The healthcare industry has undergone massive change due to COVID-19. However, these recent adaptations could just be the tip of the iceberg. 

Dr. David Nash, Founding Dean Emeritus at Jefferson School of Population Health, shared his predictions for the role of digital health in the ‘New Normal’ of healthcare in a video interview with Puneet Maheshwari, CEO of DocASAP. In his interview, Dr. Nash envisions a new normal that embraces telemedicine, incentivizes positive patient outcomes, and addresses healthcare inequities at their source.

Telemedicine Will Increase Access to Care for Underserved Populations

Telemedicine had previously been used to connect rural communities to timely care, but regulatory barriers and a lack of payment parity had prevented it from going mainstream–until COVID-19. With updated CMS regulations, loosened HIPAA requirements, and increased support from payors, telemedicine has surged in adoption. 

Dr. Nash said telemedicine will open the door to frictionless, seamless care for all patients. Thanks to the cost-savings of virtual care, Dr. Nash argued that the industry could use telemedicine to extend healthcare services to populations that normally lack access to care.   

“The tools of digital health, the marginal cost, is going to go way down,” Dr. Nash said. “That means, from a population health perspective, we can provide these services to a much broader population and even to populations with whom we don’t usually connect.”

Providers Will Virtually Screen Patients For Health Conditions

Health systems quickly implemented online symptom checkers and screening tools to triage COVID-19 patients while they remained isolated at home. As CMS slackened telemedicine regulations and payors offered more coverage, providers leveraged virtual visits to conduct screenings for other conditions. 

Dr. Nash said that providers could continue to screen patients via telemedicine long after the pandemic subsides. These virtual screenings would protect patients from spreading illness in the waiting room and allow them to receive care according to their own schedules.  

“When we do start to reopen ambulatory visits in the office setting, maybe we’ll use digital health as a screening tool to decide who really needs the laying on of hands,” Dr. Nash said.  

Providers Will Embrace “No Outcome, No Income” Value-Based Care

Adoption of value-based care stumbled when hospitals cancelled in-person appointments and dedicated their resources wholly to COVID-19. A National Association of ACOs survey reported that 56% accountable care organizations said they would drop out of their risk-based payment programs due to financial losses connected to the pandemic.  

However, Dr. Nash believes that not only does value-based care still have a place in the new normal, but that it also should evolve into a new form that will better support providers.

“My view is if you can guarantee me a steady cash flow on a per member per month basis, I’m all in,” Dr. Nash said. “It’s radical, but I’m calling this Capitation 3.0.”

Unlike previous iterations of value-based care–Capitation 1.0, a per head model without any consideration for health status, and Capitation 2.0, a bundled payment model specific to each procedure or condition–Nash’s vision would guarantee providers a steady income if their patients met certain clinical outcomes. This “no outcome, no income” model would incentivize providers to reduce error and engage patients outside of appointments. 

The Industry Will Address Social Inequities Within Healthcare

The COVID-19 pandemic exposed systemic flaws and social inequities within healthcare that have existed for years, Dr. Nash said.  

“[W. Edwards Deming] said 75 years ago every system is perfectly designed to achieve the results it gets,” Dr. Nash said. “Well holy mackerel, did we ever get the results that we deserve, which was an acute system that could barely handle the surge.”

A glaring example of inequality made manifest during the pandemic is the disproportionately high COVID-19 mortality and hospitalization rate among non-white and low-income people. For example, a report from the Kaiser Family Foundation found that 27% of black adults are at higher risk of serious illness if infected with COVID-19, compared to 21% of white adults. Meanwhile, 30% of adults below the poverty line are high risk, compared to 16% of adults with incomes above $50,000. 

Dr. Nash said the painful lessons of COVID-19 should galvanize the industry to address social inequity at the source instead of downstream. 

“We need a new approach,” Dr. Nash said. “We know we’ve had waste. We know we’ve had error. We know we’ve had inequities…Now it’s time for a whole new generation to look at these issues and say, ‘We’re just not going to put up with it anymore. We want seamless, frictionless engagement. We want outcome measures. We want to be paid fairly, and we want to reduce disparity.’ That’s a great vision that I think most people could embrace.”    

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