Covid-19 has impacted US Healthcare in significantly deleterious ways. It has undermined health insurance coverage for millions of Americans who are without work, crippled many physician and hospitals with deep financial losses due to sudden massive decrease in demand more so in financially unattractive markets and poor and rural communities, impacted health adversely for minorities, and in general, created a crisis in public health.
A significant unknown is the long-term effects of this virus on the health and wellness of the infected population. Currently, US infected population is about 7.5 million, 20% of the world’s infections. It is predicted that by March 2021, the world’s infected population will be about 300 million. This could mean about 40-60 million infected people depending on the success in controlling the pandemic.
While the long-term effects of the virus on the human body remains unknown, there are observations and reports of damage to the upper respiratory track, lungs, heart, brain, liver, kidneys, blood clots, fatigue, and mental health with PTSD symptoms. It is unknown about how Covid-19 will affect people over time and researchers recommend that doctors closely monitor Covid-19 patients, post recovery, to track organ function over time. Since the number of recovered patients will be in millions within a few years, it is important to plan for post-Covid-19 healthcare delivery. While many of these patients have been in the healthcare system prior to their Covid-19 infection, what is the likelihood that their usage of the healthcare system will increase post Covid-19 recovery and into the future for various additional disease states?
The following are some plan topics:
- Develop systems for tracking patient health post Covid-19 recovery. These should potentially be done at the physician level and track changes to patient health longitudinally. Existing EMR/EHR systems should be enhanced to provide Covid-19 specific tracking capability and analysis by patient demographics, pre-existing conditions, and medical diagnosis. This will enable accurate assessments of disease progression and treatment related to Covid-19. One important aspect is to incorporate information about mental and behavioral health.
- The current crisis has exposed an inadequacy of our current system of health insurance built on the assumption that, at any given time, a limited and predictable portion of the population will need a relatively known mix of health care services. Predicting health care needs is thus assumed to be a stable and straightforward actuarial exercise. However, healthcare during a pandemic (and probably after) is not stable. What additional billing codes will be needed for treatment of Covid-19 recovered patients? Can they covered under current existing activities? Would standard codes be needed to various types of telehealth and home-health requirements? Based on analytics from item 1 and their own claims, what type of healthcare and community wellness models will be developed to care for the Covid-19 recovered patients. What changes will be necessary for value-based or fee-for-service payment models?
- What changes to policies are necessary to cover this large population? For example, will Covid-19 be a “pre-existing” condition; will separate state licensing of doctors be discontinued, such that, on-demand telehealth services may be offered more quickly? Will the requirements for prior authorization be more universally focused on prescribers who are outliers rather than all, as these patient treatments become necessary?
- Since the cost pressures will likely increase, hospitals and health systems and other providers may benefit from consolidation. They should start evaluating their markets and prepare to engage in mergers or other innovative structures as the health industry recovers. The providers should also work with payors to structure innovative arrangements for post Covid-19 high-risk individual treatments and health management. What capacity considerations will be necessary for staffing and operations should treatment cases increase over the long-term? And what impact will it have on operating cost?
- What evolving healthcare models would be needed for chronic disease management further exacerbated by Covid-19? Will current chronic care management models suffice or would additional behavioral or mental health considerations be further incorporated and integrated in care?
Since very little is known now about the impact of Covid-19 on various disease states, it is imperative we develop monitoring and treatment constructs for Covid-19 recovered patients.