A few months ago, the world we lived in looked different—and it continues to change, literally by the minute. The COVID-19 virus has disrupted our lives in more ways than we can count.
You, our country’s physicians, and other healthcare providers know this better than most, as you have been working on the frontlines of this global pandemic. If you are unable to read any more than this first paragraph, please know that we thank you for your work. Your service and sacrifice have saved countless lives, and we thank you for everything you do and have done to protect our communities and loved ones.
Hunkered down in our homes during quarantine, the team at Cambia Grove, a healthcare innovation hub, has been focused on the most promising, impactful solutions, how they’re being used, the pros and cons of their use, and what to anticipate in the near and longer term. The 21st Century Cures Act and COVID-19 have dramatically shifted trendlines in just the first few months of 2020. For example, who could have predicted the skyrocketing pace of telemedicine adoption? Or the Impact of the Defense Production Act on medical suppliers, as hospitals as hospitals compete with one another to fill an increased need for PPE and other supplies? As we think through these changes, what has not changed are the key components and failures in our landscape to drive impactful innovation. Startups are pivoting to solve problems that are not quite understood. The lack of information sharing and technical capabilities has inhibited efforts to act in a more data-driven, scientific manner. Physicians and staff are being laid off due to payment structures that rely on the now “old” way of caring for patients. The global pandemic has exposed cracks we’ve known to exist in the healthcare system for decades—the only thing that’s changed is our sense of urgency.
FOUNDATIONS FOR CHANGE
To some, innovation is looked down on as something to fear. To us, innovation simply means positive change. We bring changemakers together to advance innovations that support a more person-focused and economically sustainable healthcare system. The healthcare sector’s collective knowledge and experience is astronomical and, when combined across silos, leaves us able to advance innovative solutions to our toughest challenges. We’ve met changemakers throughout the healthcare ecosystem, across the startup community and what we call the 5 Points of Healthcare™: Patients, Providers, Purchasers, Payers, and Policymakers. Cambia Grove’s ethos is that an innovative solution—whether a new technology, policy, procedure, device, or something else not yet imagined—can be championed by anyone passionate about transforming healthcare. Through constant discussion with our innovator community, we’re able to listen to their roadblocks and help break down the barriers to their solutions.
Barriers like misaligned incentives and missing technical capabilities impact multiple stakeholders in the healthcare ecosystem. Cambia Grove sees these barriers within three ecosystem elements: infrastructure, incentives, and culture.
The key to transforming our healthcare system to better serve individuals and communities is found when we evaluate and optimize these ecosystem elements to support innovation.
- Infrastructure: These include formal or informal arrangements and key resources needed to enable innovators to implement their work and execute their strategies, as well as the right technical and physical systems to connect solutions with end users.
- Incentives: These include both carrots (e.g., financial and non-financial rewards, recognition, and positive impact), and sticks (e.g., fines and penalties) to drive behavior. The right incentives, as well as alignment of incentives across stakeholders, must be in place for sustained change.
- Culture: These include the predominant beliefs and norms that define and drive behavior in the ecosystem. There must be an open and inclusive culture to ensure that the solutions being created match the existing problems.
To put these ecosystem elements into perspective, let’s explore their relevance to the COVID-19 response thus far, as the healthcare system looks to advance telemedicine services across the country.
Before the COVID-19 pandemic, telemedicine services were offered to some patients seeking care. Discussions were in progress about the potential benefits of telemedicine, but telemedicine was still, for most healthcare professionals, an afterthought. For those seeking care in rural parts of the country, or for those who found it difficult to physically see a doctor, telemedicine was an interesting option. But overall, it was still looking for its place to enter the headlines and secure its value proposition as the healthcare community looked to transform the system.
In Cambia Grove’s last virtual telehealth panel, providers reported that within a one-month time frame, their telemedicine usage had spiked. Providers offering telemedicine before the pandemic saw an increase from 10 to 80 percent, and I expect those rates to hold strong. This demand to offer telehealth services has prompted many organizations, including the American Medical Association, to develop telehealth implementation guides for administrators, physicians, and patients. Startups working in this space have been inundated with calls and requests for services to help patients get the care they need. You could argue that this was what the telemedicine industry needed to show its value and viability.
