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Why Healthcare Won’t Go Back to the Way It Was
From Crisis to Continuity

What’s Next for the Digital Transformation of Government

Why Healthcare Won’t Go Back to the Way It Was

As demand rises for the kinds of telehealth and digital care services made more mainstream by the pandemic, how will the government continue evolving to make the momentum last?

Illustrated by Enle Li

By now, no matter where you are or how old you are, the global pandemic has undoubtedly changed your daily life. And, perhaps, one of the most significant changes you’ve experienced is related to your own healthcare.

Before COVID-19, people’s adoption of digital health services had stalled. But as the pandemic circled the globe, virtual healthcare services became a necessity for millions of people as efforts to slow transmission of the coronavirus sharply limited face-to-face visits with doctors and care professionals.

Bringing Health Home

As people sheltered in place, making their homes into workplaces and classrooms, the doctor suddenly made house calls too. Virtually, of course. Telehealth visits surged, as did online prescription refills, and health app adoption, particularly among veterans.

In 2020, the VA provided more than 5.6 million telehealth experiences (across video visits, asynchronous telehealth exchanges, and remote patient monitoring) to more than 1.6 million veterans.

The VA reached 79 percent more veterans through virtual care in 2020 than it reached through virtual care in 2019. Before the pandemic, in February 2020, the VA completed approximately 2,000 video appointments in the home a day. In September, they completed more than 37,000 video appointments in the home on some days, representing a more than 1,000 percent increase.

“One thing that didn’t change during the pandemic,” says Neil C. Evans, MD, chief medical officer for the Office of Connected Care at the Veterans Health Administration (VHA), “was our longstanding commitment to connected care, to telehealth, to leveraging technology to extend the reach and capacity of our healthcare system to meet the needs of veterans. That’s a foundational part of the mindset of our clinicians, who view virtual care capabilities as a core part of what they offer to the patients that they serve. It was on that strength that we were able to pivot.”

Clearly, COVID-19 has been a catalyst for a shift in the mindset of patients and providers, and that shift is expected to drive huge changes in the healthcare system. Now that more people have experienced new ways of receiving and providing virtual health services — whether by video, text, chat, or other modes — it turns out that most people like it.

“Our priorities have always been accessibility, capacity, quality, and experience,” says Kevin Galpin, MD, executive director of VA telehealth services in the Office of Connected Care. “But during the pandemic, we saw a new driver — that shift to safety — encouraging people to want to use the technologies. Going forward, we believe virtual care will be a significant augmentation to in-person care, even after the pandemic because it’s not just about safety; it’s a great experience.”

Scaling What Works

“We know that virtual healthcare works,” says Ron Moody, M.D., and chief medical officer at Accenture Federal Services. “Now we need to take what we’ve learned during the current crisis and transform healthcare into a virtual-first system.”

Bringing this vision to life at scale will take ongoing commitments to research, technological innovation, and policymaking. That’s an essential part of delivering more equitable care and better health outcomes for everyone. It is also key to proving new models of health support and healthcare delivery.

“There has been unprecedented collaboration in the wake of COVID-19 on numerous fronts,” says Jill Olmstead, who leads Accenture Federal Services’ management consulting practice for federal health agencies. “Researchers are collaborating like never before to create vaccines and therapeutics, providers are partnering with technology companies to develop their virtual care capability, and patients are sharing their data in multiple ways. This combination of technology and human ingenuity is amazing – it’s just the beginning of enduring changes to the health ecosystem.”

“If you don’t invest in what’s new, you eventually become obsolete,” says Dr. Moody. “The investment in technology, process, and culture to use virtual-first and data-driven approaches to health and healthcare can increase capacity and move healthcare to become more proactive instead of reactive. Using a combination of tools, artificial intelligence, and process change, we can look at which telehealth mode or combination of other approaches gives the better outcome. Then we can implement policy change to support those capabilities being fully utilized. That’s the real engine for national health change.”

For transformation to take hold and grow, policymaking must incentivize innovation as well as accessibility to care, increasing the speed with which adoption and expanded use occurs. New, creative ways of thinking about how healthcare is delivered and funded can make appropriate care available to more people. In a more virtual future, perhaps providers will send patients home from the hospital with iPads. Medicare and Medicaid could reimburse devices and connectivity when they’re needed for healthcare. And the use of bots can increasingly help supplement shortage of physicians and nurses.

What’s Next for the
Future of Health

Government has both the resources and the capacity to scale, which gives it the ability to create lasting reforms in healthcare services. As data and new technologies become more embedded into the digital fabric of virtual healthcare, public and private-sector collaborations will become increasingly important to building flexible and resilient ecosystems of care.

“While we in public health think about populations,” says Chesley Richards, MD, MPH, FACP, deputy director for public health science and surveillance at the CDC, “all of what we do affects individuals. And so I think the more that healthcare and public health can have a seamless relationship the better. There are so many people outside of government, in academia and the private sector, for example who could do something with the data we collect. So I think we’re going to need to be more transparent about our data, providing it quicker to the public, for more people to do good things with.

“The key is that we want to get the right data at the right time into the right hands, for people to take action and protect individuals,” Richards adds. “In order to do that, we need to work closely with people in both public and private healthcare as we use the data. During the pandemic, one area where we’ve made a lot of progress is in predictive analytics modeling. I think that’s progress we can build on together for the future.”

It’s clear that a collaborative approach is a model to use the best of both the government and the private sector to transform healthcare.

When Sandeep Patel joined the U.S. Department of Health and Human Services (HHS), his team focused on finding areas of innovation in healthcare, where disconnects meant opportunities for improvement—like the one in kidney disease and dialysis.

The decades-old technology powering dialysis — while a lifesaving treatment — is expensive and burdensome for patients whose lives depend on it. Patel and his team created an innovation accelerator, called KidneyX, with the American Society of Nephrology to find a better solution. Today, scientists, physicians, engineers, designers, and others are working alongside people at the U.S. Food and Drug Administration and the Centers for Medicare & Medicaid Services, to improve or replace dialysis. They’re using innovative approaches and new technological advances to address policy issues, organ shortages, and more to help patients before they reach kidney failure.

“What’s fascinating to me about the government,” says Patel, now the director of BARDA’s Division of Research, Innovation, and Ventures (DRIVe) at HHS, “is that it provides so many levers to make positive changes, most of which don’t exist anywhere else, and are too large or intractable in any other context. Then it provides the scale to make a difference that’s hard to find anywhere else, with the potential to impact millions of lives and billions of dollars.”

Among the challenges ahead will be to build on recent gains and the momentum in virtual health to deliver better health outcomes and quality of life.

“Everything we do in science ultimately seeks to advance health and wellness, either for us or future generations,” Patel says. “It’s therefore critical for us to do everything we can to accelerate advances in all domains, the task from lab to market or bench to bedside.”

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