How Covid-19 has changed the role of hospitals
Looking at how hospitals changed during Covid-19 is a starting point for a lot of larger questions in the healthcare industry.
by Saket Agrawal
Covid-19 changed healthcare in too many ways to count. It drastically accelerated the adoption of remote health by over a decade, and along similar lines, is allowing us to rethink what aspects of healthcare we want to keep, shake up, or introduce in a post-Covid world. However things end up in this multi-faceted industry we are in, one thing I believe will undoubtedly change is how patients view and engage with hospitals.
What Covid-19 showed us about hospitals
It seems like a no-brainer to say it, but the role of hospitals is to take care of the sickest patients that need the resources that only hospitals can offer: emergency departments, specialists, and the ability to treat patients immediately and comprehensively. But when the pandemic put a pause on elective surgeries and appointments, we saw just how much ‘extra’ care was being provided in hospitals, because we saw how much of it had to be temporarily eliminated.
It brought to light the question of what kind of facility is most appropriate for the spectrum of care that patients may need, whether it’s at a hospital, surgery center, a primary care office, or at home with visiting healthcare staff or through telehealth. The circumstances created by Covid brought this question front and center for patients, providers, insurers, governments, and other regulators – something that would be a difficult feat at any other ‘normal’ time.
With all these stakeholders thinking about this question in a new way, we realize that we’re all on the same page: our goal is to drive better outcomes for patients. As technology enables us to do more, and as people get better access to more specialists and routes of care, we should be assessing what the best methods are for each patient and care situation, in order for them to achieve that best outcome.
This whole situation is sparking questions like, ‘What is the best way to triage patient loads? Do hospitals need to be massive billion-dollar campuses? Could they be more specialized and accessible?’ The answers to these questions are different for each rural or urban community, and there will be a lot of experimentation and innovation on what is most optimal in each scenario.
Telehealth and at-home healthcare also have their limits
When weighing all the different modes of care that are now available to patients, the risks and limitations need to be given just as much weight as the benefits, and those downsides can range from severe safety concerns to mere matters of convenience and efficiency.
For at-home healthcare, does the drive time in between patients make sense for a large number of healthy patients who could reasonably leave their homes for care? Maybe not when you consider the efficiency of being able to see 50 patients a day in a primary care office versus a dozen if the doctor is traveling door-to-door. But it might make sense for a patient who would otherwise go to the emergency department and then face a long hospital stay and an expensive bill. This route could pay off in the long term for both patients and providers as experimentation picks up in different communities.
The same goes for remote care – there is the right place and time for it. It’s a matter of finding that boundary of where it works best and where it falls short. How do we develop an at-scale system that helps us quickly determine when we need to get patients into a physical space, or when we can simply send them a link to log on from home and see their doctor. There are healthcare professionals and startups working on these types of questions now, and it’s going to ebb and flow until it hits the right balance.
Emerging Opportunities (& Obstacles)
Navigating different models and modes of healthcare is just one piece of the puzzle if we want to see real innovation in the healthcare industry.
Another large area that is ripe for disruption is the way that hospitals are reimbursed for care. Shifting to a value-based care system, where we look more at treating for outcomes, would significantly change how hospitals are run, and how patients engage with their healthcare process. There are so many entrenched players, so moving the needle on this front is difficult. There is also the fact to consider that hospitals already are billion-dollar communities, and massive amounts of capital have already been invested. So as innovation occurs, it is admittedly scary for them to think about how they might still be able to deliver on past invested capital. How they will continue to spend going forward is up in the air, but if they do allow themselves to adapt and innovate, it will be by building to specific needs and usages of each community and helping deliver care in the setting in which it is most effective on outcomes and costs.
The worse scenario we can see – which, in some cases, we are unfortunately in already – is the elimination of care or access becoming more difficult. Rural hospitals are shutting down at unprecedented rates. So how can we deliver care to those communities and support those hospital systems that might feel isolated? I hope there’s a way to reimagine this picture going forward, for the sake of patient care, the workforces in those communities, and public health.
One way I imagine combating the phenomena of isolation or elimination of care – especially in rural communities – is through a new appreciation for collaboration. Take the dental and medical industries for example. Historically, they have been separate. But do they need to be? Could we instead provide opportunities for medical care while we already have a patient touchpoint at the dentist? Oral health affects the rest of a patient’s medical care, so the idea of integration shouldn’t be too far-fetched. It simply requires shifting the mindset of the decision-makers who have looked at the healthcare landscape in the same way for so long. This idea of collaboration can drive a lot of conversation about new healthcare models and how hospitals are being used.
If we can get people to rethink how we identify and address patient pain points — whether it’s transportation, access to care, trouble finding the right specialists — we can breathe new life into how patients interact with their care and give everyone in the picture better odds at achieving the best possible patient outcomes.
It’s all about the right players – whether they’re veteran healthcare workers or new-to-the-field startups and VCs – who are willing to dig into a niche, solve for that niche, and then see where else their solution might apply. Looking at how hospitals changed during Covid-19 is a starting point for a lot of larger questions in the healthcare industry.