Covid-19's Lasting Effects On Healthcare

The consensus appears to be fewer hospitals (many of which will be bankrupted by the Covid experience), more remote monitoring, more patient access to data, more at-home care via telemedicine, all of which means most healthcare delivery will be done where, when and how the patient (and her insurer) wants it. JL

Anne Michaud and Xavier Cousens report in the Wall Street Journal:

We will have a national strategy for pandemic preparedness, with sustained funding to health-care system preparedness. This is so we don’t experience the resource shortages we saw with Covid-19. Many hospitals won’t survive Covid-19, and that means the ones that remain will have to reimagine how they provide care. Covid-19 has accelerated the trend of care outside the hospital, including at home. There will be more patient autonomy where technology generates and interprets health data, reserving doctor visits for new diagnosis or conditions. [Health-care delivery a decade from now will be] where you want it, when you want it, how you want it, for 90%, 95% of what’s delivered.

Margaret Hamburg, former commissioner of the U.S. Food and Drug Administration

Covid-19 will certainly change many aspects of drug approval and the overall regulatory process for biomedical product innovation—first and foremost, new and stronger emphasis on partnership and collaboration across sectors, across disciplines, across borders.

There will be greater clinical-trial innovation in terms of design infrastructure and some of the tools for doing clinical trials. This includes opportunities to integrate digital technologies, such as telemedicine, and hopefully also shine a brighter light on the importance of diversity in clinical trials—making sure that trial participation looks like those who are suffering from the disease and at risk for the disease.

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I would like to see a stronger alignment on, what are the unmet public-health and medical-care needs? Certainly for whatever the next emerging infectious-disease threat might be. But there are many other areas of our current set of disease challenges—including chronic disease, diabetes and obesity, and opioid addiction. So can we do both: Work together in new ways, and also create new incentives to drive innovation to develop products that are truly needed, but where the market may not drive that innovation and product development adequately?

Jay Shore, a psychiatrist and chair of the telepsychiatry committee at the American Psychiatric Association

With the economy as it is, there will be fewer resources [and greater need for patient care]. My guess is resources will need to be more efficiently used. One of the positive things about the pandemic with telehealth is some of the regulatory, billing and jurisdictional barriers have been loosened to increase flexibility. We’ll see more virtual care across the board because both systems providers and patients will have gotten used to it.
We had this radical transition to a more virtual environment. If Covid-19 hadn’t hit, it would have been more gradual.
You interact with patients through multiple different mediums: in person, via video, via phone, via patient portal, via the web, via secure texting. What is the blend for any one individual patient? And how do we figure this out as individual providers in the health-care system? That is a challenge we’ll have to address.

Marc Harrison, president and CEO of Intermountain Healthcare, a nonprofit health-care system in Utah, Idaho and Nevada

Covid-19 taught us things about technology and the importance of prevention, as well as some hard lessons around racial disparities. We knew there were problems, but we didn’t know they were as big as they are. The behavioral-health crisis, which was terrible before, has gone crazy. There are good solutions, but they require a different way of doing things, such as integrating mental health with primary care. [Health-care delivery a decade from now will be] where you want it, when you want it, how you want it, probably for 90%, 95% of what’s delivered.
I had a pretty exciting last nine months with my multiple myeloma diagnosis and a bone-marrow transplant and some experimental therapy. Some of those things are going to have to happen in hospitals, but Covid-19 has accelerated the trend of care outside the hospital, including at home. We’re about to start our at-home bone marrow transplant program. We think about three-quarters of a transplant can actually happen outside the hospital. One thing I know is it’s going to be higher value—lower cost and higher quality.

Suzet McKinney, CEO of the Illinois Medical District, a 560-acre concentration of health-care institutions, labs and a biotech business incubator in Chicago

We will need to have a national strategy for pandemic flu preparedness, with dedicated and sustained funding to both public-health-emergency preparedness, as well as health-care system preparedness. This is so that we don’t experience the same types of resource shortages that we saw with Covid-19.There will be many hospitals that won’t survive Covid-19, and that means the ones that remain will have to reimagine how they provide care, not just to protect their bottom lines, but more specifically to provide care to vulnerable communities, especially ones with a large representation of underrepresented minorities. There has been very little investment in aligning the research community with the practice community. The [Centers for Disease Control and Prevention] has developed 15 national public-health-emergency preparedness capabilities that are designed for use by state, local, tribal and territorial public-health agencies. However, there will need to be greater development of the true operational capability of all these plans, meaning the ability to actually implement all of the plans that we’ve established over the years.

Eric Topol, executive vice president and professor of molecular medicine, the Scripps Research Institute

During the pandemic, several health systems have kept patients with Covid-19 at home and monitored them with sensors on their arms where they can track them remotely. That is where we’re headed. Right now, telemedicine is kind of like version 1.0, but in the future you may actually be able to take your smartphone, pop in a probe, and do an ultrasound exam on any part of your body except your brain.
There will be a shift to more patient autonomy where they will have the technology to generate and interpret their own health data, while reserving in-person doctor visits for serious matters like a new diagnosis or a threatening condition.
The biggest opportunity would be having a virtual medical assistant where a person has all their health records continually updated seamlessly from the time they are in the womb until the present. Not only that, but it integrates their genome, their microbiome, their environmental sensors and up-to-date literature on any risks and provides feedback to the patient to prevent provoking a condition.

Nicole Martinez-Martin, assistant professor of pediatrics at Stanford University, specializing in biomedical ethics and research

The pandemic has highlighted trends that were already in effect, which is that information and tools about health are available outside of health-care institutions. Who has access to your data? What kind of ability do people have to consent over the uses of their data? What kind of protections are there for that data? One look into the future is legislation that’s passed in Europe, the GDPR, and the California Consumer Privacy Act. This legislation is meant to give individuals more ability to consent to how their data is used and what data is collected. At the same time, there’s still a very strong trend towards health data being used in partnerships with big data companies like Google and others, which can still make issues like consent and transparency regarding data usage challenging.