If theres a silver lining to the coronavirus pandemic, it's that we've finally opened the door to new care paradigms — and opened minds to new possibilities. While we'd never wish for a pandemic to galvanize change, what’s happening now in healthcare is exciting. And it's just the tip of the iceberg of what the future holds.
Our healthcare delivery system is transforming before our eyes, from hospital care to doctor’s office visits to urgent care clinics and specialist consults. The sharp lines between our services blur as we merge, layer and integrate these disciplines into a new whole.
Contrary to popular belief, no "new normal" will follow the pandemic. COVID-19 is effecting change in areas where we’ve long needed it but have struggled to gain traction. For years, forward-thinking hospitals have worked to scale their virtual care programs and extend more services into their communities. Our response is changing acute care drastically, forever, and mainly for the better. In this article, I share some of the new paradigms that are emerging before our eyes.
Putting patients front and center
As a healthcare consumer, you've likely only experienced medicine under a provider-centric care model. Everything about our healthcare ecosystem — from our hospitals’ physical layout to the skills we teach and learn in medical school — supports a narrative in which patients travel to providers, whether it’s in a primary care setting or emergency medicine.
With a little help from the pandemic, patients are now turning this paradigm on its head. A few years ago, consumers showed relatively little interest in telehealth. However, as they adopted it at unprecedented rates during the pandemic, they quickly appreciated its convenience and timeliness. Today, patients report high rates of satisfaction with virtual care and say they intend to continue using it. Given this shift, health systems would be wise to embrace the emerging patient-centric paradigm.
For me, this shift is both welcome and long overdue. However, as hospitals race to expand their virtual care programs, I believe a few words of caution are in order.
Care continuity
To promote the long-term health of our communities, delivery systems must be able to integrate episodic and long-term care, whether delivered via telehealth, in the emergency department, or in the doctor’s office. This requires a redesign of our infrastructures with an eye toward integration. The virtual care boom of 2020 has exacerbated healthcare’s endemic fragmentation. Many patients are bypassing their established care teams and instead turning to third-party telehealth services. While many organizations can provide episodic care via telehealth (acting much like an ED or urgent care clinic), they’re poorly equipped to manage chronic and complex conditions.
Patient navigation
We also must consider how patients will navigate these new high-tech, low-touch systems. This is a tall order considering how many patients get lost in our current hightouch system. I recently followed up with an older woman I’d seen in the ED for wrist pain. Four days later, she was running into issues scheduling follow-up appointments with her primary care physician and a specialist, and her pain was worsening. There was no one to manage her care between these visits other than me through a series of follow-up calls, guiding and helping her navigate so she wouldn’t fall through the cracks.
These are just some of the dangers of the fragmented healthcare system we currently have. While we must evolve our system to accommodate virtual care, we must also ensure it’s integrated sufficiently to manage and transition patients across multiple care teams.
I highly doubt patients will fare better under virtual care unless we build touchpoints to monitor their progress and promote seamless hand-offs between providers. Solutions might include telenavigation programs, which pair at-risk patients with support staff serving as links between the patient and the healthcare team.
What’s good for patients is good for healthcare organizations
So where should hospitals invest? I strongly believe that services that meet patient needs with convenience and accessibility will always win in the end.
Telehealth is an instructive example. Health systems that adopted virtual care early did so because these services make sense for patients. They trusted that the dollars would follow if they improved access and provided value to the community. The pandemic proved them right, allowing them to virtually carry on many of their operations while their less nimble competitors floundered.
Telerounding
While the idea of a hospital or emergency room making home visits might seem strange, forward-thinking health systems are already bringing these ideas to life. For example, some hospitalists are discharging stable patients as “inpatients” and rounding on them at home. Mobile care teams bring services like infusion, labs, imaging and nursing care directly to the patient. A growing body of research suggests that this “hospital at home” concept is safe, effective and highly satisfying for patients with certain diagnoses.
Telenavigation
Because virtual care can be a confusing concept for patients, some health systems are using telenavigation to move them seamlessly through the process. In addition to helping patients schedule follow-up appointments, navigators assist with basic needs like medication and food delivery and transportation. Some hospitals and urgent care centers have also implemented “virtual front doors” to help patients choose the most appropriate care setting before leaving home.
Care team integration
Finally, while our hospitals physical footprints will likely shrink over coming decades, our sickest patients will always require inpatient care. I expect we’ll therefore see our hospitals gradually evolve into superacute facilities — essentially critical care units equipped with EDs. At the same time, our outpatient offices and clinics might coalesce into larger care centers with broader capabilities. For example, a combined primary and urgent care clinic linked with virtual home care allows for convenience of care, options for higher-touch needs, and the opportunity to scale. And ideally, we’ll see integration between inpatient and outpatient settings, with specialists treating patients in both locations.
Conclusion
In the past twelve months, our industry has made enormous strides in creating the hospital of the future. To continue this positive evolution, we need to keep focused on what’s best for patients so we can deliver the quality care they expect and deserve. We also need to ensure that virtual care models are integrated with more traditional methods to ensure continuity of care and a well-coordinated and positive patient experience. While paradigms never shift smoothly, our efforts will pay off in the form of an agile, responsive healthcare system that meets the needs of 21st-century consumers.
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