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Preparing for health care delivery in a post-COVID-19 world

Benefits Administration and Outsourcing|Health and Benefits
COVID 19 Coronavirus

By Drew Hodgson | April 28, 2020

As cases in the U.S. peak and fall, employers should prepare their employees to navigate through the changes that lie ahead.

The COVID-19 pandemic is reshaping the health care delivery system.

Employers are now under immense pressure from a financial perspective and are challenged to adapt current models to better deliver care during these unprecedented times. These direct and indirect forces will impact how employers design health care programs to get high value for their members in a post-COVID-19 world. As cases in the U.S. peak and begin to fall, employers can now act to reshape health care delivery and prepare their employees to navigate through the changes that lie ahead. Here’s what employers need to know about the post-pandemic delivery of health care.

First, let’s recognize that non-COVID-19 services are decreasing, or in some instances being eliminated entirely in the short term including:

  • High-cost elective procedures, such as joint replacements and spinal surgeries
  • Specialist visits
  • Emergency room and urgent care visits
  • Annual wellness
  • Physical therapy
  • Lab work

As the U.S. reopens in stages, the health care system could be overwhelmed by pent-up demand, while medical staff recover physically and emotionally from the tireless work they are enduring today. At the same time, utilization may be tempered by patient trepidation around re-entering physician offices and especially hospitals. It is also likely that the delivery landscape will vary by market, with some locations returning quickly while others face greater barriers, creating access challenges.

This creates an opportunity for employers to begin planning now as to how and where they want that pent-up demand for care to be delivered.

Guiding employees

To start the process, we recommend that employers begin analyzing their geographic footprints and population demographics that are essential to identifying areas of opportunity for improvement. Employers can then identify differences and focus attention on delivery solutions and on driving utilization into high-quality providers at the local market level.

A combination of analytics and market tools can help employers synthesize the data to provide an actionable look at the landscape of available solutions. These solutions could include:

  • Centers of excellence
  • Narrow or high-performing networks
  • Clinics
  • Direct contracts with a health system

There is also the potential for increased out-of-network utilization as members struggle to make appointments and outpatient capacity is stretched. By understanding the impact at an individual market level and implementing strategies that encourage in-network utilization, employers can limit the cases where out-of-network is unavoidable and reduce adding unnecessary costs to the plan. Other innovations that triage and direct care are at play that must be incorporated into near-term health care planning.

The new role of virtual care

Current delivery dynamics have ignited a surge in the adoption and use of virtual care. This is enabled by modalities beyond phone, including video, messaging, patient portal connectivity and asynchronous data sharing. The growth of virtual care is expected to have a transformative impact on the delivery of health care. Employers should examine and actively manage their approach to virtual care as they transition back and plan for a post-COVID-19 environment. The immediate need has been to treat patients without the risk of exposure in a physician office. Beyond safety and convenience, the scope of virtual care has grown from primary care to many types of specialty care.

A myriad of other factors must be considered including:

  • Payment levels
  • Regulations
  • Treatment approaches
  • Coordination across a multi-disciplinary care team

These are no doubt trying times. However, by mining data now, employers can help employees navigate through an uncertain health care landscape and improve delivery of health care services into the future.

Author

National Health Care Delivery Practice Leader

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