If you’re not a health care worker or manufacturer of essential medical equipment or technology, sit down.
March 22, 2020 – Your neighborhood’s only grocery store has a five-alarm fire. First responders are feverishly rescuing people and attempting to extinguish the flames with a powerful hose. Seeing the distress and chaos you assume that surely there is something you can do to help. After all, you’re a highly-educated engineer (or whatever) who is quite capable of doing lots of things. You tap a firefighter holding a spraying hose on the shoulder, asking where you can help. As he turns to tell you to back off, the water stream shifts away from the flames. You tap another firefighter running into the building to make the same inquiry, costing her precious seconds for re-entry, as she provides the same retort. All professionals on the scene don’t want or need your help unless you have a hose or fire-retardant gear. Nothing else at that moment matters but saving lives. You return home frustrated that despite your intellect and capability, the situation simply has no need for your skills.
In this time of national emergency, those of us that have dedicated our lives and careers to the betterment of our country’s health system feel a similar frustration as we watch the world around us burn. In truth, unless you have medical training, or are capable of producing gloves, masks, or ventilators, there is little value to add in the current moment. Anything else you attempt to do only serves to create noise. Webinars about value-based systems or thought leadership papers about how your solution could (or could have) address the solution are inconsequential unless they can be deployed now. Today. Immediately.
The damage from this will be enduring and will act as a catalyst to several other slow-motion situations that will require a far-wider range of professionals (similar to how the engineer in the grocer’s neighborhood may be called on to assist re-building the facility).
The most immediate post-COVID-19 crisis is certainly going to be the implications of a significant increase in the country’s vulnerable and unemployed. It is common consensus that we have (or will) enter a serious recession that will push unemployment past 10 percent, the same level as the “great recession.” A majority of economists believe it could be closer to 20 percent. Both the best- and worst-case outcomes will result in a veritable doubling or tripling of Medicaid beneficiaries and may well serve as a catalyst for states that have resisted Medicaid expansion to shift their posture.
The health system’s ability to absorb such a drastic shift in reimbursement following the financial trauma from this pandemic is low to say the least. Medicaid rates and the associated utilization and cost parameters threaten significant financial pressure on a system that already cross-subsidizes these lower rates with healthier parts of the system. State budgets will be dwarfed as tax revenues fall and costs increase. Hospital balance sheets will bleed as providers urgently look for ways to provide necessary care while preserving the financial integrity of their institutions. And so on.
This shift presents an opportunity to organize our country’s technology, care models, payment configurations, and investment in service of improving access and care to those most in need while the economy strengthens. It will be an opportunity to participate in a historic moment to drive the next generation of our system. All hands will be needed.
Other moments of urgency will relatedly ensue. An unprecedented electoral event and legislatively driven, structural change a la a second New Deal is no longer theoretical. Nonetheless, redressing the economic pain will create the conditions for significant reform.
Until the flames of COVID-19 are completely extinguished, the greatest service each of us can provide is to stay safe – to set an example of adherence to governmental edicts, protect our family, volunteer when needed or asked in our communities – and prepare for the day after tomorrow when we will have to rebuild and fix a system that will likely prove insufficient for the pandemic it just endured. When the fire is out, there will be considerable work for all of us to do. Be ready for it.
David Smith, CEO and founder of Third Horizon Strategies, is an expert in managed care, alternative payment models, and public health. He has established several coalitions focused on these efforts, most notably in the areas of Medicaid payment reform, opioid use disorder treatment, market stabilization, and health care and social disparities. He is the co-founder of the Health Care Council of Chicago (HC3), a group of Chicago-based health care businesses focused on economic development, system transformation, and social disparities.