Thursday, January 28, 2021 | Ginger Biesbrock
The world has experienced a year unlike any other in this generation, putting 2020 in the history books as the year of COVID. As 2021 begins, it’s important to take time to think about the long-term impacts from the pandemic on the healthcare industry and patient care. Although history books will focus on the pandemic of 2020, the healthcare industry could, and should, focus on the disruptor of 2020. A disruptor is defined as something that interrupts an event, activity or process by causing a disturbance or problem. A disruptor can also be a force for good when it causes radical change in an existing industry or market by means of innovation, a concept often highlighted in the business industry but rarely used in conjunction with changes in the healthcare industry. The current trajectory of healthcare in the U.S. is not economically sustainable and not maximally effective. Accordingly, healthcare leaders and society at large agree change is needed. As opposed to small, incremental improvements, the healthcare industry needs a significant disruption. Viewed through the lens of disruption, innovation and care transformation, there is no opportunity for change like the present.
The pandemic has created economic instability for most healthcare organizations and providers. Other effects include less than desired patient outcomes from poor access, missed care opportunities, worsening of existing health disparities due to lack of resources and technology needed to seek healthcare, and a burned-out healthcare workforce. While these challenges aren’t new, they have all been amplified by the pandemic and there is an increased urgency to implement solutions. Historical events, such as the 1918 flu pandemic, have provided valuable insights into the effects of a public health emergency, both short and long-term. From a healthcare delivery standpoint, many governments embraced new concepts of preventive medicine and socialized medicine after the 1918 flu pandemic. The U.S. also adopted the employer-based insurance plans that expanded access to healthcare for the general population1. Fast forward to the 2020 pandemic and there are many opportunities for innovation in cardiovascular care with ‘hints’ at transformation, but no clear path to achieving true transformation. If the 2020 pandemic is not utilized as a disruptor and a catalyst for innovation and care transformation, it will be a missed opportunity.
Disruption creates a need for action. The type of action is a choice. For some, the action will be to look inward and make changes to do more with less. Others will look externally to see how the disruption has changed the industry and patient and provider needs, and look to innovate and transform to better meet those needs. A review of this concept in the business industry would suggest that the former approach often leads to demise while the latter approach can lead to expansion into new services and markets creating a trajectory otherwise unforeseen2.
Applying These Concepts to Cardiovascular Care
There is a significant body of literature about leadership in health care. Effective organizations bring the right people to the table with requisite skills in both management and leadership3,4.
Cardiovascular programs need to have an effective leadership and management structure to provide vision and foster an environment supportive of innovation and transformation. Applied to surviving during a time of disruption, management will tend to concentrate on preserving and improving the status quo, while leadership is about challenging the status quo and creating something different and more effective5.
Where does a program start? Below are three types of innovation described by Regina Herzlinger, Harvard Business school faculty6, viewed through the lens of the COVID pandemic.
Early in the pandemic, MedAxiom described the rapid transition to virtual care through telehealth services in “Survey Report: Impact of COVID-19 on Cardiovascular Organizations,” published in April 2020. According to the survey findings, most programs transitioned to a virtual delivery model in less than two weeks and changes in reimbursement and regulations that supported the transition closely followed.
Numerous learnings stemmed from the transition to virtual care delivery. The transition highlighted the capabilities and ability to do this work effectively while putting a spotlight on disparities in access to healthcare. Patients without access to technology had an even harder time receiving needed care. Further, the early pandemic forced a shift from preventive, routine care to urgent only care. Many stories have been shared about patients that waited too long to seek care or missed routine evaluations only to present with acute needs. A shift in the healthcare delivery model needs to recognize those disparities and assure access to routine, preventive care, as well as urgent needs. Virtual care worked, and needs to stay, but must evolve. A digital transformation must complement face-to-face care such that virtual care be embedded when and where it is most effective for communication, care coordination and care delivery.
Device therapies, pharmacologic therapies and procedural therapies have all progressed in recent years. Innovations are allowing clinicians to make earlier diagnoses and promoting tools for effective primary and secondary prevention. In coronary artery disease, non-invasive imaging technologies are emerging that provide both anatomic and functional data to better define risk and can guide management strategies. The anticipated result is a shift toward health maintenance with reduced need for, and more effective use of, invasive treatment options. A recent article in JACC by Ferraro et al, provides a disruptive example using the evaluation and treatment of patients with stable angina with a CT-guided algorithm7.
