Lessons From a Crisis

Covid-19 has created four significant crises in health care, according to The New England Journal of Medicine: The loss of employer-sponsored insurance for millions of Americans; deep financial losses for medical providers; racial and ethnic disparities in the healthcare system; and a failure of the public health system to identify and control the spread of coronavirus rapidly.

Seattle Business magazine asked five prominent health care executives to weigh in on how the pandemic has fundamentally changed the way their systems operate. One thing all have in common is a renewed focus on telemedicine.

Aileen Mickey, M.D., chief medical officer, EvergreenHealth Medical Group, Kirkland

Covid-19 has changed everything and thats not a hyperbole. Like many health systems, hospitals and practices, theres been a financial impact, and were looking at the best way to budget for 2021 during many unknowns. However, the most notable impact has been on operations.

From employee, patient and visitor screening, to creating virtual waiting rooms for in-person visits to help us maintain social distancing our workflows have been almost fully redesigned to ensure we can continue to take care of our patients, and do as safely as possible. We were also one of the first sites in our region to establish drive-through testing, which has been a new concept for us.

The pandemic has also led us to expedite our virtual health platform so that we can offer telemedicine for almost every practice, both primary care and specialty appointments. There are certainly some silver linings that have evolved very quickly. It has forced us to look at the business model for health care moving forward and discover ways we can further ensure we remain viable during the next catastrophe for the communities we serve and those who depend on us.

One of the most empowering things Ive learned is that we can be even more nimble than we probably thought. We can make difficult decisions quickly with successful outcomes, like establishing our virtual health platform at lightning speed, and I think we will retain this attitude toward innovation and our thought processes. We wont hesitate to take a leap when its the right thing to do for our patients. I am very hopeful that this intense collaboration, as well as the drive to innovate and step out of our comfort zone, remains as we move into 2021.

Rick Ludwig, M.D., medical director of U.S. Family Health Plan at Pacific Medical Centers, Seattle

At the onset, it was an immediate big deal. We had to very quickly and immediately deal with contact tracing and quarantining any employees who may have been exposed. We were fortunate that none of our clinic employees came down with Covid, but of course, some of our patients did, including one that survived at 96 years old!

We put in place processes where employees were assisting our nurses in reaching out to patients to make sure they were OK, make sure they had their medications and were not delaying essential care this evolved into telehealth. Through telemedicine, weve learned that there are many avenues to reaching and caring for our patients other than the traditional visit. Well never go back to just saying, You need to come in.

One of the things Ive seen is that things like one-way grocery aisles or standing in circles waiting to pay, will become routine. Masking and social distancing will feel more comfortable, and these precautions, along with a vaccine, will help reduce the virus spread. By mid-next year, we might feel comfortable traveling again.

From a business perspective, for those of us that have had capitation systems [where providers are paid a set amount for each patient assigned to them, even if that patient doesnt seek care], we are more financially stable. Groups that are all fee-for-service had a tough time. People taking care of patients can be somewhat handcuffed by fee-for-service.

Now that its pretty clear well continue to be paid for televisits, I wonder at what point do you say, This is too complicated, and all payers want to move to capitation systems? This situation may accelerate a move from fee-for-service to the more value-based approach. If we are paid a regular monthly fee, and for that fee we are responsible for the health of a patient population, we can provide that service any way that is appropriate.

There are still huge challenges ahead of us all, but I think were able to move forward now, working together with more stability and comfort with what were doing and whats ahead.

Lisa Brandenburg, chief health system officer, UW Medicine, Seattle

Throughout this crisis, we have changed and adapted our care delivery models so that patients feel safe in our clinics and hospitals. Early in the pandemic, we also greatly expanded our telehealth capabilities as an alternative to in-person care. We know that we must continue our work on both fronts to be a successful health care organization in the future.

When the first cases of Covid-19 occurred in our community, UW Medicine activated an Incident Command System to oversee the response to this health crisis at our four hospital campuses and large network of outpatient clinics. We also immediately reached out to our Institute for Health Metrics and Evaluation colleagues to ask for their help in predicting how many Covid patients we might need to be prepared for.

This enabled our infectious disease specialists to develop consistent policies and best practices for delivering safe and effective care that became national models, and for us to plan extensively for the Covid patient surge. We will continue to apply these learnings and a system approach to decision-making as we look for ways to reinvent UW Medicine in a post-Covid-19 world.

We are also holding regular town halls to address the concerns of employees related to Covid-19. We have also developed many wellness resources to help them cope with stresses at work and at home.

Nancy Davidson, M.D., executive director and president, Seattle Cancer Care Alliance, Seattle

Since Seattle was the first U.S. epicenter of the Covid-19 outbreak, our team was placed at the forefront of establishing practices and procedures to ensure we were able to provide care while keeping patients and staff safe. Our experience has been documented in several medical publications and has subsequently been used as a resource for other cancer centers nationwide.

One of the most interesting things we have been considering is the location of SCCA staff as well as the location of services for our patients and what can be done remotely. While staff who do not interact directly with patients continue to work remotely, SCCA has expanded the way it delivers care, particularly in the field of telehealth.

While some oncology services such as testing, blood draws, infusion and radiation are delivered on-site, our entire field is exploring which services must be done face-to-face and which services, such as long-term follow-up via telehealth, might be able to be safely and efficiently performed remotely.

Cancer has not paused during the pandemic, and its clear Covid will be with us for some time. Some individuals are not incredibly enthusiastic about visiting health care facilities due to concerns about potential exposure to the virus, and we must combat this. SCCA has implemented infection prevention protocols to protect patients.

We have been thoughtful and strategic as we have reopened access to higher intensity treatments like bone marrow transplants and have reopened clinical trials. As a breast cancer specialist, I am also eager for women to continue to return to regular preventative screenings, such as mammograms.

I do believe that the pandemic has strengthened unity across the health ecosystem, which at times can seem fragmented.

Theresa Sullivan, chief executive officer, Samaritan Healthcare, Moses Lake

There were many changes that we made within the first week of a potential Covid-19 patient in our community. For instance, we created a Nurse Hotline that was available 24 hours a day for people to call if they had Covid-like symptoms to find out if they should come in to be tested or stay at home in isolation, or other questions. We also established Respiratory Virus Evaluation Center at our clinic with a separate entrance from the rest of the clinic patients. We also instituted twice daily at start and end of shift temperature and symptom screening for all employees as they enter and exit any of our buildings.

Additionally, with all of the changes occurring so quickly and frequently, we have implemented a number of new communication methods for staff including a daily organization-wide Covid update sent through our emergency communication system. This has now been reduced to twice a week. We also started a video message from the CEO that is sent to staff at least twice a month.

We can apply some of our learning to the new hospital that we plan to build. While our plans for the new hospital were near complete prior to Covid, we plan to reevaluate those plans considering our Covid experiences. We needed more negative pressure rooms for Covid patients that we had to retrofit in our current hospital. We plan to look at this in the plans for the new hospital and where the rooms are located. We will also look at the plans with more scrutiny of patient and visitor flow and how areas can be adjusted to reduce traffic through an area, if needed.

We also saw more people embrace virtual visits. Telehealth and virtual visits were already growing before Covid. There was quick movement by many organizations to provide more services virtually. I think this will continue. A number of employees were instructed to work from home in coding, billing and other nonpatient care areas. I think there will be continued telecommuting for some positions.

This situation also really demonstrates the importance of the rural health care system.