HIT Perspectives: Post-COVID-19: Five Things That Will Come Roaring Back with a Twist

HIT Perspectives – June 2020

Post-COVID-19: Five Things That Will Come Roaring Back with a Twist

Tony Schueth

 By Tony Schueth,  CEO and Managing Partner

Quick Summary

  • Telehealth will redefine value-based care business models to cut costs and revamp care models.
  • Population health will prominently reemerge when payers, policymakers and providers get back into full gear.
  • Health IT will become vital for efforts to modernize public health systems.
  • APIs and price transparency tools such as real-time benefit check will take hold.

Now that the world is starting to open back up, we are beginning to think about what it will look like post COVID-19. Many priorities seemed to be, well, deprioritized as the focus was solely on flattening the curve. But, in reality, not everything stopped dead in its tracks. Work was getting done, just in the background. So going forward, the questions are: what priorities will reemerge in the post-COVID-19 world? And in what form?

I conceptualize these as waves which crest, crash and reemerge in a transformed state. I learned this paradigm from my graduate school professor, Ray Ewing. In his book, Managing the New Bottom Line, he viewed them as waves. (It’s still available and I highly recommend it.)

Here are five “waves” we think that will come roaring back, though with a twist:

  1. Value-based care (VBC). Whereas pre-COVID-19, VBC was the rage, during it, it’s been more about preventing people from getting the virus and treating those who did. Requirements for coverage and reimbursement, among others, were waived or relaxed by insurers. Several things are clear for the immediate term. There will not be any meaningful numbers on costs and outcomes anytime soon that VBC organizations can use for quality and reimbursement. They are likely to eat the downside risk this year and perhaps into 2021. Many will want to revisit contracts in light of their COVID-19 experience.

Prediction: Revenues and patient volumes will inevitably recover. The twist: much of the rebound will be due to a renewed reliance on telehealth. It will redefine VBC business models to cut costs and revamp care models. 

To be sure, telehealth had a growing foothold in the pre-COVID-19 world. Post-COVID19, it became, of necessity, the major treatment modality to keep patients and providers safe. But now telehealth is here to stay in an even bigger way, providing an enduring impact on efficiencies as well as reimbursement and care models. Going forward, VBC organizations will revisit reimbursement rates and cost sharing in light of telehealth adoption and impacts. Quality metrics will need to be revamped. Care models will change. Non-physicians (such as nurse practitioners and pharmacists) will be have a larger role due to telehealth. They will be working top-of-license and provide much more care and at lower costs.

Telehealth will allow care to be provided outside of hospitals at lower cost in virtual care settings. Increased access to care for minorities, the elderly and the chronically ill — made possible by telehealth — will create renewed emphasis on preventive care and patient monitoring. Keeping healthy patients healthy will become as important as getting sick patients well. This in turn will improve quality and help drive down costs. In short, telehealth will help VBC organizations move from denying payment to guiding quality, cost-effective care.

  1. Population health. Population health also has been around for a while, but it never attained the prominence that some thought it deserved. However, it was reasserted when the COVID-19 crisis hit. As the virus swept the country, data were needed to identify vulnerable individuals and better understand infection and mortality among various population groups. It became clear that the economically disadvantaged and minorities were disproportionally affected.

Prediction: Population health will crest with COVID-19 and then wane as we experience a new normal. However, it will prominently reemerge when payers, policymakers and providers get back into full gear. They will require data collection on vulnerable populations including minorities, the elderly and chronically ill — to assess risk, save money and develop more effective health interventions for certain populations as never before. The twist: the scope of needed information will expand beyond demographic and clinical data and require advanced analytics for analysis. 

Going forward, population health management will become top-of-mind for payers and providers in the value-based care world to improve access to care and reduce costs to vulnerable populations. In the past, it has relied on the clinical and demographic information residing in claims data and electronic health records. Going forward, population health management will require Information on the social determinants (SDOH), including employment, education and access to food, housing and transportation. In fact, some believe that SDOH may be more important to a patient’s overall wellness than their clinical care. This is especially true for minorities and those experiencing socioeconomic disadvantages.

But what SDOH data should be retrieved? Where will it come from? First, payers and providers will need to figure out exactly what problems they want to solve and what data they want. It sounds easy but they will have to rethink their business and care processes in order to know which populations they want to reach out to and why. To be sure, geography and market share will play big roles in new decision making.

As for where to get the data, there’s already a lot of it out there. Marketers, political campaigns and others gather tons of socio-economic data on us every day. While it may not be down to the individual level, it often is down to neighborhoods, which will go a long way in addressing SDOH issues. Which ones are close to transportation or are in the middle of food deserts are already known, for example. Payers and providers don’t necessarily have to begin de novo. They can find ways to access and leverage extent data sets related to SDOH. New apps will be created to collect and share the information among various end points.

Artificial intelligence and machine learning-based algorithms will be key to understanding the complex data related to SDOH. They will be needed to provide the added depth and specificity with the volumes of data that will be pouring in. Trending analytics still will be useful but won’t be enough.

