How to create capacity for healthcare surges?

Elnahal, Shereef, Kushal T. Kadakia, and Suhas Gondi. 2021. “How U.S. Health Systems Can Build Capacity to Handle Demand Surges.” Harvard Business Review, October 4, 2021. https://hbr.org/2021/10/how-u-s-health-systems-can-build-capacity-to-handle-demand-surges.

There are compelling ideas around reimbursement, telemedicine and “hospital directed healthcare”. Each one merits its own ideas (and financial modelling), but building virtual dashboards (and failure to divulge ROI, including cost savings) is a glaring omission on this paper. I won’t get into details for this, though.

The highlights are as follows:

  • The pandemic has highlighted a major problem in U.S health care: Its brick-and-mortar facilities are ill-prepared to deal with surges in demand
  • During the chaos created by the Covid-19 pandemic, manufacturers across industries have been forced to adjust to rapid changes in demand for goods ranging from toilet paper to nasal swabs
  • Their response is an extreme example of episodic demand spikes, which occur seasonally in many industries
  • America’s health care providers can take lessons from these industries and build flex capacity outside of their rigid, brick-and-mortar care models to better manage episodic demand and meet public health challenges like those posed by the current pandemic
  • We describe how health systems can do that by embracing innovations such as telemedicine, walk-in clinics, and home-based care
  • If health systems struggle to manage the flu, it is no wonder that many hospitals have suffered from chronic capacity gaps and significant financial strain during the pandemic, where cases have rapidly ebbed and flowed
  • Empty beds and operating rooms mean lost revenue, so health systems are incentivized to maximize utilization, which discourages them from keeping extra capacity available for admission spikes
  • Health systems already struggle during flu season, with primary care physicians increasing staffing by 30% and still reporting both capacity gaps and financial deficits
  • We argue that providers’ operating models need to develop “seasonality” functions: flexibility on capacity to adjust the where, when, and how of care delivery in response to unpredictability on the demand side for the pandemic and beyond
  • In 2012, the Centers for Medicare and Medicaid Services launched a pilot program to evaluate whether home-based primary care could reduce hospitalization rates for this population
  • Health systems can build on existing home-based primary care models and new pandemic-era home monitoring programs to increase “slack” for hospital care by reducing the likelihood that frail, elderly patients will require scarce resources during periods of high demand
  • While the emergency department (ED) is appropriate for many cases, health systems could better manage spikes in demand by using walk-in sites such as urgent care centers, which research suggests could serve as a temporary valve for nearly a quarter of ED cases
  • Consider New York Presbyterian’s Express Care Service: Under this model, low-acuity patients waiting in the ED for care can elect to see a provider immediately via a virtual appointment in dedicated onsite telemedicine rooms instead of waiting hours for an in-person consultation
  • During the Covid-19 pandemic, the Mount Sinai Health System in New York City developed a similar telemedicine model for palliative care, with operators activating a backup pool of physicians in response to a spike in ED-associated consults
  • At University Hospital, we established a virtual urgent care service during the pandemic, which was especially helpful for individuals experiencing acute problems related to their chronic diseases but who were reticent to seek in-person care
  • To reserve inpatient beds for higher acuity cases, health systems can use hospital-at-home (HaH) programs, which enable patients with acute conditions such as pneumonia or heart failure to be stabilized at home through home and virtual visits and remote-patient-monitoring technology
  • With Covid-19 hospitalizations rising during the winter, the Centers for Medicare & Medicaid Services announced a new Acute Hospital Care At Home program encompassing more than 60 different conditions to alleviate the strain on inpatient capacity
  • University Hospital is in the process of establishing such a program for high-acuity patients who are admitted frequently. To build on this momentum after the pandemic, health systems will need to engage with regulators and rethink inpatient resource allocation and with innovators already developing new use cases for HaH for specialties such as surgical care and oncology
  • Health systems are incentivized to design staffing models that distribute physician time according to patient needs rather than optimizing solely for the volume of services needed to cover fixed costs

(If you notice, I am experimenting with the form around here).

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