Health systems: Emerging COVID-19 consultants for businesses?

Health systems like the Mayo Clinic and Cleveland Clinic are taking on adviser roles with businesses that want medical experts to inform their COVID-19 reopening plans. But what pressures and dilemmas do these types of partnerships present for health systems? 

As federal and state COVID-19 responses face their own delays and politicization, businesses are looking to health systems as credible, neutral partners when creating and implementing COVID-19 safety measures for customers and employees. 

Corporate affiliations aren't new territory for health systems. But relationships where health systems serve as a COVID-19 consultant — like Nashville, Tenn.-based Vanderbilt University Medical Center joining American Airlines' travel health advisory panel and Rochester, Minn.-based Mayo Clinic advising Delta Air Lines — can come with high stakes. 

Three questions to consider:

1. How involved should a health system's leadership be?

In a recent interview with CBS' "Face the Nation," Terry Shaw, the CEO of Altamonte Springs, Fla.-based AdventHealth, said he "wouldn't hesitate to go to Disney as a healthcare CEO — based on the fact that they're working extremely hard to keep people safe." The comments came July 12, the same day Florida recorded more than 15,000 new cases of COVID-19

AdventHealth has a longstanding relationship with Disney theme parks. As part of its current collaboration with Disney, AdventHealth employees are taking temperatures at the gates of the theme parks and the entrances to Disney Springs.

The role CEOs and executives should play in these types of partnerships isn't clear cut. It can range from being hardly noticeable to vocally endorsing a company's preparedness like Mr. Shaw. The role executives play in the Mayo Clinic-Delta partnership is a little clearer. Executives from both organizations will form an advisory council that will review and assess the airline's safety protocols. But questions remain around the extent to which health system leaders will be held accountable for the role they choose to play in these partnerships.

2. What if a health system's clinical guidance contrasts with the actions of the companies they endorse, or if their clinical guidance is never followed in the first place?

Public health and business interests don't always align, which can put health systems that are advising businesses on COVID-19 safety measures in tenuous positions. Businesses ultimately choose whether or not to follow recommendations. 

Take Cleveland Clinic's recent partnership with United Airlines. Under the partnership, medical experts from the Cleveland Clinic were picked to advise on social distancing, new technologies, training development and quality assurance programming for the airline company. 

Days after Cleveland Clinic affiliated its reputation and expertise with United, the airline's new CEO, Scott Kirby, rejected the concept of social distancing while flying, stating "airplanes don't have social distancing" during a May 28 conference. United Airlines began booking flights to full capacity. 

United's move to abandon social distancing raises questions about the dilemmas these strategic partnerships may place on health systems. Could a health system's credibility be damaged if partners don't heed medical advice and people's safety is compromised? Conversely, if a business taps a health system to guide their reopening and it goes well, will health systems benefit by getting credit for that? Ultimately, no single health system is the definitive expert on advising businesses on a novel virus like SARS-CoV-2, which makes the partnerships even more complex.

3. Beyond public health, what other motivations are behind the partnerships? 

Health systems are still experiencing major volume losses amid the pandemic, while businesses are still reeling from closures or unsustainable declines in customer volume.

Arguably, there are points beyond the scope of public health that motivate both health systems and businesses to partner up. It's likely that large health systems like Cleveland Clinic and Mayo Clinic would benefit financially from having patients safely traveling to their institutions again for elective procedures, while the airlines benefit from filling seats. 

And while partnering could be risky for a health system's credibility, both employers and health systems need each other to continue thriving. Health systems rely on higher payments from employer-based health plans to balance out lower reimbursement from Medicaid and Medicare. If employers don't reopen or close, many employees will move to Medicaid or become uninsured, which will present financial strain for hospitals. On the other hand, employers need health systems to give the thumbs up for their return to work plans, not only to make sure their employees feel safe, but also to show they put in effort to mitigate risk should legal issues arise.

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