  1. Public health. The COVID-19 crisis catapulted public health back to the forefront. Its importance seems to be dependent on the crisis at hand, whether it is in response to a pandemic like COVID-19 or more issues like tracking and tracing measles outbreaks that affect people in their normal lives.

Prediction: public health will come roaring back after the immediate COVID-19 crisis dies down. It will be high on policymakers’ radar so new resources and funding will be made available to modernize public health systems. The twise: Health IT will become vital for those efforts. 

Health information exchanges play an expanded role. They will increase their connections to various data sources, but also will be adapting their networks to carry nonmedical information, such as information on SDoH that will be used for improved public health surveillance.

Capabilities in electronic health records (EHRs) will be expanded for surveillance related to chronic diseases. Not only can EHRs help identify patients at risk, their data can be leveraged to trace patients and staff for follow-up if they have been in contact with providers who test positive for the virus. EHRs also will become a useful tool for electronic case reporting, in which the EHR would automatically generate reportable conditions directly to public agencies for review.

New apps will arise to collect and share public health data.  For example, wireless tracking tools, such as real-time location systems (RTLS) linked to smart phones, will expand their capabilities to track and deploy strategic medical supply reserves and personnel. Apps will create new and easier ways to track and trace infection contacts and patterns in a community.

  1. APIs. Application programming interfaces (APIs) were all the buzz before COVID-19 hit, primarily due to regulatory and statutory requirements. [Click here to read POCP’s insights on the latest regulations concerning APIs and interoperability. These regulations were finalized just as the pandemic was starting — the same week as cancelled annual meeting of the Healthcare Information and Management Systems Society (HIMSS), which was to have been the regulations’ coming out party.] Emphasis was placed on using HL7’s Fast Healthcare Interoperability Resources (FHIR) standard to facilitate patient data exchange.

Prediction. Post COVID-19, APIs will continue their emphasis on data exchange using FHIR. The twist: the buzz will be around APIs using the standard for new public health, patient safety and research use cases. 

FHIR has relatively recently burst on the healthcare scene as the standard of choice for clinical and coverage-related data exchange. FHIR accelerators — including the FHIR at Scale Taskforce and the HL7 DaVinci Project — continued their work throughout the COVID-19 crisis to identify scability gaps and enhance FHIR adoption throughout the healthcare community and value-based care.

Going forward, FHIR-based APIs will play a huge role in collecting and exchanging data that will be key to surveillance and other public health activities. For example, APIs will used to track and trace contacts for future disease outbreaks, not just pandemics. They will follow the lead of two new APIs. One is a new FHIR-based application called eCR Now, which aims to give public health officials a more detailed and real-time view of the spread of COVID-19.  A new partnership between Apple and Google will allow development of FHIR-based APIs for contact tracing through smart phones.

FHIR-based APIs will roar back to address patient safety through access to and sharing of data in electronic health records (EHRs), including patient demographics and clinical information. They will provide insights on adverse reactions and issues with new therapies, existing therapies and vaccines for all kinds of diseases. APIs will facilitate the sharing of this information with providers, payers, public health officials, drug manufacturers and regulatory agencies, such as the Food and Drug Administration.

APIs will facilitate research. For example, they can help identify and enroll patients in clinical trials for diseases that had taken a back seat during the COVID-19 crisis.

  1. Transparency. Pre-COVID-19, transparency meant price transparency. There’s still a lot going on in that arena. An example is the real-time benefit check (click here to read more about it).

Prediction: There will be enhanced transparency in terms of who gets what care, at what costs and at what outcomes in the post-COVID-19 world. The Twist: The definition of transparency will be transformed, based on the TRUST (Transparency, Robust Screening, Strict Control, Treatment) model.

The TRUST model arose from South Korea’s response paradigm during the short-lived, SARS (Severe Acute Respiratory Syndrome) pandemic in 2008. Having this in place gave South Korea a jump on the COVID-19 response. As a result, the country had fewer infections and deaths compared to other countries.

Going forward, the TRUST model will inspire new modalities for transparency in terms of screening capabilities, treatments, quality measurement and outcomes. And it surely means there will be better communication of the controls on both people and the healthcare system that will be put in place by federal, state and local governments, in normal times and during disease-based crisis.

There also will be a new emphasis on transparency beyond price. An example is prior authorization (PA ) for drugs, devices and services covered under the patient’s medical benefit (mPA). Electronic medical prior authorization is in its early phases, but work will continue to accelerate. Payers will ramp up efforts to assess how pharmacy and medical claims are processed, as well as increase the accuracy and availability of PA requirements and benefit detail in workflow in real time. EHRs will begin to work on supporting mPA, such as the ability to handle attachments.

COVID-19 has changed the world in innumerable ways and created many twists on how and where health IT is used. Need more information? POCP is here to help. We’re tracking these and myriad other developments related to COVID-19 and beyond.  Reach out to me at tonys@pocp.com.

In this Issue:

  1. Innovations in Formulary, Benefit and Eligibility To Transform the Point of Care Experience
  2. Four Factors Driving the Momentum of Telehealth Adoption That Will Continue After the COVID-19 Crisis
  3. Post COVID-19: Five Things That Will Come Roaring Back With a Twist