The term “what goes up must come down” is widely attributed to Sir Isaac Newton. Legend has it that the epiphany of gravity came to young Isaac when an apple fell onto his head as he sat beneath a tree in an orchard. It’s very likely that the story of the apple is more illustrative than factual. A physicist credited with three laws of motion forming the basis for classical mechanics probably didn’t need to be hit in the head by a piece of fruit to appreciate the force of gravity. What we do know is that objects thrust into the air, unless propelled beyond the outstretched arms of gravity, return to the Earth. When we emerge from the COVID-19 crisis, it will be likely that not all things will have landed in the same spots that they inhabited before. Our strategic thinking should contemplate the question “what if not everything returns to normal?”.
In health care, like the rest of our lives, there will be a craving for normalcy. What constitutes normal—or more precisely, the prospect for a new normal—merits careful consideration as the crisis passes. What if vestiges of social distancing linger? What if sitting in crowded waiting rooms no longer feels safe? Or if scheduling appointments with everyone arriving at about the same time no longer seems advisable? What if face-to-face encounters with health care providers are less and less necessary with virtual visits having become so common during the outbreak? What if there is a higher premium placed on capacity management, particularly the utilization of ambulatory space? What if the virtual platform results in greater connectedness between mental health patients and their providers? What if unused ambulatory space becomes a tool to address longstanding socioeconomic health disparities?
Many hospitals and health systems faced significant financial challenges resulting from a temporary interruption in elective surgical volumes. The payment system that has evolved over 40 years of negotiations between providers and insurers has resulted in a dangerous and disproportionate reliance on private sector surgical prices to subsidize government shortfalls and to fuel the operations of health care providers. What if all stakeholders came to the conclusion that some form of price compression—a narrowing of the gap between medical and surgical prices—was needed to bring things into better balance? What if price compression alone isn’t enough; what if the best long-term answer is for health care to operate as a privately-provided but regulated public utility with all-payer rate regulation? What if an optional federal health plan emerges to compete with private insurance plans?
Not all changes that may come from the pandemic would necessarily originate from outside the health care provider community. Some may be initiated by the providers themselves. What if intra-system clinical consolidation accelerated, resulting in health systems having fewer program locations operating at higher and more proficient/efficient volumes? What if primary care practices re-imagined their clinical and business models, intensified their patient acuity, introduced new divisions of labor and changed their economics for the better? What if traditional succession plans changed and new skill sets were needed to manage organizations with fewer vertical silos and an increasingly remote workforce?
One of my favorite Broadway musicals, Wicked, is an imaginative prequel to the ageless children’s story The Wizard of Oz. Every blockbuster musical has a show-stopping song to close the first act. In the case of Wicked, that song is called “Defying Gravity.” But more emotionally riveting than the thunderous end of the first act is the last musical number at the end of the play. The two principal characters, in stirring harmony, contemplate what each has meant to the other’s life. In an ingenious play on words, the lyrics are haunting:
Who can say if I’ve been changed for the better?
I do believe I have been changed for the better.
And because I knew you…
Because I knew you…
I have been changed for good.
It’s impossible for any of us to come away from this crisis untouched. Much of life will get back to normal. Much of health care will get back to normal. But not everything will get back to where it was…in some ways there will be a new normal. Who can say if we’ll be changed for the better? It’s OK to hope that we’ll be changed for good.
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About the author: As executive director of the Vizient Research Institute, Tom Robertson and his team have conducted strategic research on clinical enterprise challenges for 20 years. The groundbreaking work at the Vizient Research Institute drives exceptional member value using a systematic, integrated approach. The investigations quickly uncover practical, tested results that lead to measurable improvement in clinical and economic performance.