At the height of the coronavirus pandemic in April, the director of the Centers for Disease Control & Prevention offered a grim warning: a resurgence of COVID-19 this winter could hit the United States healthcare system harder than the first wave.
Of course, knowledge is power. Healthcare providers agree that one reason COVID-19 was so devastating was the lack of precedent and the fact that the pandemic required immediate firefighting, leaving less space in the early days for coordination across government, providers, stakeholders and private entities.
This article was written in collaboration with Premier.
Today, with the cognizance that COVID-19 may surge again as the nation heads into flu season, providers can take all the actions they need now to ensure they’re prepared for the future.
Clinically prepare with an early notification system
Providers have an integrated, near real-time surveillance system at their fingertips. More than 1,200 hospitals across the country already have in place the technology to surveil COVID-19 suspected and confirmed cases, predict disease progression and surge, determine the supplies necessary to care for the infected population, improve the quality of medical interventions and ultimately prevent the spread of the disease.
Fueled by national and local sources of data, this technology enables providers to predict COVID-19 surge in a specific locality and forecast disease progression. Foresight is crucial. One of the earliest warning signs that can signal a future pandemic hot zone is a sharp increase in specific COVID-19 symptoms within a defined community. This technology is already integrated within all major electronic health record systems and will further be used by approximately 150,000 clinicians to predict future cases. They are enabled to do this with natural language processing and machine learning, two technological capabilities that look for signs and symptoms that are often recorded within physician’s notes.
Even better, this technology’s predictive analytics are customized for each facility, indicating the health systems’ projected caseload for five to seven days. When health systems can predict where COVID-19 cases will increase, down to the county and facility, they can adjust staffing levels, coordinate with their supply chains to assure access to proper equipment and pharmaceuticals, align COVID-19 testing protocols, and prepare to limit non-essential services as needed.
Predict and manage cases
In a clinical setting, COVID-19 information offered at the point of care allows providers to initiate the right treatment for the right patient at the right time. From the height of the pandemic, infection preventionists were able to utilize clinical surveillance intelligence that includes COVID-19-specific alerts and patient flags for tracking and analytics. Alerts for suspected or positive cases enabled infection preventionists to isolate patients appropriately to prevent disease transmission or spread. This clinical surveillance technology continues to be the key to success in identifying potential cases and reacting appropriately.
Furthermore, providers have been leveraging clinical decision support technology that is powered by natural language processing and machine learning to flag suspected or confirmed COVID-19 patient cases directly in the electronic health record (EHR), regardless of the site of care. This is critical because patients who have early symptoms of COVID-19 are more likely to seek a primary care visit than present to the hospital. Premier’s clinical decision support intelligence extends beyond the functions of current-day EHRs by reading free text, including clinical symptoms recorded within the treating clinician’s notes. With this ability, providers can assess if medical practices within a specific zip code are noting upticks in COVID-19 symptoms – say, fever, cough and loss of smell – and can react appropriately.
Anticipate supply needs and capacity
Model-based tools available today will aggregate clinical and supply chain data and apply the insights to individual hospitals, offering near real-time information to guide decision-makers’ preparations for surges in bed and supply capacity. Providers need this capability so they can adequately anticipate surges in COVID-19 along with the implications for supplies, including personal protective equipment (PPE), therapeutics and blood needed by the providers.
Providers rely on these insights to manage patient care needs and supply inventory during any potential future surges. A supply chain forecasting solution helps providers anticipate their personal protective equipment (PPE) requirements, along with other equipment necessary for treating patients. Ideally, providers are enabled with a supply allocation model that predicts the number of disease cases across a seven-day period by county and models the supply levels a healthcare provider will need based on estimated case volume and typical surge demand.
Premier members shared that one of the most effective tactics during the height of the pandemic was a daily capacity management huddle, in which caregivers from across the hospital discussed patient volumes, beds and staffing. During these huddles, multidisciplinary teams collaborated on processes the teams could employ to meet the daily demands and displayed visual management tools that collated all the pertinent information into a snapshot. Members shared that these tools were a gamechanger for staff to quickly ascertain availability of resources and beds during COVID-19. Teams came together to gain visibility into projected patient flow, conduct resource planning and plan around if/then scenarios if a patient surge was predicted for the day.
