COMMENTARY

Advancing Healthcare During the Pandemic and Beyond

Richard S. Isaacs, MD; John Whyte, MD, MPH

Disclosures

December 02, 2020

COVID-19 has exacted a massive human and economic toll throughout the world and disrupted every aspect of our lives, including, of course, healthcare. In addition to the millions of people who have been directly affected by the virus, many patients have delayed cancer screenings, avoided care of chronic conditions, and have been afraid to seek emergency room treatment for heart attacks and strokes.

Fortunately, there has been promising news as well, as we have learned a great deal about the virus and are making progress in developing treatments to more effectively combat COVID-19. Recent news about vaccine development is also very promising.

While that news has rightly garnered the most interest, there have been three significant developments in healthcare during the pandemic that will have sustained benefits in how we deliver care to patients in 2021 and beyond.

Accelerating Widespread Adoption of Technology in Healthcare

Technology is embedded in many aspects of our lives — including banking, retail, and travel, to name a few — but healthcare has been slow to maximize technology and deliver on the full potential of telehealth. Until now.

Over the years, several regulatory issues in payment policies and professional licensing have prevented widespread telehealth adoption, such as little or no payment for telehealth except under very limited circumstances, and antiquated medical licensing policies that required patients and physicians to be in the same state, even for virtual encounters.

But with widespread stay-at-home orders and the removal of many payment and regulatory barriers during the pandemic, patients and physicians have embraced technology and telemedicine, including those who had not previously tried these services or only used them infrequently.

During the early stages of the pandemic, for example, 80% of care delivery was via telehealth, including video and phone appointments. While in-person visits have increased over the past few months, many patients have decided that they appreciate the ease and convenience of getting their care remotely. And physicians are finding that they are getting to know many of their patients better through video visits, because patients are more comfortable and more open during a video visit from their home than they are in the doctor's office.

In addition, healthcare is also becoming more similar to the retail sector, with an abundance of sophisticated trackers, sensors, wearables, and self-tests that enable patients to play an expanded role in their diagnoses and management of their care.

This trend will continue to accelerate. A recent report from Accenture shows that 44% of patients are using new devices or apps to help manage their health conditions, with 90% reporting a positive experience. The challenge for physicians moving forward will be to develop new strategies to more fully engage with patients who seek greater control of their healthcare.

Increased Focus on Equitable Care and Disparities

This year has brought increased focus on delivering culturally responsive and equitable care to reduce and eliminate disparities and improve population health. Although the problems are long-standing, the disproportionate mortality rate of COVID-19 in the Black and Latinx communities has brought them into greater focus.

Our country is becoming increasingly diverse, and our healthcare system must deliver care to all patients in a way that acknowledges and honors this diversity in the clinical setting, by respecting patients' health beliefs and practices and demonstrating a deeper cultural understanding. It's crucial that we have trusting relationships with all patients, regardless of their background, ethnicity, or socioeconomic status — and a crucial part of building this trust involves clinicians being aware of potential unconscious bias and taking steps to mitigate it.

But health consequences are just one manifestation of pervasive disparities, including but not limited to access to fresh fruits and vegetables, transportation, public parks and walkways, clean air and water, and quality education and housing. We can't eliminate health disparities if we don't solve the root causes. While resources will be more limited in a post-COVID world, we must continue to prioritize the types of investments that we know improve the overall health of our communities — making them all better places to live, work, learn, and play.

Moving Care Delivery From Hospitals to Home

For many years, patients needing healthcare have gone to physician offices and medical centers to receive medical treatment. But this is changing, and the pandemic has only accelerated the trend of bringing care that was previously delivered in a hospital setting to patients' homes.

This has been made possible by the increasing sophistication of remote patient monitoring tools, which provide real-time data as well as early warnings about changes in clinical status to physicians and care teams. Thanks to a variety of digital diagnostic tools, physicians can now remotely listen to the hearts and lungs of patients recovering at home from COVID-19 and monitor other health issues, such as diabetes and hypertension.

These technologies have supercharged the capabilities of health professionals who provide care in the patient's home. For example, physicians at Kaiser Permanente have provided chemotherapy to many cancer patients in their homes during the pandemic. We were even able to conduct clinical trials in the home. We would not have done either of these pre-COVID.

This trend of bringing care to the patient — rather than the patient coming to the care — will continue to accelerate in 2021 and for years to come, as our healthcare system ultimately delivers truly patient-centered care.

COVID-19 has created tremendous hardship as people around the world have faced extraordinary health, personal, and professional challenges. Yet at the same time, the turmoil we have experienced has created an opportunity to rethink and reimagine healthcare in a way that is inspiring a period of transformation, one that will have a positive and lasting impact on health and healthcare for years to come.

Richard S. Isaacs, MD, is CEO and executive director of the Permanente Medical Group in Northern California and president and CEO of the Mid-Atlantic Permanente Medical Group. John Whyte, MD, MPH, is the chief medical officer of WebMD.

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