Road to Recovery

The four phases of pandemic recovery

By Barry P. Chaiken, MD, MPH

The COVID-19 pandemic has presented all of us with unique challenges. Hospital patients and staff have suffered greatly, but there is a road to recovery. First, let us review what I believe are the four phases of pandemic recovery.

Phase 1 has businesses reopening, a decreasing rate of new SARS-CoV-2 infections, and no vaccine or prophylactic or therapeutic treatments.

Phase 2, which covers a three- to six-month period, has businesses modifying their practices (e.g., limiting the number of tables in a restaurant), a steady incidence of new infections, and no vaccines or treatments.

Phase 3, which we will enter at the end of this year assuming no huge second wave of infection, has businesses expanding their service offerings, a decrease in the rate of new infections, no vaccines, and only a small possibility of treatments for the disease.

Phase 4 represents our new normal. Businesses are open, and the incidence of COVID-19 is low either due to herd immunity or an effective vaccination program.

The challenges facing provider organizations varies based upon the phase of the pandemic we are living through.

Phase 1

During Phase 1 of recovery, provider organizations will focus on the following broad areas to begin to revive their revenue streams: elective procedures and surgeries, diagnostic imaging, oncology, population health, ambulatory care, and telemedicine.

While these areas broadly identify what offerings might help recover revenue, each organization must examine all available service line capabilities in detail. They then must prioritize the service lines that deliver the greatest revenue while simultaneously maximizing the efficient use of available facilities and staff. In addition, all restart plans must anticipate future waves of COVID-19 cases and provide for potential curtailing of services.

Although meaningful cost accounting of service lines is hard to come by for most organizations, analysis of historical trends offers some insight into what services may prove most profitable. Dashboards can be built to reveal previous treatment trends by service line and month of service. Using these trends as a baseline, organizations can prioritize which service lines to restart, tracking their progress by comparing current utilization to historical trends.

Each service line can be broken down into intertwined processes, with productivity dashboards created to manage each process. In addition, other dashboards tracking the entire service line can inform both managers and frontline staff as they work to ramp up capacity.

Phase 2

Phase 2 will present organizations with opportunities that require adjustment in care delivery methods. Let us start with telemedicine. Prior to the pandemic, most organizations avoided offering telemedicine services due to telemedicine’s small reimbursement rate and its potential to cannibalize more profitable in-person ambulatory visits. Now, with ambulatory clinics shuttered and a waiving of reimbursement rules by CMS and private insurers, provider organizations have rapidly expanded telemedicine visits to satisfy the needs of patients and preserve as many revenue-producing services as possible. Physicians accustomed to in-person visits quickly shifted to care delivery through laptops, tablets, and smartphones. Telemedicine use grew exponentially during Phase 1 and has played an important role in patient care.

In Phase 2, provider organizations must continue their telemedicine offerings and redesign their care delivery processes to incorporate telemedicine into their overall ambulatory care strategy. We know there have been delays in care for many patients. As organizations continue to catch up on delayed surgeries, diagnostic tests, and therapeutic treatments, they also must work to analyze and redeploy their assets—facilities, equipment, and staff—to maximize patient throughput and associated revenue.

Due to the upheaval in the care delivery system, there is an opportunity to expand market share. The financial shock to small provider practices and stand-alone ambulatory care centers has forced many of these entities to close their doors or be acquired by larger organizations. The shrinking of the provider market offers opportunities to expand services to new geographic areas. Organizations that do not quickly open service lines provide an opening for their more agile competitors to capture patients who are underserved. For some organizations, this increase in patient volumes can turn some service lines into significant profit centers.

There is even a real estate opportunity. The pandemic has helped organizations learn which activities could effectively be delivered from a work-from-home environment. Moving workers out of offices frees up space for other uses that can help expand service line capacity. In addition, the economic downturn and business closings allow for less expensive expansion of services into geographic areas that now have a surplus of reasonably priced office space.

While the length of Phase 2 is unknown, organizations should begin identifying their priorities, evaluating their opportunities, and building data-driven plans for thriving during the next phase of the pandemic.

Phase 3

Phase 3 of the pandemic is when provider organizations should build upon the activities begun and redesigned in phases 1 and 2. Steps will need to be taken to reimagine the use of real estate, linking those strategies to expanding market share through any acquisition of hospitals, clinics, and physician practices.

Population health, which was severely disrupted during the first wave of the pandemic, requires a redesign to satisfy the new reality of care delivery. For example, telemedicine may become a major care delivery mechanism for population health. This will require new metrics to manage patients and track effectiveness of interventions.

Expansion of service lines requires a continuing evaluation and rework of asset utilization, which includes facilities, staff, and supplies. The focus must be on optimizing capacity management. As before, assessing and monitoring dashboards can offer the analytics to understand the impact of changes and identify opportunities for improvement.

The increased focus on analytics throughout provider organizations creates an opportunity to embed clinical analytics in electronic medical records to inform clinicians at the point of care. This includes physicians, nurses, pharmacists, and therapists, who have learned through their use of COVID-19 tracking dashboards how important point-of-care data is in informing their patient care decisions.

Phase 4

The last phase of the pandemic is Phase 4. This is the period when healthcare delivery processes can be redesigned. Robust analytics are embedded in both clinical and administrative workflows such that all decision-making is informed by self-service dashboards. These new analytic workflows enhance outcomes, patient experiences, and staff productivity.

While the pandemic has strained our healthcare system almost to the breaking point, it has created numerous opportunities for us to improve. I believe analytics and decision-informing dashboards will play a key role in allowing us to take advantage of those opportunities.

Barry Chaiken is the clinical lead at Tableau Healthcare and has more than 25 years of experience in medical research, epidemiology, clinical information technology, and analytics. He is board certified in general preventive medicine and public health and is a fellow, and former board member and chair of HIMSS. Chaiken may be contacted at bchaiken@tableau.com.