Chartis Top Reads – Week of February 21 - 27, 2021

Our research team breaks down this week’s top healthcare news.


Top Reads Overview

In an age of unprecedented change, staying current has never been more important. Our team at Chartis is curating news most relevant to the healthcare industry and tracking the topics that are trending on seven key issues: high reliability care, digital and advanced technology, financial sustainability, health disparities, the health ecosystem of the future, partnerships, and the provider enterprise. Each week, we break down what’s happening and why it matters.

The State of COVID-19

The Buzz This Week

Following the deadly surge in November and December, COVID-19 cases are now down 77 percent in the United States over the last six weeks. There are numerous factors causing the decline:

  • Vaccination rates are rapidly increasing. As of this week, nearly 15 percent of the U.S. population has received at least one dose. Some experts estimate 150 million Americans will be vaccinated by the end of March.

  • Seroprevalence, the number of people with antibodies from previous infections, is high. The number infected is almost certainly much higher than those who have tested positive for the disease or antibodies. Combined with increasing vaccination rates, this means there are fewer people without antibodies to contract the disease.

  • Preventative behavior may have improved. While travel was up over the holidays, activity has been down since the start of 2021. Additionally, a study in The Lancet showed that spikes in cases in the South caused improved behavior in mask-wearing and an increase in mask mandates.

  • Seasonality may have had an impact. The cold weather typically makes us more vulnerable to respiratory diseases because of decreased Vitamin D levels, increased blood pressure, and cold, dry air. But the cold weather may also have had a positive effect on COVID cases. In some locations, group socialization of a certain size was only permitted, or people only felt comfortable socializing if gatherings occurred outdoors. With bitter temperatures, many decided to forgo gathering and hunker down at home, potentially preventing some of the spread.

Why It Matters

Immunity may be higher than suspected. Many of those who were mildly symptomatic or asymptomatic may never have tested for the disease or antibodies. Especially in certain communities early in the pandemic, tests were nearly impossible to secure. Additionally, antibody tests do not look for memory T-cells, which could provide immunity, so even those with no detectable antibodies present may still have natural immunity.

The Centers for Disease Control and Prevention (CDC) estimates 15 to 30 percent of U.S. adults have had COVID. It is possible that even 30 percent is an underestimate, and if we add to that the growing percentage of Americans who have been vaccinated (currently at 15 percent), we may be beginning to reach levels at which the number of people susceptible to coronavirus is declining to a significant degree.

The models for 2021 have thus far been inaccurate. The rapid decline of cases is a positive, but some worry publicizing the good news will cause the public to become lax in social distancing and mask wearing, or even refuse the vaccine. Areas of the country have seen increased complacency during lulls in the pandemic, leading to spikes in the following weeks. We cannot forget all we have learned about pandemic safety simply because cases are declining, but we must also balance the risks of continued closure, like isolation and the safety net provided by in-person schooling, should cases continue to decline.

Partnerships

The Buzz This Week

Throughout the pandemic, the public and private sectors partnered to deliver numerous invaluable contributions to slowing the spread and treating the disease. They rapidly developed new products, increased production of medical supplies, and readily shared information in an attempt to achieve the best outcomes. While many aspects of the response were successful, there are lessons to be learned about how to strengthen public and private collaboration for future public health emergencies, including:

  • Improving data and analytics through real-time data collection and sharing to produce real-world recommendations from data. This may mean streamlining data collection tools so data can be easily shared and analyzed across broad populations.

  • Developing new care delivery approaches to adopt clinical advancements that address the emergency while maintaining continuity of care for other patients, appropriately deploying scarce resources, and ensuring financial sustainability through reliable payment models while proactively monitoring equity.

  • Strengthening innovation and supply chain readiness, including improving communication and coordination at a regional and national level, developing a more robust national stockpile to prevent price gouging in an emergency, and identifying emergency supply needs for pandemic purposes.

Why It Matters

Strengthening public-private collaboration will be necessary to future public health emergencies, but the lessons learned also apply in non-pandemic times. Public-private partnerships can drive improvement in health outcomes. Only 20 percent of many health outcomes are linked to medical care. The rest are attributed to environmental and socioeconomic factors. States and the federal government control a large portion of spend on healthcare through Medicaid and Medicare. Some of the same tactics noted above that may improve response in future crises may also improve response to social determinants of health (SDOH).