While some organizations are having success implementing telemedicine, there are still huge barriers to expanding these services nationwide.One critical element is the technical infrastructure available to connect patients to internet-based telemedicine services. The American Recovery and Reinvestment Act of 2009 included funding to advance broadband access to individuals across the country. As a former congressional staffer, I worked to implement these efforts with our technology partners in Washington State. Unfortunately, 11 years after that bill passed, we still have coverage gaps in both rural and urban environments.While there is no exact count, it is estimated that 41 to 162 million Americans are without access to broadband services. Many of these people are also in rural communities, with limited physical options for accessing care. For us to fully realize the benefit of telemedicine services, advancing a technical infrastructure must be part of the equation.
Another part of the equation to advance telemedicine services is the incentives. Right now, the largest incentives in question are financial. Who pays, and how much do they pay, for telemedicine services? Before COVID-19, payment parity was an issue. Now, in response to COVID-19, the Centers for Medicare and Medicaid Services (CMS) have broadened the list of telemedicine services available for Medicare reimbursement. These 85 telehealth codes are currently temporary, but as they are battle-tested, Medicare may begin to see an increasing value in remote visits. Additionally, as we hear of more offices looking to close their doors because of a lack of in-person visits, it may be asked: are telemedicine services a way to keep doctors’ practices afloat? There are too many questions without answers around incentives for us to give a clear answer at the moment, but as we look to advance telemedicine, incentives must be addressed to adequately implement these services for the safety of patients and physicians.
Finally, advancing telemedicine will require a cultural shift. Typically, cultural shifts are the most arduous.They take time and trust. As we have responded to the pandemic, the initial cultural shift has been made in record time, as the need has outweighed the risk. As we look to discover how telemedicine will continue to be used in the long run, we must be sure to establish trust in these services throughout the 5 Points of Healthcare to continue building out services for those who need them. The more we use telemedicine services, the more we will trust this new type of interaction. It will also take honest feedback between all parties involved to identify the problems we need to solve.
My second-grader son taught me that in order to “listen” you must be “silent” (the two words contain the same letters!), and it will be important for us to listen silently to make sure that innovations in the telemedicine space remain focused on what is needed most for the patients and physicians involved. While infrastructure and incentives are tactically focused, culture shifts are human-focused and typically lack linear progression.
NO CONSTANT BUT CHANGE
Impactful healthcare innovation doesn’t happen in a vacuum; it happens in response to a need. We have seen the need to connect physicians and patients in a new way because of the COVID-19 crisis. The crisis has been an unforeseen pressure test that’s unleashed a tremendous urgency to advance telemedicine services. It also proves that if there's a will, there's a way. Healthcare organizations have been making rapid decisions that show that they aren’t as inflexible as they purport to be, and the system’s problem-solving efficiency in pursuit of a common goal—to advance telemedicine—has been pursued at a rapid pace.
The solutions seeing success during the COVID-19 crisis have been driven by an outsized need to support physicians and patients in a physically distant world. Certain ecosystem elements must be addressed to help advance innovations like telemedicine to ensure that we have the technical infrastructure to reach those in need, the financial incentives to pay for healthcare, and the trust in the new technology to help ensure its viability and use. Regardless of whether you think telemedicine is a useful innovation, without these ecosystem elements in place, we risk falling behind on innovations that may be useful in supporting better health.
As we look back on our original question in seeking to describe the healthcare landscape, the best answer seems to be that the landscape is in a state of flux. The COVID-19 crisis has shone a light on some of the ways our healthcare system is broken, as well as the need to build up a better foundation in transforming that system. As we move forward, it is my hope that we can all work together to support you and your work to help individuals and communities through the global pandemic and beyond. Thank you again for your commitment to serve. We at Cambia Grove invite you to share your thoughts with us—as we listen silently—to help transform the healthcare system into one that is more person-focused and economically sustainable for all.
Join us in that conversation on Twitter @CambiaGrove, or learn more at cambiagrove.com.
Maura Little is executive director of Cambia Grove, a healthcare hub focused on advancing innovation in healthcare. Through strategic initiatives and community programming, Cambia Grove breaks down systemic barriers to model sustainable innovation in healthcare. You can find Maura on Twitter @MauraLittle or email her at firstname.lastname@example.org.