Accommodate the workforce and patient preferences for care
Community members may begin to revert to the mentality of earlier generations, when people often refused to go to the doctor unless they were extremely sick. The current economic climate coupled with new patient fears and ongoing high-deductible health plans are likely to lead to medical avoidance for a period of time. And for the patients who require an in-person clinic visit, health systems have already implemented new guidelines and limitations that restrict the number of family members or individuals that wish to accompany them.
Telehealth quickly emerged as a winner during the pandemic and will remain in the spotlight going forward. While staffing models within nursing have remained fairly constant for years, COVID-19 encouraged swift adoption of virtual technology for nurses to triage and care for patients. Going forward, the opportunities explode for ways virtual care and remote staffing could be leveraged. Functions that may lend themselves to virtual care include patient and family education, admission assessments, care planning, increased touchpoints for patients in isolation and patient and workforce safety. In April, with COVID-19 cases swelling, one health system noted its use of tele-ICU technology to increase its ICU capacity by nearly 150 percent.
As health systems adopt care delivery models to understand what patients need, they will also have to account for the effect on their clinicians and doctors. They’ll need to strategically attend to those clinicians and physicians who may gravitate toward virtual care versus those who prefer providing care in an office setting. Some clinicians love providing care through telemedicine portals, while for others it exacerbates the symptoms of burnout because of the perceived distance from their patients and the lack of connection.
Health systems have forged stronger partnerships with staffing agencies, as well, to help fill gaps in needed areas or reallocate resources. Some Premier members worked with trusted staffing partners to efficiently reapportion their furloughed clinicians to geographies of high need and return them as the pandemic allowed. An ideal agency partnership supports credential sharing to fast-track temporary employment; tracks each employee's status and contract completion; and communicates key information to the employee's home healthcare system.
Strengthen your financial position
While hospitals received some help in the form of emergency relief legislation, providers know they will need to take action to compensate for falling revenues, the changed payer mix and rapidly evolving cost structures. To stimulate swift margin improvement, once hospitals and health systems assess the cost implications of COVID-19, they’ve created actionable financial transformation strategies that maximize outcomes through rapid-cycle margin improvement.
A roadmap to financial sustainability helps providers recognize the changes that must be made in both the short and long term to ensure sustainable transformation. For rapid-cycle margin improvement, providers should target five key areas with this approach: balance sheet/cash flow, programmatic rationalization, corporate/fixed costs, revenue cycle and reactivation.
It’s clear that COVID-19 is going to inspire a stronger shift toward value-based care in the near term. In the fee-for-service model, volume is an important indicator relative to revenue, yet patient preferences and utilization are already shifting toward less consumption of healthcare services coming out of the first wave. Going forward, some providers will look at risk-based arrangements to protect future revenue, including capitation and other innovative arrangements.
During this movement, there’s no doubt that a stronger alignment will be needed between the health system and the employed and community physicians around cost and efficiency, with a common goal of reducing unwarranted variation. Providers will want to explore financial mechanisms and incentives that can help solidify this alignment, such as expanded use of the Hospital Quality and Efficiency Program to improve quality and reduce costs across the system.
Looking Toward the Future
While the U.S. healthcare system was caught off guard by COVID-19 – as, arguably, were all the other nations’ – we’ve emerged stronger. The industry has the capabilities, infrastructure and resiliency to actively respond to a resurgence or other crisis. In the meantime, the nation has taken crucial steps to help fix the supply chain. Premier’s approach includes real-time, nationwide data-gathering on the availability of critical items, their sources and potential pandemic threats; a strong infrastructure for, and investment in, domestic manufacturing; revitalization of the Strategic National Stockpile; and continued partnership between public and private entities.
Learn more at premierinc.com/covid-19-response.