What happens in the aftermath of the coronavirus is still uncertain, but it is clear that this upheaval presents an opportunity to adjust today’s misaligned health care system to something more equitable, sustainable and valuable to patients.
A recent article in the New York Times, asked if COVID-19 brought an “unanticipated silver lining” to the health care system– telemedicine is now more widely available, there has been a shift in where care is being delivered (less in offices and more in patients’ homes) , and how it is delivered (more by visiting nurses and other non-physician health care practitioners). These are the unintended consequences of addressing a crisis that has exposed the flaws of a fragmented health care system with little strategy to absorb the shock of a pandemic.
Another opportunity for adjustment is to address market failures that lead to waste and unnecessary care that offer little value for patients— and cost the U.S. health system more than $100 billion annually. Greater efficiencies in spending can be reinvested into high-value care, including disease prevention, addressing disparities, innovative technology, as well as a more robust strategy to be better prepared for the next crisis. The keys to achieving these kinds of efficiencies will be in providing better information and better incentives to align care with value.
The opportunity to reduce waste is most evident in addressing low value care. COVID-19 led to a sharp decrease in potentially low-value and unnecessary elective procedures. Some of the cancelled procedures may save patients from the harm and costs of services that may never have been needed in the first place (although what is low value will depend on the type of care and patient characteristics). Inadvertently, the COVID-19 pandemic has done something organizations such as Choosing Wisely have been trying to do for years: reduce the prevalence – and spending – on low-value care. When we arrive in a post-COVID crisis health care system, we need to ensure low-value care does not return to prior levels.
For the past two-plus years, the Research Consortium for Health Care Value Assessment (The Value Consortium) has explored ways to encourage more efficient health care spending and reduce low value care. There is more to be done as the COVID-19 pandemic brings to light a stark reality of the inefficiencies of our health care system – we simply cannot afford 30% waste in a health care system that was dramatically unprepared and under-resourced for the current pandemic and that must be better prepared for the next one. There are several questions to tackle as the health system and public policy grapple with lessons learned from the pandemic. Through The Value Consortium’s Grant-Making Center, we will collaborate with health policy and research experts and seek answers to key questions in a series of papers that focus on how to use health care dollars wisely in the context and aftermath of COVID-19 in order to help hospitals and other providers cut waste and support a more robust, evidence-based understanding of value in health care.
Working together with experts we will answer questions like: “How can we continue to avoid the low-value services while resuming the high-value ones that have also been curtailed in the COVID-19 environment?” “Will post-pandemic care better treat patients in appropriate and lower cost settings, including via telemedicine?” “What incentives in the system should be prioritized for better alignment with value?” “How can disparities that have been exacerbated by the pandemic be addressed in ways that deal with both the near-term exacerbations and the long-term underlying problems?”
It is, of course, too early to determine exactly how this pandemic permanently changes our health care model. But examining how we can provide more value in our health care system is one important way we can learn from this crisis.
Research conducted by the Value Consortium is made possible in part by funding from the PhRMA Foundation as part of its Value Assessment Initiative. This blog post was also featured on Altarum’s website.
About the Authors
Beth Beaudin-Seiler, PhD is the Manager of the Value Consortium and a Health Care Research Analyst with the Systems Research and Initiatives Group at Altarum.
Mark Fendrick, MD is Co-Director of the Value Consortium and a founding Partner of VBID Health. He is also the Director of the University of Michigan Center for Value-Based Insurance Design and a professor in the Department of Internal Medicine and the Department of Health Management and Policy.
George Miller, PhD is Co-Director of the Value Consortium and a fellow with Altarum’s Center for Value in Health Care. He is also a fellow of the Institute for Operations Research and the Management Sciences.
Paul Hughes-Cromwick, MA is the co-director of Altarum’s Sustainable Health Spending Strategies.