Make Adaptability a Lasting Effect of the COVID-19 Pandemic

Thursday, March 26, 2020 | Joel Sauer

Let’s face it, there are situations where timing matters. We can all remember certain outcomes that could have been altered with early intervention or changes that we simply didn’t make happen. Relax, this is not an “I told you so” piece confusing hindsight with brilliance on the COVID-19 (coronavirus) situation. Instead, I’m hoping to demonstrate that the amazing reaction by the provider community to the pandemic, implementing sweeping operational changes on a huge scale all in the matter of days or weeks, is a model we should hang on to long after this crisis is over.   

Granted, these were done under tremendous stress and duress at a pace that is unsustainable as a model going forward. However, it proves that organizations – both big and small – can implement changes quickly and modify in real time as needed. This rapid change process is employed by many technology companies, including Google1, to better adapt to the market and increase the likelihood of being prepared when opportunity knocks. As a science this change cycle takes the form of 1) Empathize, 2) Define, 3) Ideate, 4) Prototype and 5) Test.2   These innovative companies do this in a matter of weeks, not months or years. Many of you may have followed similar processes, formally or informally, in your reactions to the unprecedented pandemic.

    COVID-19 Resources

Temporary or Permanent Market Changes

There are many, including MedAxiom’s president, Jerry Blackwell, MD, MBA, FACC, who feel that some of the emergency changes we’ve implemented in reaction to the coronavirus will be permanent. An example is the pivot to telehealth for seeing follow-ups and out-of-town consults. Even before the pandemic telemedicine was certainly on the increase. It was used reluctantly and stingily due to reimbursement challenges, but most were predicting it would eventually be part of our daily lives. Ta da! Here we are and it’s hard to imagine that telemedicine will ever go back to its negligible status in our care portfolio.

Related is the state licensing construct. Many legislatures have already or are considering relaxing licensing requirements to help alleviate perceived provider shortages around certain services due to the COVID-19 quarantines. Will these all sunset when the crisis is over? Or have we entered a new era of national credentials that create the commoditization of certain medical services, including some staple cardiovascular essentials? Adaptability in this environment may continue to be valuable.

Adaptability Pressure Pre-Coronavirus

Even before the Coronavirus, there were outside forces conspiring to eat our collective lunches that should motivate our need to be adaptable. Household names – some known for game-changing innovations – like Apple, Google, Walmart, Cigna and others have all set their sights on healthcare. Some of their activities have been very public. In other cases, like Haven, the combined healthcare company established by Amazon, Berkshire Hathaway and JP Morgan led by Atul Gawande, MD, activities have been eerily private. What we know for sure is that these companies are well funded and reach into a huge percentage of American consumers’ lives and will have a significant impact on the future of our industry.

Beyond these name brands, at the MedAxiom CV Transforum Fall’19 conference last October, Rafael (then Richard) Rakowski presented his innovative Medically Home, LLC, model. Medically Home seeks to move many of today’s hospital patients to the home to avoid dangerous hospital acquired conditions and into a more healing environment. You may be surprised by the acuity of the patients they target – and it’s not theory, it’s happening. For Rakowski, this is personal and drives him forward. His father died in the hospital, not from his illness, but from what he is certain was a series of hospital mistakes. 

In this HeartTalk video "There's no place like home!" Rakowski explains how they bring the services historically performed in the hospital to the patient's home, creating a virtual, home hospital.
 
Beyond the above there are other agents of change that will surely provide both threats and opportunities to our systems. The migration of formerly inpatient-only procedures to the ambulatory setting is one example. There’s an entire industry springing up around this transition. Heightening the magnitude of these outside forces is how they currently tend to focus on the most profitable aspects of our service lines. Losing these margins – or even maintaining them at a reduced rate of return – will have compounded effects on organizations as a whole.
 
Discipline vs. Obsolescence
 
In many of our organizations we pride ourselves on financial discipline. This is evident in our painstakingly detailed annual budgeting processes, need for formal business plans to justify off-budget changes and/or hires and C-suite approvals on budgeted replacement staff. This control routinely leads to changes – even some measured at one-one-hundredth of one percent of our total budget – implemented in months or years, certainly not days or weeks. Is this discipline or recklessness?

There are many examples of companies that no longer exist due to their inability to adapt. Formerly household names that have largely disappeared include Blackberry, Kodak and Myspace. Certainly, there were unique circumstances around each one and the world is always clearer in hindsight (and I said I wouldn’t do that!). Something they all share is the trait of being very slow to implement change and adhering cult-like to models that made them successful in the past, despite strong signals that those models were dying. Does that sound familiar? Are we hanging on to fee-for-service and volume too long? Would our telehealth systems be further along if we were more adaptable?

Conclusion

It has been nothing short of amazing to watch the MedAxiom Community respond and react to the coronavirus pandemic. The speed at which major changes have been implemented is breathtaking and the positive impact to cardiovascular patients – patients who may have otherwise simply gone untreated and become highly vulnerable (empathy) – immeasurable and worthy of a standing ovation.

To accomplish this rapid response, you surely dismantled traditional decision-making processes and instead implemented a fast-track path to action. With empathy already in place (step 1), in some form, I suspect your teams have and will continue to rapidly define the problem(s), come up with ideas to solve each, quickly develop pilots or even sweeping implementations of those solutions, then calibrate in real time. You are demonstrating the essence of innovation and adaptability! 

As noted earlier, the current level of crisis and energy is not something that can be sustained long-term, nor is it healthy for our staff, providers and patients. Eventually the emergency will end and, we all wish, that will be sooner than later. Once it’s over I hope we don’t move back to business as usual with respect to our decision making and adaptability.

Beyond COVID-19 there have been and will continue to be myriad challenges menacing healthcare and our organizations. You’ve just proven that under extreme pressure you and your organization can adapt quickly. That skillset will continue to be valuable so hang on to this innovative spirit as strongly as you currently hold discipline to traditional business models. Adaptability will serve you well – just as it has in response to the pandemic.

1ACC Cardiovascular Summit 2020, “How Technology Can Make Health Scient More Accessible,” Kapil Parakh, MD; Google FIT

2Hasso-Plattner Institute of Design, Stanford; https://www.interaction-design.org/literature/article/5-stages-in-the-design-thinking-process

 

Illustration: Lee Sauer

About the Author
Joel Sauer

Joel Sauer, MBA, is Executive Vice President of MedAxiom Consulting. Joel consults around the country in the area of value-oriented physician/hospital partnerships preparing health organizations for the value economy. His work includes vision and strategy setting, creating and implementing effective governance and leadership structures, co-management development, joint venture and other innovative partnerships, and provider compensation plan design. Beyond the above, Joel has a wealth of experience in service line development, clinical strategy development, provider workforce planning; including care team creation and physician slow-down policies, MACRA and bundled payment planning, and operational assessments.

To contact, email: jsauer@medaxiom.com



Comments

Posted by: Paula Reisdorfer on May 20, 2020 @6:46:51 pm

Written creatively. Good read. Thanks for the link!

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