April 29, 2020 - 1289 views|
COVID-19 could catalyze a more open, distributed model of care delivery and hasten the emergence of new health disciplines.
Imagine a world in which a pandemic such as COVID-19 is not a once-every-100-years occurrence but a once-a-decade event. This is not a prediction; neither is it beyond the realm of possibility. A 500-year flooding event has a 0.2% chance of occurring in one year; Houston, Texas, experienced three such events three years in a row. In the past 20 years alone, we’ve seen 60.8 million people affected by H1N1 swine flu in 2009; a SARS-CoV epidemic starting in 2002 and again in 2018; a MERS-CoV epidemic starting in 2012; an Ebola epidemic starting in 2014; and Zika in 2015. Malaria kills several hundred thousand people per year, Dengue is spiking, and we’ve had an uptick in polio.
What makes an outbreak an epidemic, and an epidemic a pandemic, is a roll of the evolutionary dice and a particular expression of animal behaviors (including our own) that affect viral transmission routes, virulence, minimal host-virus co-evolution and evolvability of a virus itself. Combine genetics and human behavior just so, and we see COVID-19.
Examining the impact of more frequent pandemics on healthcare is an important thought experiment. How might the possibility of COVID-19 as a recurring experience change us in terms of how we deliver care, how we live and work, how we protect ourselves and move from fear back to active living? The possibility that COVID-19 could be a cultural catalyst for lasting change in healthcare and society at large makes this thought experiment all the more urgent. We must encourage and plan for policies that lead to better systems and lives.
Potent Conditions for Change
Climate change is usually cited as creating the conditions for more chaotic weather and dramatic shifts in rainfall. This results in some fundamental changes in biomes that lead to increased pandemic possibilities based on new species-to-species interactions. Some of these arise from behaviors such as mass migration that stress our water supplies and cause us to search out risky food supplies. This, in turn, increases the chance of the spread of infectious diseases. Additionally, viruses, once at equilibrium with their animal and human hosts, suddenly have new transmission routes, vectors and evolutionary pressures.
In the geopolitical realm, gene editing techniques like CRISPR, meant for good, could be used for faster and smarter responses to infectious diseases but also misused to create a ”plague bioweapon.” Shifting alliances, growing nationalism and increased protectionism could affect supplies of key raw or finished ingredients for pharmaceutical therapies and medical equipment beyond obvious threats to strategic supply chains. A country’s ability to quickly respond to infectious diseases could fast become a national security issue.
How the Future May Unfold
Cultures will adapt. Businesses, governments and individuals might treat pandemics as another recurring hazard to manage with the right supplies and contingency planning. Food supply will become a more strategic national value chain. More people may work from home or distributed remote locations, even to the extent that the nature of cities and work spaces might change from a pure physical notion to new physical/digital/virtual concepts. Smaller communities might pool their health resources. Face masks might become extremely effective at filtering viruses and be worn by everyone all the time – moving from safety to fashion statement. When AI agents start to uncover signals in medical records databases of an emerging threat, smartphones could light up with built-in tracking and warnings activated by health officials.
In this world, imagine:
The fear of infectious disease could become the catalyst to realize the vision of precision, contextual and holistic care. Healthcare might have the chance to finally transition away from episodic transactional models to a continual engagement in each person’s life.
But this is possible only if we are thoughtful in how we use the COVID-19 crisis as a catalyst for change
Sparking an Overdue Response
We don’t need to wait for a new pandemic to start building a more resilient, continuous, consumer-centered system of care. Take telehealth. Because most government and commercial health insurance plans limited reimbursements for virtual consults, health systems had little incentive to adopt that channel. When COVID-19 emerged, The Centers for Medicare & Medicaid (CMS) quickly expanded telemedicine reimbursements. Healthcare systems began promoting that option, and telehealth consults jumped dramatically. In a “new-normal” world, there’s no reason to reverse course, so long as we design for effective engagement.
Other measures we imagine taking to fortify our healthcare system are less familiar: machine learning, precision medicine and health engagement, in-home health tools, wearable diagnostics with seamless data tracking and bio-engineered foods. These are simultaneously intriguing, beguiling and disruptive. There’s also the concern about how much privacy we might have to trade for more protection against the next pandemic.
The Four Qualities of Change
To ensure these concerns don’t inhibit change, new healthcare services and solutions must express these four intertwining qualities:
Continuous healthcare delivery will involve a wide range of companies, from Apple and Google to CVS and Walmart. If traditional players don’t seize this opportunity to reinvent the industry, technology giants, national retail players and entrepreneurial entities likely will develop the alternative systems of care that the pandemic is priming our culture to accept.
Ongoing Ripple Effect
Clearly, other changes will be needed to support a pandemic-ready continuous health delivery system. These include physician training in leading continuous care teams focused on care in the home, new payment models such as Direct Contracting and other forms of risk-sharing and outcome-based pricing, subscription and freemium models, and perhaps even bidding.
What we’ve covered here is just the start of the thought experiment. While it looks forward, it is not science fiction. We have many of the tools in place to realize the vision but have been kept back by a fragmented and rigid system. What we need is to take advantage of a cultural catalyst and make sure we are designing for effective engagement and better outcomes. For all its horrors, the COVID-19 pandemic may be the agent that takes us to a better place.
This blog is part of our special report on the future of infectious disease. Stay tuned for more blogs on this topic.
Visit our COVID-19 resources page for additional insights and updates.