Will COVID-19 Change the U.S. Healthcare System for Good?

As coronavirus spreads throughout the U.S., it has exposed weaknesses in the country’s health care system, forcing those on the front lines to make unimaginable choices and to deliver treatment using untested technology.

Faculty and students in Saint Joseph’s health administration and health education master’s programs are seeing it all happen first-hand. Many are current or former physicians, nurses and health administrators. Those still employed in the field are balancing academics with working on the front lines in confronting the pandemic.

We asked three faculty members — Louis Horvath, M.S., who directs both degree programs, Robert Johnson, J.D., who teaches an online course in health care ethics, and Thomas Martin, Ph.D., an assistant professor of health services, to discuss how the response to coronavirus could lead to long-term changes in how care is delivered and managed.

Below are some key insights from those conversations.

The Future of ‘Virtual Visits’

Martin, an expert in the intersection of health policy and technology, who previously led the health informatics program at Temple. He is a former director with the Healthcare Information and Management Systems Society (HIMSS) where he focused on telehealth, remote patient monitoring, and digital health. He says once the immediate threat of coronavirus has passed, there could be a “sea change” both in use of and attitudes toward telemedicine, and how states license health-care professionals and we pay for healthcare as a nation.

“This is an inflection point for all of us as a country about how we utilize our healthcare system. We’ve removed several barriers to accessing care over the past month,” Martin says. “In the past, we have perhaps historically over-utilized our system in all the wrong ways particularly when it comes to hospital stays and ER visits. Telehealth has always offered potential relief and expanded access to care, even pre COVID-19.”

In order to free space at hospitals for coronavirus patients and encourage people to stay home and practice physical distancing, many medical practices have moved to telemedicine appointments, conducted via phone or video chat, to determine whether a patient needs to be seen or to give treatment for non-emergency cases.

“Increasingly websites for medical professionals, practice groups, and insurance companies are now encouraging video consults with doctors where probably a month ago you went there to book a traditional face-to-face appointment,” Martin says. “We’ve very quickly flipped the switch to keep patients and medical professionals safer by seeing them virtually.”

He notes that one of the issues that comes into play with offering virtual health care is licensure -- typically, medical professionals are licensed to practice in just one or a few contiguous states. This is partly because medical board requirements vary by state, and also because states want to keep talented physicians from leaving or a sudden influx from out of state competition.

But new questions arise when a larger number of appointments are not being conducted face-to-face -- and in times of crisis like the one we are in now, when many hotspots for coronavirus are waving state licensure requirements because they don’t have enough people in-state to treat the patient load.

“It’s certainly something I’ve seen come up among other health care providers: How do we make the transition from state-based licensure to more nationwide certification. What is a high quality encounter and appropriate payment for the service? It was an important and ongoing policy discussion way before COVID-19,” Martin says.

He says the current crisis will offer a chance to reflect on what virtual and high quality care entails and how access to these services can be expanded. According to Martin, one major differentiator will be health systems’ using data to provide a consistency of care whether a patient is having a physical or seeing a specialist.

“When we talk about health care and quality, I always give the example of our focus on creating a Learning Health System across all sectors of health care,” Martin says. “Our health care systems need to rapidly deploy technology, aggregate data, and then make informed decisions in near real time. This needs to occur while providing high-quality care and more importantly, ensuring access to our sickest and most vulnerable populations ”

Tough Choices and Interconnectivity

Johnson teaches an online course in health care ethics, and he said the pandemic has prompted him to “recreate the course on the fly to make it immediately timely and relevant.”

“The issues health care institutions are facing right now very much provide factual situations for our students to deal with,” says Johnson, a lawyer who focuses on issues including health care administration. “Many of them because of their day jobs are already living this in some very relevant ways.”

Many students in the class are already facing tough choices related to keeping their employees safe, the rationing of care and the logistics of locating scarce medical equipment. He says some of these challenges point toward longer-term change in how providers and patients view the interconnectivity of the health care system.

“My health is important to me and it should be important to you as well because we impact one another,” Johnson says. “We’re also seeing the need for health care to work beyond corporate boundaries seamlessly.”

He says another important lesson from the pandemic is that the system wasn’t ready for it.

“Sept. 11, 2001 certainly changed the way we looked at security. I think COVID-19 is going to fundamentally change the way we look at health care and public health especially,” Johnson says. “We’ve got to have a system in place that responds in a more cohesive, comprehensive manner than we have in this crisis.”

From Local to Regional

Horvath, who has more than 25 years of experience in health care management, says one of the issues that providers need to confront is how to look at hospital networks differently.

“We have all of these hospital networks, and I think the next question we need to ask ourselves is can we take that to the next level and have a regional health care system,” Horvath says. “That regional system needs to focus on population health, wellness and prevention.”

When pandemics arise, providers need to be able to easily shift resources to hotspots. “One of the biggest areas I’m concerned about is the rural health care system,” says Horvath. “The impact on them is going to be horrible.”

He notes that during natural disasters, FEMA will work with states and municipalities to shift police, firefighters and utilities crews to impacted areas in order to help keep the public safe and bring services back on line. “The question is should we be doing the same here, and taking a much more coordinated approach,” Horvath says.

According to Horvath, another question is how can we innovate to create an easier, faster and more seamless method of diagnosing patients with coronavirus, or during future pandemics. His ideal would be an app that could allow people to take the test remotely, and alleviate both the risk and uncertainty involved with possibly infected patients having face-to-face interaction with health care workers and then having to wait days or longer for the results.

“In a crisis, the best will come out and the worst will come out,” Horvath says. “In terms of crisis management, you’ve got to be calm, you’ve got to be logical, rational, timely and decisive.”