COVID-19: The great reopening has begun!

By Robbie Hughes, Founder and CEO, Lumeon 

State by state, country by country, health systems are counting cash on hand and trying to thread the needle through the balance of their own health economics and public health concerns, as discussed in my last blog COVID-19: paying for the new normal.

With a huge backlog of pent up demand, as I’ve described in a previous post, it is expected that there will be (socially distant) queues round the block for every aspect of care that should otherwise have been addressed in the last 3 months. Patients who needed care have stayed home, and now they’re going to come in to be seen, but with limited capacity to manage, health systems need to drive more efficiency and do more with less.

Except the situation is more complicated than that: ED visits are down because demand is down – there are fewer emergencies when people are staying at home – and with 3 months of government-prescribed bed rest, much other ‘normal’ demand has evaporated too.

The bigger problem is that for demand in healthcare to exist, there has to be a ‘need for intervention’ and a ‘desire to take action’. The ‘need’ may still be there, but it seems the ‘desire’ is not. A straw poll amongst our customers shows that nearly all of them are seeing the same phenomenon: patients are scared to go into hospitals.

This is a problem, particularly when the core of the profit center of the average health system centers around the need to carry out an actual intervention on a patient. We’ve progressed a long way in the last few months, but tele-robotic keyhole surgery from the comfort of your own home seems to be a bridge too far.

So, what can be done to remedy this situation? We’re seeing emails going out from health systems advertising that they’re open and can perform virtual visits, but this isn’t enough. Populations have been scared into staying home and it has worked well: getting them out and into the one place they know actually has COVID-19, the hospital, is going to take more than a newsletter.

The answer is going to comprise a few key parts:

1. Prioritization 

Resources are limited and they need to be focused on the right things, so understanding the clinical need in our list, and then finding a way to understand which of them are mentally ready to take action is going to be important. Marketers would perhaps describe this as the difference between Addressable and Obtainable market.

2. Individualized engagement 

Every patient is different, and the combination of their clinical situation, their financial situation, and their emotional state is going to be what determines how we engage. For some patients, the newsletter will be all it takes to ‘activate’ them, but for (many?) others, it will take more. How we personalize the engagement to the specific needs of the individual will be key.

3. Individualized journeys 

Engagement achieved, patient ‘activated’, the need now becomes more complex: we need to ensure that the specific interventions applied are the correct ones for the patient in question: do they have specific underlying conditions that open them up to more risk? Do we really need them to come in for testing, or can we rely on the results we have for them already? Can the one test they need be done on main street rather than in the hospital? How do we ensure we’re doing everything we can to reduce exposure for that individual?

4. Combining virtual with physical 

When is it appropriate to apply virtual visits? Can this patient be seen remotely only, or is there a risk that this patient needs a blend of physical and virtual? How can we determine this up front so that we can plan accordingly?

These are just some of the issues, but they highlight the problem and its evolution. We have more to worry about than just trying to schedule a backlog of activity in a reduced capacity environment with additional supporting costs. We have a problem that requires a sensitive application of clinical and operational best practice, on an individualized basis to a disengaged population, that fundamentally doesn’t trust that ‘things will be fine’ in the way that they did before.

Orchestration 

This, above and beyond anything else, is an orchestration problem: how we ensure that the patient and care team are guided to do the right things for every patient on a case by case basis. Without an advanced orchestration capability, we will be forced to apply ‘worst case’ measures to every patient because we won’t be able to implement anything else. This won’t be sustainable.

Case study 

Interestingly, we have seen this exact problem manifest for different reasons before the crisis in outpatient surgery. One of our customers had a surgical optimization unit that delivered great outcomes, but they couldn’t scale it to meet demand in an affordable way. They wanted to ensure every patient was properly optimized, but the cost of doing so was unsustainable in their model. We deployed our solution and in the first 3 months of activation were able to individualize the care plan of every patient, such that 89% of cases were able to be optimized virtually, rather than face to face as they had been previously. We also showed a reduction in late delays and cancellations as well as a substantial increase in clinical team ’joy at work’ and case load (happier AND more productive).

What’s interesting about the 89% number is that this was an average number – the key to the system was that on a day by day basis, this number fluctuated dramatically depending on the case mix. This is the key to orchestration – a system responding dynamically to the inputs presented – and this kind of work will be the foundation to what is needed across the board moving forward.

To learn more about what we did here and how it can be applied to COVID-19, download out Virtual Care Playbook for Surgery.

The old tactics of the handsome physician on the billboard and a US Hospitals gold star isn’t going to cut it any more. Patients are scared and unless they get assurances that their individual needs are going to be met and best practice applied, they won’t come in and that fantasy revenue ‘bump’ that hospitals are anticipating isn’t going to materialize.

As you might imagine, I spend a lot of time going from and to airports (at least normally…) in Ubers and Lyfts. On every journey, I always ask the drivers the same question: “You have a choice between two docs: one that listens to you, gives you what you want, charges more, has a great office and bedside manner but takes longer to get you better, and the other that doesn’t do what you want him to do, has worse bedside manner, is cheaper but gets you better faster. Which do you choose to see?”

The answer is nearly always…”the first guy of course” because “you don’t want to save money when it comes to your health” and “the first guy listened to me and did what I wanted whereas the second didn’t”

I do wonder whether, after all this is over, the answers will continue to be the same. I’d bet that the definition of quality in American healthcare is about to shift to the stuff that actually has value rather than the stuff to which we arbitrarily assigned value.

Time will tell – watch your R number out there and stay safe.

As always, feel free to send me your views, or go to our Virtual Care for Surgery webpage to see what we’re doing to help our customers address the challenges of reopening in the COVID-19 era.