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World: Since early 2020, the Covid-19 pandemic has dominated the healthcare landscape in the United States. It has identified five critical priorities that, when taken together, can make health care in the United States more accessible, inexpensive, and focused on keeping people healthy rather than only treating them when they are sick.

Given that the United States healthcare system has always concentrated on treating the sick, some physicians are bound to oppose these priorities. However, the consequences of Covid-19 are unavoidable. Provider groups that refuse to change risk jeopardizing their own and their patients’ futures.

The five distinct priorities are intertwined and must be addressed simultaneously. They provide steps on a route that can lead to a more healthier America when taken together.

1. Put an emphasis on bettering one’s health.
One of Covid-19’s most noticeable features is that it frequently exploits underlying chronic illnesses including diabetes, heart disease, and obesity. With these chronic diseases already at epidemic levels in the United States, the population was ripe for Covid-19 to wreak havoc.

According to the Centers for Condition Control and Prevention, six out of ten Americans have at least one chronic disease (CDC). Chronic diseases were responsible for seven out of ten fatalities in the United States prior to the pandemic, killing more than 1.7 million people each year.

The Covid-19 outbreak has to to light the enormous threat that chronic diseases pose. According to the Surgo Foundation’s Covid-19 Community Vulnerability Index, Arkansas, Louisiana, Mississippi, and Oklahoma received the greatest vulnerability scores, as reported by PBS. According to the Boston University School of Public Health, all four states are among the seven least healthy. Covid-19 would have been lethal even if chronic conditions had not been present, but their existence made Americans more vulnerable. Disease prevention must become a primary goal for the nation’s health-care system.

Individual choices can help with prevention, which is partly behavioural. Adult obesity is higher than 20% in every state and territory in the United States. In Vermont, the healthiest state in the US according to a recent USA Today rating, more than 90% of inhabitants say they exercise on a regular basis, compared to 23.8 percent of Americans who don’t. In 14 states, cigarette use — a well-known risk factor for a variety of chronic diseases — remains at 19 percent or higher.

However, health-care practitioners must facilitate prevention to a larger extent. At Intermountain Healthcare, we have a programme in place in some Utah clinics that involves primary care doctors directly assisting patients in improving their overall health — for example, connecting a patient with mental health services or nurse diabetic educators, or arranging for home health visits. Physicians will have fewer patients to care for as a result of this focus on preventive care, allowing them to spend more time with high-risk patients and getting ahead of possible health problems. Controlling high blood pressure, diabetes, osteoporosis, colorectal cancer, and other health problems has improved by 20% for patients in the programme. In comparison to regular clinics, better health has cut expenses by $648 per patient per year ($1,908 per year for individuals 65 and older).

2. Address Racial Inequalities
The Covid-19 pandemic has to to light the widening racial inequities in health care, which must be addressed quickly if health equity is to be achieved.

The Covid-19 hospitalization and death rates per 10,000, according to a study published in JAMA, were 24.6 and 5.6 for Black patients, 30.4 and 5.6 for Hispanic patients, 15.9 and 4.3 for Asian patients, and 7.4 and 2.3 for white patients, respectively. These huge discrepancies are unfortunately not new or exclusive to Covid-19.

Addressing the social determinants of health is critical to addressing these inequities. According to the CDC, there are five important issue areas to consider: 2) health and health care (lack of access to quality health care, health insurance, and/or linguistically and culturally responsive health care); 3) occupation and job conditions (the disadvantaged tend to work in jobs that can have more health risks); 4) income and wealth (financial challenges that make it difficult to ). (inequities in access to high-quality education, which can limit job and career options).

To address these concerns, Intermountain Healthcare is collaborating with and sponsoring a number of Nevada and Utah nonprofit organizations. We’re funding a three-year pilot project in Utah to address the socioeconomic determinants that influence health in low-income zip codes with $12 million in funding and staffing. The experiment, which is approaching the conclusion of its third year, has resulted in a 12.7 percent reduction in emergency department (ER) visits among patients who have participated in the initiative. Because the pilot was so successful, the Utah legislature has decided to adopt the approach statewide.

