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By R. Todd Lancaster, MD, MPH
It is an understatement to say that much has changed during the Covid-19 pandemic. Many sectors of business and society have adapted to become more agile, as they have learned to function under new expectations and rules. The health crisis that the pandemic ushered in will ultimately serve as a turning point in how the healthcare community understands the delivery of care. The pandemic clearly exposed the rigidity of our interconnected health system and showed how a novel respiratory disease could disrupt every aspect of patient care in the U.S., which not only impacted patients infected with Covid-19, but diminished health outcomes across many disease states. In the current system, as emergency departments and ICUs have faced a surge of patients, it has created a ripple effect that has the potential to negatively impact nearly every area of patient care.
To be sure, while incorporating lessons learned from the pandemic, healthcare delivery will necessarily evolve to a decentralized model of care that offers more flexibility and balances patient volumes more equitably across large health systems, local hospitals, outpatient clinics and urgent care. In addition to decentralizing care, providers will offer a more efficient – and cost effective – healthcare experience that centers around the patient, including both clinical outcomes and patient satisfaction.
Decentralized healthcare increases access to care
As a physician with extensive experience treating patients in both an inpatient and outpatient setting, I have seen firsthand how the healthcare ecosystem can function at its best with alternative sites of care and large hospitals working hand-in-hand. Alternative sites of care, such as an office-based lab (OBL), are meant to augment, not compete, with hospitals and create options that balance the distribution of patients across the continuum of care.
By offering patients the option to seek high-level care at facilities other than a hospital – which is presumably in a larger town or city – more patients can access care where and when they need it. For providers everywhere, the pandemic has demonstrated in stark terms the importance of keeping intensive care units and emergency departments available for the most severely ill patients. By diverting patients who do not require the high-touch care of an ICU or an overnight hospital bed to the outpatient setting, we can preserve hospital capacity, and more effectively meet the needs of severely ill patients in the hospital while also mitigating patient exposure to potentially communicable diseases at the hospital.
Among other tough lessons, the pandemic has also exposed the dangers of delayed care. During the pandemic, some patients with various chronic or acute conditions were either forced to – or elected to – delay their treatment. In many cases, this delay allowed those illnesses to progress, thus transforming a once easily treatable condition into one that required more extensive levels of care. This fact alone has led to multiple surgical procedures which may have initially been avoided. It follows then, that if patients were not forced to delay care, or if they felt more comfortable in pursuing care, then many of these more extensive treatments or surgeries could have been avoided. Specifically, if capacity for care could have been increased by maintaining open hospital beds, or if patients were offered a care option in a facility that was not actively treating Covid-19 patients, then delays in care may have been curbed. Limiting these delays would improve patient outcomes, improve patient satisfaction and reduce costs by avoiding previously unnecessary procedures.
Patient-centered care can improve outcomes
Companies that focus on e-commerce and transit have spent the better part of the previous two decades optimizing the consumer experience. Amazon and Uber found inefficiencies in their respective industries and grew their companies with a model built entirely around making the consumer experience easier, faster and more efficient.
The same customers who order their groceries on Amazon and their rides on Uber are simultaneously going through experiences in healthcare that don’t always match that level of consumer-first thinking. Delivering quality healthcare is vastly more complex than the consumer industries dominated by Amazon and Uber, but the fact remains that our healthcare system needs to take the patient experience into greater consideration.
Alternate sites of care create flexibility to design a physical space with the patient experience in mind through each element of the clinic. When we designed our clinic in Wellesley, Mass., we asked questions like: Is it easy to park? How long is the walk from the front desk to an exam room? What is the appointment booking process like? Who are the people each patient interacts with?
By answering those questions and designing the clinic around a positive patient experience, we can not only make the experience more enjoyable, but we can improve the amount of value that we deliver to the patient. As value-based care becomes the standard for reimbursement models – reimbursing providers based on health outcomes rather than individual services provided – the providers are taking on more responsibility for the patient’s health outcome. That means patient retention and adherence are more important than ever before, and positive patient experiences can keep them coming to appointments on time and managing their care properly.
The pandemic has spurred an era of innovation that will forever change how providers and patients think about healthcare delivery. By converting the hard lessons learned from the pandemic into positive change, we will build a decentralized healthcare ecosystem that works more efficiently and delivers a higher quality of care. When the next public health crisis occurs, we will have a much more balanced approach that delivers quality across the spectrum of care, thanks to those lessons learned.
Dr. R. Todd Lancaster is a board-certified vascular surgeon. He is the Chief of Vascular Surgery at Newton-Wellesley Hospital and is a lead physician at The Vascular Care Group Wellesley.