During the early stages of the COVID-19 pandemic that turned the world upside down, the Vizient Research Institute undertook a study which posed the question, “What if not everything goes back to normal?” Based on careful observation of events underway, a national survey of commercially insured patients assessing their confidence and preferences and a series of interviews with health care leaders and national stakeholders, a series of hypothetical scenarios was compiled. From those scenarios emerged 11 “big audacious changes” (BAC), which are postulates, not predictions, intended to stimulate critical thinking. The eleven BACs were organized into three major categories: supply and demand, systemic and opportunistic.

The shift from in-person visits to virtual encounters occurred quickly during the early stages of the pandemic and was already underway at the beginning of the study. The extent of this shift and its durability would be influenced by the first two BACs, patient reticence and a drop in elective demand. Patient reticence to engage with the health system extended well beyond the shift to virtual encounters. Emergency room volumes fell, even for life-threatening conditions like heart attack or stroke. Scheduled surgeries were postponed, initially to conserve provider capacity but subsequently reflecting patient reluctance to return to health care facilities.

An unexpected byproduct of the move from face-to-face visits to virtual encounters was a sharp decline in the number of ancillary services per evaluation and management encounter. As surgical volumes rebounded during summer months, concerns surfaced over a second surge of infections. To the extent that seasonal ebbs and surges repeated in any regular pattern, overall annual surgical capacity would be reduced.

Looking beyond the short-term impacts on supply and demand, the study contemplated the possibility of longer-term systemic changes. Even temporary interruptions in elective surgical volume had created serious financial difficulty for many hospitals and health systems, suggesting that the payment system may have evolved to favor surgical prices to a dangerous level. The first systemic BAC put forward was price compression between surgical procedures and medical cases. A more sweeping overhaul of the payment system—all-payer rate regulation—could occur with or without the emergence of an optional federal health plan. Experience has shown that rate regulation, were it to occur, would be followed rather quickly by global spending budgets.

Lastly, three opportunistic changes were considered. Rather than being imposed on health care providers externally, the opportunistic changes—if they came about—would be initiated by the providers themselves. Clinical program consolidation, an intensification of patient acuity in primary care practices, and a purposeful disruption of traditional leadership succession plans were each considered as part of the study.

A survey of senior executives at nearly 200 Vizient member hospitals and health systems assessed their estimates of the relative likelihood, disruptiveness, and their organization’s preparedness to adapt to each BAC. Organizational preparedness was measured across seven readiness domains:

  • Financial
  • Decision-making structure
  • Workforce, composition and development capability
  • Culture
  • Outside relationships
  • Physical assets such as locations, buildings and equipment
  • Technology

The focus of the study centered around the “readiness gaps” related to various BACs. Potential changes with relatively high likelihood, disruptiveness or both—combined with low organizational preparedness—merit strategic attention.

The findings from the Vizient Research Institute’s latest study titled “Defying Gravity: What if Not Everything Returns to Normal?” will be published and shared with participants in all Vizient Member Networks at the end of January.

For more information about joining a Member Network and accessing the resources provided by the Vizient Research Institute, contact Tom Potter, senior vice president, member connections.

Published: January 15, 2021