At Intermountain, we think that healthcare systems should be evaluated based on how they treat those who have been historically underserved. We have made equity a basic principle of our system by using data to discover where discrepancies occur and then intervening. We hold ourselves accountable by setting key performance indicators and evaluating our progress on a regular basis. What is clear is that we, as well as the entire healthcare industry, still have work to do.

3. Increase the availability of telehealth and in-home hospital services
We’ve asked people to come to us for aid in health care for a long time. We need to completely shift our mindset and become more customer-centric. People need to be cared for closer to their homes. To do so, when providing care, we must meet individuals where they are as much as possible.

The fast embrace of telehealth by both consumers and clinicians is perhaps the most significant transformation in the delivery of health care that Covid-19 has brought about. According to the federal government, nearly half (43.5%) of Medicare primary care visits were delivered via telehealth in April 2020, compared to less than 1% in February 2020. (0.1 percent ).

Across our 25 hospitals, 225 clinics, and various partner hospitals, Intermountain’s use of telehealth visits has increased from 7,000 in March 2020 to a current average of more than 73,000 per month.

Telehealth has far-reaching effects. It has the potential to improve access to care while also transforming the economics of rural hospitals and remote communities. In the decade leading up to the pandemic, a hundred and twenty rural hospitals in the United States had closed, and 25% of the survivors were on the verge of closing. Covid-19 has simply heightened the danger.

This is where telehealth enters the picture. Telehealth not only connects rural hospitals with specialists like neonatologists, neurologists, and cardiologists, but it also allows patients to obtain care without having to go to larger, more distant facilities. They can stay in their communities, surrounded by their support systems, with the majority of the compensation going to the local hospital. This benefits both remote hospitals and rural towns, where hospitals are sometimes the main jobs.

US Health care per capita
US Health care per capita

Acute and chronic clinical illnesses should be treated with hospital-level treatment at home, but only around 116 “Hospital at Home” programmes were accessible countrywide in spring 2021. According to preliminary national studies, home-based hospital care is 19 percent less expensive than traditional hospital care and has equal or better outcomes.

4. Create Systems That Work Together
Another crucial takeaway from the pandemic is that integrated health care delivery systems — those that provide their own health insurance plan or do so in collaboration with an external insurer — are better able to adjust and align incentives to quickly changing circumstances. In December 2020, a PwC Health Research Institute study indicated that systems with their own health plan were better able to withstand the financial impact of the pandemic.

According to the American Hospital Association, hospitals throughout the country could lose $54 billion in net income in 2021 as a result of the pandemic. Non-integrated systems will have to cut services, raise rates, or delay introducing vital community services to make up for the loss.

By transporting patients between institutions, across space, and among caregivers — and, perhaps most crucially, between care providers and insurers — integrated systems can “balance the load.” They are able to immediately exchange lessons learned and best practices. They are also likely to be the greatest candidates for caring for Covid-19 long-haulers. Furthermore, as an integrated system, Intermountain Healthcare was able to leverage its IT systems to quickly identify qualifying high-risk patients and persuade them to obtain their vaccinations when vaccines were available.

The integrated approach allows the cost of delivering care and the cost of insuring care to be linked in ways that benefit both the insurer and the provider, whether a health system offers an insurance plan on its own or through a partnership with an external insurer. That’s because when health-care expenses are cut, both parties benefit; when the healthcare system and insurance plan are separate, cost-cutting measures benefit the insurer or payers (e.g., employers), not the health-care system.

This is something we’ve seen firsthand. SelectHealth, an in-house nonprofit health insurance company operated by Intermountain Healthcare, serves almost one million members in Utah, Idaho, and Nevada. It also works with other healthcare organizations; for example, it has a collaboration with Idaho’s St. Luke’s Health System. The goal in each of these setups is to deliver excellent treatment while better aligning and integrating the costs of care and insurance.

