Looking Ahead: Promise After a Tumultuous Year

By Matt Fisher, Esq
Twitter: @matt_r_fisher
Host of Healthcare de Jure#HCdeJure

Every year brings its own successes and trials, but 2020 brought more than its fair share of trials. The biggest issue that dominated healthcare throughout the year (and will continue to do so into 2021) was COVID-19. The unexpected, swift, and far-reaching impact of COVID impacted all levels of healthcare, society, and more. The impact likely cannot be understated as it has yet to be fully determined.

As so often happens though, the trials and tribulations of COVID also resulted in silver linings and signs of optimism. Foremost among the benefits was the opportunity for telehealth and digital health to achieve widespread adoption and use. It offered a chance for the long held promise of technology based care solutions to improve access, promote efficiency, and otherwise streamline care delivery. While the full promise was not necessarily achieved, significant advancement did occur, which meant a near universal desire for utilization to continue (that means both among patients and clinicians).

The COVID pandemic also highlighted the capabilities of science and research to rise to a challenge by diving into an issue with an amazing amount of speed. COVID-19 was a novel presentation of the virus, but multiple vaccines with apparently very high success rates (at least based on initial trials that provide the basis fro emergency use) were able to be developed and rolled out to the general public. The ability to produce vaccines with such speed should draw attention to likely advancements research and clinical trial work. Without developments on those fronts over the years, the foundation would not have existed to enable the development of the vaccine so quickly.

Another sign of hope from the pandemic are widespread calls for increased adoption of value based care models of care and reimbursement. When services were halted and patients could not see clinicians, money stopped flowing since reimbursement in fee for service relies upon actual delivery. That scenario can change if reimbursement occurs on a per month payment and then care is delivered against money already in hand. It is firmly acknowledged that value based care comes with material risks (it would not also be called risk based contracting if that outcome was not true), but a push to a new structure is not necessarily uncalled for. The volume of calls for value based care varied throughout the year and adoption was not clear, there could be growing support as a means of being financially better prepared going forward.

The quick recap of 2020 is not all-encompassing, but can provide a bit of a jumping off point to identify what may be in store for 2021. Any predictions about a new year should come with more than a few grains of salt, especially when so much remains in flux as a result of COVID. However, identifying potential trends may still be possible. With all of the caveats, here are some thoughts and considerations about what 2021 may bring.

Maturation of Telehealth
After adoption should come refinement and maturation of ideas and solutions. While telehealth solutions have been around for a long time, the lack of widespread utilization or scale meant that practical issues had not necessarily been identified. Additionally, the rapid rollout and relaxation of compliance requirements from the federal and many state governments meant that non-healthcare specific solutions were put into place. What will maturation mean then? It should mean enhanced workflows that make it easier for both clinicians and patients to access all in a private and secure environment that meets basic regulatory requirements (but should practically go above and beyond).

Another aspect of maturation should be appropriate triaging of care and services. While more care than expected was determined to be appropriate through remote means, not everything can be done remotely. Striking a good balance between in-person and remote care will be essential for entrenchment. The balance also calls for changes to clinician schedules. If telehealth will become a part of how care is delivered, then time must be carved out for that means of care delivery. Telehealth cannot and should not just be pushed to after hours or stuck in between other visits. Will systems and practices make that commitment?

Maturation also calls for permanence around telehealth reimbursement. Legislative and regulatory change remains somewhat elusive or less extensive than necessary. Pushing on the policy front will be essential because without money, use will not remain.

Platforms, Not Silos
Data and use must be able to flow easily across and within systems. Interoperability is a common way to refer to such easy flow of information and data. However, many legacy systems do not necessarily make the flow easy and throwing new solutions or tools into place also does not mean connections will be made. One means of resolving the issue could be introduction of platform solutions. The concept of the platform would be to implement one central point that connects various systems and acts as a single hub for interaction. Workflows would arguably be refined and data could then be found more easily.

The drive for application interfaces and upcoming enforcement of information blocking regulations will theoretically make these changes more possible. Opening access could be expected to benefit all connected to healthcare, but the will must be there too.

More Individual Access to Information
A spate of HIPAA based settlements by the HHS Office for Civil Rights has made it clear that the individual right of access must be respected. If individuals are denied the right to access information them repercussions will follow. A combination of the implementation of the information blocking regulations and potential changes to HIPAA regulations will further drive the access to information. Further, general attention to the right of access that has ben driven by COVID should also keep the issue forefront of mind. All of the changes add up to freeing data with the hopes of empowering more individuals.

Health Disparities
COVID brought to health disparities into a stark light as individuals of color and facing various social determinant impacts suffered worse outcomes. Outside of COVID, societal issues also emphasized the lack of attention and support for individuals outside of the majority. Additionally, different systems and devices are being found to contain inherent biases, such as devices not being able to accurately record information or detect issues from individuals who do not have white skin. Hopefully that means an honest, introspective look at longstanding systemic issues that have been ignored with the goal of improving care for all. While health disparities cannot be solved overnight and without acknowledgement of past wrongs, a start can be made.

Hope for COVID
For a last prediction, hope is coming on the COVID front. The start of widespread vaccination will hopefully begin to alleviate the worst issues from COVID, but also underscores the lingering need for communal action and support. It will be well into 2021 before a sufficient number of individuals receive the vaccine, which means all must still pay attention to using protective equipment and being careful in public. It has been a long period of restrictions and caution, but hopefully a little bit more time will be seen as a small sacrifice to promote a better future.

What Will Happen?
Every prediction carries a lot of uncertainty. The only guarantee is that unexpected events will happen and progress will be made. Regardless of the accuracy of a prediction, the key is for everyone to keep looking at ways to improve healthcare and support the general public good.

This article was originally published on Mirick O’Connell’s Health Law Blog and is republished here with permission.