A growing awareness that the COVID-19 pandemic is a long-term healthcare concern is pushing the care experience for individuals without the illness back into the collective industry consciousness, Thomas H. Lee, MD, the editor-in-chief of the New England Journal of Medicine, wrote in an op-ed in the publication.
And to that end, the industry is going to need to adapt its response to the coronavirus pandemic to its usual healthcare efforts, the physician said. Although coronavirus will likely remain top-of-mind for many healthcare experts, a strategic and managerial pivot to segment COVID and non-COVID patients should be on the horizon.
The healthcare industry is facing a near total preoccupation with COVID-19, and to most extents that is understandable. The illness quickly ravaged the nation, and as of the publication of this article, has yielded a death toll upwards of 61,000, according to the Johns Hopkins tracker. More than one million patients in the country have it, and medical providers, hospital and health system administrators, payers, and health policymakers want to make sure those patients can recover.
But in Lee’s words, that means doctors, including himself, don’t have much bandwidth left for patients without COVID-19.
“But, of course, they are out there,” wrote Lee, who is also chief medical office for Press Ganey. “They feel like they are invisible — they actually apologize for disturbing us at this terrible time. And even though they don’t have the virus, they are being deeply affected by the Covid-19 pandemic. Their care is changing — sometimes for the better, but sometimes not.”
There is evidence of this trend. Data from Evidation has shown one in five patients with a chronic illness are worried about maintaining their health and wellness during the outbreak, with 53 percent saying they are worried about visiting their provider offices.
And that’s just for chronic disease management. Patients experiencing acute care episodes are also struggling, Lee pointed out. During a gruesome week for Brigham and Women’s hospital, at which Lee practices, he and his colleagues saw 24 inpatients with COVID-19, 9 of whom were in the ICU. This came at a just over 700-bed hospital. Fifty-one clinicians at the hospital had tested positive for the disease.
Just four weeks later, each of those numbers nearly doubled, he reported.
At the same time, Lee saw three of his non-COVID patients suffer their own health disasters — three patients over the age of 60 suffering a stroke, breaking a wrist, or seeing an abscess grow in a toward a recently replaced hip.
These were serious concerns, but the patients could not see the same hospital experience they could have because of restrictions from COVID-19. Most notably, their wives could not join them in the hospital, an unnerving situation for patient, loved one, and provider.
This situation is not sustainable, Lee hinted.
Instead, the US is currently gearing up for a long-term fight against the coronavirus. The virus and the illness it causes are not going away until a vaccine is widely available, and even then experts are not entirely sure the course of action forward from there.
One month later, medical providers are instead contending with how to balance their COVID-19 cases and their regular care patients.
“After all, even though Covid-19 patients are filling our ICUs, ambulances, and emergency departments, life has gone on for everyone else — and with it, life-threatening medical problems have been occurring at their usual rate,” Lee pointed out. “And many of these non-Covid patients are suffering complications in their care due to the pandemic.”
To that end, Lee offered up one strategic and one managerial recommendation for balancing both COVID and non-COVID patients.
On the strategic side, Lee recommended patient segmentation early on in the care process, keeping stark separation between coronavirus and non-coronavirus patients the entire time.
This strategy is likely underway at a number of healthcare organizations, he acknowledged. Primary care clinics are becoming almost entirely telehealth-based, while many emergency departments across the country have begun the process of distancing different cases for the sake of capping coronavirus spread.
“While this is a good practice, we should go much further with this strategic step,” Lee said. “Ideally, we would have some hospitals and emergency departments for Covid-19 patients, and other hospitals for everyone else.”
This would’ve helped for a number of his patients who have suffered acute care episodes during the height of the coronavirus spread. These patients had to come into the hospital for serious health complications, potentially be exposed to the potentially deadly virus, without their family caregivers there to support them.
This stark segmentation strategy would have further protected Lee’s patients from the illness while allowing their loved ones to be there during a visit, a key comfort for both the caregiver and patient experience.
This strategy, too, has been popping up nationwide, although at a smaller scale, Lee pointed out. In fact, it’s further evidence that the coronavirus has sparked industry collaboration and team-based care.
“This kind of separation is in fact emerging in some cities where the pandemic is forcing collaboration among competitors,” Lee stated. “Acute and non-acute facilities are being designated or created for Covid patients only or for non-Covid patients only, particularly within some large delivery systems.”
This idea of segmentation should carry over to a managerial standpoint, Lee continued. Just as healthcare organizations may physically segment COVID and non-COVID patients, they may also segment their care management styles.
“One shouldn’t do the same thing the same way for all patients — and if there was ever a time when one size does not fit all, this is it,” Lee said. “So, in Covid and non-Covid patients during this period of radical redesign, we should be measuring thoroughly and relentlessly what is happening to patients and what they are experiencing.”
Efforts to improve care need to be targeted to that specific patient’s care need. This is not necessarily a new concept; patient engagement is not a one-size-fits-all approach, and that principle applies during the coronavirus. What works in managing chronic disease in non-COVID patients may not work in managing disease in COVID patients.
As the healthcare industry works to pin down a timeframe on the coronavirus pandemic, acknowledging that they have a day-by-day understanding of how long the crisis will last, it will be important to begin integrating some business as usual. That should begin with taking care of non-COVID patients and delivering them a good care experience.
“The Covid-19 crisis is like nothing in history. It is an all-hands-on-deck moment, except that it isn’t simply a moment,” Lee concluded. “As we take on this challenge, we should remember that there are patients who are at risk of being temporarily invisible — the ones without Covid-19. Their suffering is real, as is that of their families. They don’t have to be casualties of war.”