5. Adopt a value-based approach to care.
The broad acceptance of value-based care, in which providers, including hospitals and physicians, are compensated based on capitation and patient health outcomes, would hasten the implementation of the aforementioned priorities. Traditional fee-for-service care, on the other hand, does not address prevention or equity. It has been a staunch opponent of telemedicine. It does not fully exploit the benefits of integrated healthcare systems.

Value-based care increases quality of life while also correcting incentives that aren’t aligned (e.g., paying providers on the basis of the volume of procedures they perform rather than outcomes). It can lower health-care costs by increasing access to care and keeping people healthy, reducing the number of treatments and procedures required. (For example, SelectHealth’s focus on value-based care enabled them to cut its rates by 2% to 3% for those insured through the federal exchange each of the last three years.)

However, unless hospitals are part of an integrated system, value-based care can jeopardize their financial health for the reasons I’ve stated. The defective fee-for-service system was meant to wait until people became sick before treating them, not to encourage people to keep healthy. The epidemic brought this weakness to light.

According to Ceci Connolly, president and CEO of the Alliance of Community Health Plans, “the pandemic opened the eyes of a lot of providers who make their money through volume.” “They had no volume and no revenue all of a sudden.” Regardless of volume, providers with value-based agreements with health plans received a check every month. Because they weren’t as concerned about volume or reimbursement, they were able to focus right away on telemedicine and other innovative ways of caring for patients.”

Value-based care allows providers and insurers to create and implement a variety of intriguing innovations that are not possible with volume-based systems. For example, Intermountain Healthcare and the University of Utah Medical School are collaborating to create a new medical educational programme — the first of its kind in the United States — to train the next generation of physicians in population health, which focuses on keeping people and communities healthy. Intermountain is investing $50 million in the effort, which will help doctors examine not only a patient’s acute medical requirements, but also the socioeconomic determinants of health.

To make the transition to value-based care work, it will need a lot of money, effort, flexibility across companies, and, for some, a leap of faith away from convention. Intermountain Healthcare has discovered the following to be effective:

Provider panels should be aligned and reorganized. A provider’s panel must have a sufficient number of patients covered by value-based contracts (i.e., capitation) to make the modifications worthwhile, as well as financially and clinically viable. Patients allocated to a provider should include a mix of persons who are reasonably healthy and those who have chronic diseases that require more comprehensive and intensive care.

Healthcare expenditures in the United States are significantly higher than those of other developed countries
Healthcare expenditures in the United States are significantly higher than those of other developed countries

Reorganize your teams and workflows. Following the alignment of panels, teams supporting physicians must be reformed and appropriately resourced in order to flourish in this new paradigm of care. Workflows and processes at the core must be tweaked and accepted. Daily huddles should bring teams together to manage patient outreach, repair care gaps, and organize treatment for the patient’s changing requirements.

Providers and teams should be educated. To succeed in value, it takes a village. Ensure that everyone, no matter how big or small their position, is prepared to contribute to this team effort by educating them on the basic tenants of value-based care.

Utilize cutting-edge technology. To harness and unlock the value of this data, use technologies to connect disparate data sets and overlay complex algorithms. This information can be utilized to notify professionals about potential patient health issues.

Make use of real-time data. Teams must incorporate real-time, actionable insights into their regular activities. Predictive analytics allow doctors to focus on who should be on their appointment calendar — and shift away from episodic therapy and toward preventive, holistic care.

Financial incentives should be aligned. The incentives should be geared at keeping people healthy rather than merely generating revenue.

The cost of health care in the United States will continue to climb unless a speedier transition to value-based care is made. That is unsustainable for both the providers and the patients. Health care is already pricey and difficult to obtain for many Americans. If costs are not kept under control, the problem will only get worse.

The pandemic has made the direction that health care in the United States must follow very obvious. The question is whether provider organizations and private and public insurers are not already on this route and recognize that it is the only way to achieve a system that provides better care — care that keeps patients healthy — while also being financially sound.

- A word from our sposor -

Healthcare in the United States should focus on 5 critical issues