We have taken great pride in our health care colleagues' heroic work during this pandemic. But the COVID-19 pandemic has highlighted many of the U.S. health care system's fundamental problems and exposed new ones.
We have seen this as hospitals tried to purchase personal protective equipment, the devastating effects of the disease on the Navajo Nation, the challenges of an employer-based health insurance system amid record unemployment and the loss of more than 100,000 Americans.
We owe it to the nation and subsequent generations to make meaningful, lasting changes that improve the system for everyone. The COVID-19 crisis presents that opportunity; let’s not waste our chance.
The first step is to return to a fundamental premise: the needs of our patients must always come first. Today, many patients — our neighbors — have fallen through gaps in our current system because they don’t have insurance, live in poverty, or live in a community that doesn’t have access to doctors or a hospital.
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For too long, many of us in health care have viewed these problems as mostly someone else’s responsibility. We’ve seen our job as caring for individual patients and strengthening our bottom lines to fulfill our missions within the financially oriented, competitive business model that underlies our health care system.
Strengthen public health systems
The time has come for the health care community to take ownership and prioritize these core system issues, including appropriately strengthening our public health systems, and hold ourselves accountable, to improve the overall health of Americans. The most important factor our nation’s great medical institutions need to be measured on is the health of the populations we serve.
Here are five ideas we think should rise to the top of reform efforts:
1. Integrate and collaborate. Some health systems already offer the full continuum of care for their members or a distinct geography they serve. We need more of these linkages — among university medical centers and rural hospitals, community hospitals and post-acute care facilities, and physician groups with fragile but essential physician practices.
With greater collaboration, we could improve infection-control practices, tap more effectively into supply chains for PPE, and elevate the level and availability of health care available in all our communities. The federal government should both reduce barriers to this collaboration and promote it. The goal is to help each other, not compete with each other, in service to communities and the nation.
2. Work across geographic and other boundaries. The pandemic highlights the "haves" and "have nots" — by geography, financial resources, ethnicity, race, and access to and coverage for health services. When there is a specific need in one part of the country, or in one type of care facility, we must quickly refocus our resources to where they are most needed.
UCSF and many other systems did this by sending teams and providing telehealth services to help those overwhelmed in New York and the Navajo Nation, and this kind of interstate collaboration should be our national standard. Relaxing state licensing for telehealth consultations across state lines is one obvious way to get this started, as would consideration of a national medical license.
Add capacity to the system
3. Create additional surge capacity. We must re-envision and invest in a more capable national emergency response, so that we never again struggle to have adequate PPE, testing, extra hospital capacity and other assets, perhaps working through the Assistant Secretary for Preparedness and Response. Likewise, at the state and local level, we must secure adequate infrastructure — people, equipment, supplies and facilities — for inevitable future needs. Preparedness at this level has not been woven into our health care infrastructure, and we need it.
4. Replace the volume-oriented reimbursement system with one based on population outcomes. A population health model could reduce overall health care costs by reimbursing physicians and hospitals for keeping people well, not for more visits or procedures.
Expanding this model would refocus payments to services where the need is the greatest — behavioral health and preventive services — which are in short supply because they are poorly reimbursed in our fee-for-service system.
Medicare Advantage and provider-sponsored Accountable Care Organizations are two such models that could provide a starting point for encouraging our system to do what’s best to keep patients healthy, versus just doing more.
5. Ensure access and coverage for all people living in America. Our patchwork quilt of coverages – Medicare, Medicaid, and individual and employer-based insurance coverage – offers inconsistent access to all in our country.
Meanwhile, pandemics don’t recognize or respect a person’s documentation or insurance status. How can Medicaid, which relies partly on state contributions, function effectively during a recession, when the needs are the highest but a state’s ability to pay is at its lowest? And when the jobless rate soars and nearly 27 million people have lost their employer-sponsored health insurance since March, we know we have a flawed model. A bipartisan dialogue about what a new model looks like starts with honest acknowledgement of the flaws in our current system.
Federal, state and local governments and health departments, as well as nonprofits and the private sector, all have roles to play in envisioning the health care system we want for ourselves, our neighbors and our country. We believe it’s possible to work together to realize this new future. Let’s get started.
Mark Laret is president and CEO of UCSF Health. Dr. David J. Skorton is president and CEO of the Association of American Medical Colleges.