There are many other examples that will have an impact on workforce needs, skillsets, operational processes and changes in both provider and patient expectations. Team-based, multidisciplinary care will promote effective and efficient care. The pandemic has caused programs to redeploy providers, develop new care pathways and redefine relationships with hospitalists, ED, intensivists and with each other. This redeployment of providers, which utilized skillsets in unique ways, was an innovation and proved the cardiovascular industry’s ability to adapt. Barriers that were economic and related to “turf” were broken down with ease and grace. However, solutions to support long term transitions are required and reimbursement changes and physician compensation models must adjust to support/encourage team-based care delivery. The work must happen at a pace that will support innovation and a true transformation of care.
The traditional fee-for-service model is at a tipping point. The pandemic has shown that a reactive care delivery model in a fee-for-service funded environment is ineffective. Limitations to elective procedures, ambulatory care services and overall reluctance to seek healthcare has created an economic perfect storm for healthcare organizations. In addition, non-acute services that utilize acute care hospitals as their site of service, came to a halt. This created both economic struggles and more importantly missed care opportunities.
The cardiovascular industry recognizes the opportunity to transition many services to ambulatory surgical centers (ASCs) and office/outpatient departments. The pandemic has highlighted that having non-acute care sites of service is important. An example of a recent delivery innovation in the cardiovascular space is the transition of percutaneous coronary intervention (PCI) to an ASC. A position statement from SCAI in May 2020 stated: “the ability to perform PCI in an ASC has been made possible” and is happening effectively when structured appropriately8. However, full adoption will require multiple changes including health policy, economic alignment, facility planning, integration models and operational structures.
As tragic as the last year has been, there is an opportunity to use the disruption to author positive, lasting change. Dyad leadership, a vision for innovation and utilizing lessons learned will allow true cardiovascular care transformation to occur. Although only a few innovations have been highlighted, the underlying ingredients are the same – vision and leadership. The ACC and MedAxiom have a joint mission: “To transform cardiovascular care and improve heart health.” We are in the business of care transformation and will work tirelessly to lead members with vision, education, organizational resources and advocacy. Let’s transform cardiovascular care, together.
Learn more about the MedAxiom Consulting Team and how we can help you and your organization tackle issues such as patient access, effective leadership, staffing/operational efficiencies, adaptability and more.
Illustration: Lee Sauer
Spinney, L. (2017). Pale rider: The Spanish flu of 1918 and how it changed the world: PublicAffairs.
Mauborgne, R., & Kim, W. C. (2007). Blue ocean strategy: Gildan Media.
Chazal, R. A., & Montgomery, M. J. (2017). The Dyad Model and Value-Based Care. Journal of the American College of Cardiology, 69(10), 1353-1354. doi:doi:10.1016/j.jacc.2017.02.007
Fry, E. T. A., & Walsh, M. N. (2018). Cardiovascular Health System Leadership. Journal of the American College of Cardiology, 71(5), 575-576. doi:doi:10.1016/j.jacc.2017.12.039
O’Reilly III, C. A., & Tushman, M. L. (2016). Lead and disrupt: How to solve the innovator's dilemma: Stanford University Press.
Herzlinger, R. E. (2006). Why innovation in health care is so hard. Harvard business review, 84(5), 58.
Ferraro, R., Latina, J. M., Alfaddagh, A., Michos, E. D., Blaha, M. J., Jones, S. R., . . . Weintraub, W. S. (2020). Evaluation and Management of Patients With Stable Angina: Beyond the Ischemia Paradigm: JACC State-of-the-Art Review. Journal of the American College of Cardiology, 76(19), 2252-2266.
Box, L. C., Blankenship, J. C., Henry, T. D., Messenger, J. C., Cigarroa, J. E., Moussa, I. D., . . . Tukaye, D. N. (2020). SCAI Position Statement on the Performance of Percutaneous Coronary Intervention in Ambulatory Surgical Centers. Catheterization and Cardiovascular Interventions.
Ginger Biesbrock, PA-C, MPH, MPAS, AACC, is Executive Vice President, Care Transformation. She is a respected executive, provider and teacher with 20+ years of experience in the health care industry with a concentration in clinical care and operations. Before joining MedAxiom Consulting, Ginger was Director of Operations at West Michigan Heart, a 39 Physician practice with 24 mid-level provider. At West Michigan Heart, Ginger oversaw all operations for ambulatory services, tertiary care and rural health practices. Prior to that Ginger was the COO of the Cardiovascular Group at Centra-Health.
Her areas of consulting expertise include APP Utilization, Care Team Optimization and Transitions of Care.
To contact, email: firstname.lastname@example.org