  • Improving data and analytics: Public-private partnerships can help bring integration of SDOH data and medical and health system data through creation of standard screening tools that can be utilized by both payors and providers. Uniform data screening tools could then be analyzed and used more broadly across organizations to help improve SDOH.

  • Developing new care delivery approaches: States can use payment policy to integrate SDOH by offering covered services as part of health plans, incorporating SDOH-specific quality incentives, or risk-adjusted payments to providers based on SDOH coding.

  • Strengthening innovation: Rather than needing a robust supply chain of medical products, adequately addressing SDOH requires a full, complex set of service offerings. Public entities can work with private and community partners to ensure there is ample supply of housing services, nutrition services, or crisis intervention services. Additionally, states can work with private partners to identify and test ways to improve SDOH and share those successes or failures broadly.

Provider Enterprise

The Buzz This Week

New data and commentary were released this week related to the state of physician practices in the United States nearly one year since COVID-19 arrived.

  • The Commonwealth Fund released its sixth report tracking outpatient visit volume, including data through the end of December 2020. The data show that by mid-September, in-person outpatient visits rebounded to levels seen in their study’s “baseline” week of March 10 and remained stable through the end of 2020, despite the largest surge of U.S. COVID cases in November and December. In this latest report, the data are compared not only to the baseline week of March 10, 2020, but also to “typical” visit patterns from prior years, where visits usually increase at the end of the calendar year due to seasonal illnesses and, in some cases, a desire to utilize services within a given insurance coverage year.

However, in 2020, the in-person visits are shown to have been similar to the fall — and substantially lower in December compared to prior years. This gap is particularly evident for patients aged 3-17 years old, and for certain service lines, including pediatrics, physical medicine and rehab, pulmonology, and otolaryngology, which have also experienced the largest cumulative visit volume declines, of 25 percent or more. Behavioral health has also seen a continued substantial overall drop in in-person visits but has the highest sustained volume of telehealth visits — 56 percent of total baseline visits in December.

  • In a recent HealthLeaders Finance podcast, MGMA CFO Akash Madiah underscored that though visit volumes are generally returning, the financial damage from COVID will linger. Practices should take advantage of government loans, he suggests, and plan ahead for additional administrative work related to these loans in the coming years. He also recommends that financial recovery is not restricted to regaining volume — proactively prioritizing cost containment and reduction rather than reacting to cost pressures will be important for sustainability. For example, practices and healthcare organizations more broadly should assess physical space, determining how much of the practice/business can effectively continue remotely, reducing the need for the high fixed costs of medical office space.
    • Related to vaccination, the latest results from the ongoing Primary Care Collaborative (PCC) physician surveys were released, revealing that primary care practices could help with vaccinations but face many barriers. 40 percent of physicians surveyed were willing and able to administer the vaccine but have been unable to obtain it, and 20 percent would provide the vaccine but lack the required staff. One-quarter are still waiting for a scheduled vaccine delivery.

Why It Matters

The trends evident in the newly released data and analysis suggest that physician practices are on the road to recovery, though there is still a long way to go, and some practices have not made it through this experience. In the PCC survey, nearly 40 percent of those surveyed knew a clinician who had quit, retired early, or closed their practice. Visit volume may be returning, but practices will need to continue to encourage patients to return for postponed care, embrace telehealth (depending on the service) to reach existing and new patients, seek other sources of revenue (such as government funding), and proactively manage costs before they prevent positive margins despite volume recapture.

In addition, many practices that have survived — particularly primary care — are willing to contribute to the vaccination process. In fact, per a recent Green Center Patient Survey cited in the PCC survey, two-thirds of patients expressed that they had trouble finding COVID information they trust, but 80 percent trust their primary care provider. Enabling primary care practices to educate patients about the vaccine and administer it could help close the gap to widespread immunization. However, until vaccine production increases and distribution extends to primary care, this important channel for vaccination will remain impeded.


Contributors

Roger A. Ray. MD
Chief Physician Executive
[email protected]

Alexandra Schumm
Principal, Vice President of Research
[email protected]

Abigail Arnold
Senior Research Manager
[email protected]


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Past Top Reads

DECEMBER 2020
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NOVEMBER 2020
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SEPTEMBER 2020
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AUGUST 2020
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Chartis Top Reads - Week of February 21 - 27, 2021 | The Chartis Group