. Biden’s team can simply show a montage of Trump’s bombast where he downplayed COVID-19’s lethality, dismissed doctors’ concerns about the shortage of personal protective equipment or exaggerated how well the US was containing the pandemic. Incidentally, the most iconic picture of the administration’s scornful indifference is the current vice president, Michael Pence, visiting a hospital without a mask, surrounded by health-care workers wearing masks.

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