The coronavirus pandemic is rapidly reshaping the way patients access care and the strategy of healthcare providers treating those patients. The situation echoes other recent national seismic shifts —the Great Recession and Affordable Care Act—that drove changes like increased healthcare consolidation and value-based care. Patients, many reluctant to seek care at medical facilities or even prohibited from doing so for elective procedures, need a new model that offers remote care options for treating chronic conditions.

IDNS TAKE THE LEAD

The pandemic has demonstrated the importance of strong care coordination, especially for patient distribution and medical supplies, as well as more proactive patient engagement, from telehealth to artificial intelligence in electronic medical records.

State and local governments steering these efforts during the first wave are leaning on regional integrated delivery networks with strong clinical integration and tightly aligned physician organizations. These IDNs will be the organizations best positioned to emerge as leaders under new market conditions.

Nonprofit IDNs in New York City, South Florida and Portland, Oregon, have collaborated on regional COVID-19 patient management. The state of California and L.A. County reopened the closed St. Vincent Medical Center as the 266-bed Los Angeles Surge Hospital in April 2020, managed by IDN heavyweights Kaiser Permanente and CommonSpirit Health. These markets have robust public hospital systems serving as safety nets in normal times and care coordinators during this health crisis.

But that’s not the case in other states. In Michigan, the CEO of the state’s largest IDN (John Fox at Beaumont Health) has complained about the lack of state coordination and real-time hospital data causing gluts of patients at some ERs while others could take on more. Some health systems simply don’t submit data to the state.

The combination of artificial intelligence with telehealth outreach will be key for IDNs to identify COVID-19 patients in a potential second wave but can also be parlayed for a panoply of other chronic conditions and elective procedures.

Well-capitalized IDNs such as PeaceHealth in the Northwest or Trinity Health’s Michigan hospitals have a crucial combination of telemedicine/remote monitoring technology and care coordinators to keep patients informed about their care. Ensuring patients feel comfortable and know when to come in keeps patient satisfaction rates higher and increases medication and treatment adherence.

These advanced data analytics could predict patient needs for elective procedures and managing chronic conditions. Patients who skipped care during the spring also face taking longer to pay down deductibles, which could discourage care in the fall and winter, when many patients have traditionally met their deductibles.

Just as patients have put off elective procedures and well visits, IDNs have delayed acquisition activity. The aforementioned Beaumont postponed its acquisition of Summa Health of Akron, Ohio. In North Carolina, Cone Health called off its purchase of Randolph Health. As with elective procedures, we may see a release of pent up demand in M&A activity as COVID-19 cases die down, but many parties may reconsider the necessity of their planned mergers. Instead of growing by acquiring existing hospitals that may become deserted in the next wave of COVID-19, IDNs may prefer to expand by building more nimble freestanding ERs and microhospitals.

IDNs will be more focused on investing in IT, integration and alignment, which will allow them to pursue more innovative reimbursement contracts.

Payment models that can ensure steady income may become preferable to the fee-for-service model that requires strong patient volume. Capitated models or bundled payments that offer guaranteed monthly payments may provide more predictability than a performance-based contract that requires providers meet certain benchmarks.

PHYSICIANS SHOULDER BURDEN

The COVID-19 pandemic forces physician groups to change the way they deliver care, which could impact access for patients if a practice ends up closing or is acquired by an IDN or insurer. Telehealth has become a primary way to care for patients through video, symptom trackers, wearable devices or apps.

To help providers facing financial challenges, physician groups can apply for forgivable small business loans and payroll assistance through the federal CARES Act. CMS also added new COVID-19 clinical trial improvement activity to MIPS reporting to help practices meet their threshold for positive payments.

But will these measures be enough to maintain sustainability for physician groups that may not have the resources or incoming revenue to survive this pandemic? Patients have concerns about going to a physician’s office and are cancelling routine visits, blood work and screenings, which could lead to a sicker population with unmanaged chronic illness and other costly diagnoses.

A study by the Medical Group Management Association found 97 percent of physician practices had a negative financial impact attributable to the virus, indicating patient revenue decreased 55 percent and patient volume decreased an average of 60 percent by mid-April when the virus was just starting to impact some regions.

Physicians have adapted to the post-Affordable Care Act landscape through payment reform, affiliation or acquisition, and this new financial burden may force practices to further relinquish their autonomy to IDNs and insurers, both of which are eager to hold influence over more physicians.

THE FUTURE OF HEALTHCARE DELIVERY

The healthcare industry moves at a tectonic pace, with tension released by occasional major quakes. This pandemic is one of these major quakes. We know at the patient level every aspect of care will be different, from making appointments to follow-up engagement. Physicians and IDNs must adapt their revenue streams and innovate to provide access to care for patients, or risk being another casualty to COVID-19.

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