Even prior to the public health and natural disasters of 2020, experts from across the healthcare spectrum were already looking into policy and regulatory recommendations to improve the country's ability to prepare for and respond to crises. In February, the Healthcare Leadership Council and Duke-Margolis Center for Health Policy released their recommendations in a report focused on ways to maximize resources and strengthen disaster preparedness infrastructure going forward.
The COVID Impact
Neil de Crescenzo, president and CEO of Change Healthcare, served as executive committee chair of the Healthcare Leadership Council (HLC) during much of the work on this project. "We actually started this process before COVID, but it took on a whole new importance once the coronavirus was identified," he said. The members of HLC, a coalition of chief executives across all subsectors of the American healthcare industry, were already aware of policy and communication gaps prior to the pandemic. However, COVID-19 response underscored barriers and a lack of coordination hampering a rapid, adequate response to emerging threats.
Calvin Schmidt, senior vice president and worldwide leader for Government Affairs & Policy with Johnson & Johnson, noted that every sector of healthcare stepped up to meet the occasion of the pandemic. "But the goal is to put infrastructure in place so we aren't reliant on heroes but are instead prepared," he said. "We need to know that an overwhelmed hospital can get their hands on what they need without delay."
Schmidt, who chairs the HLC task force on patient safety and quality, said that one section of the report recommendations addresses capacity, modernizing the supply chain and ensuring more resilient stockpiles. "We should never again have a situation where states and healthcare providers are feverishly competing against each other for supplies," he said.
Mark McClellan, MD, PhD, founding director of the Duke-Margolis Center for Health Policy, concurred, noting, "The COVID-19 pandemic and immediate response has exposed vulnerabilities in the nation's ability to handle a national-scale crisis. Fragile supply chains that rely on single sources outside the country were tough. There is broad agreement that we need more robust supply chains that include domestic sourcing, as well as multiple sourcing.
"The new report is intended to be actionable based on shortfalls identified in dealing with the pandemic. We want to learn from what didn't work and build on what did."
Turning Lessons Learned into Action
"Public emergencies will continue to happen and may become more frequent and severe," said HLC president Mary R. Grealy. "The next pandemic, natural disaster, or global crisis can be handled more effectively with better preparedness. That begins with the government at all levels and the private sector taking action now, while lessons from COVID-19 are still being learned."
The recommendations call for some of the temporary steps taken to address the pandemic becoming permanent going forward, particularly in terms of making it easier to create public-private partnerships, streamlining regulations to allow providers to practice where they are most needed without some of the more unwieldy state licensure issues, and enhancing communications and data sharing. McClellan noted the recommendations are a combination of actions that could be ramped up quickly and those that are more aspirational and factor into long-term plans.
Experts agree the pandemic exponentially enhanced telehealth adoption for patients and providers. Andrea Willis, MD, senior vice president and chief medical officer for BlueCross BlueShield of Tennessee, said, "Looking at how we did telehealth expansion, we saw a lot of single providers jump into the fray to make sure patients could get the care they needed. We're grateful to them. It helped us broaden our thinking on what we can do to support them."
Another area of focus coming out of the pandemic is a heightened sense of urgency to address health inequities. While many clinicians were already aware of disparities in care, the pandemic shone a bright spotlight on the issue. "The exacerbations were right there in our faces," Willis said, adding social determinants must factor into preparing for future disaster responses.
"The pandemic laid bare the need to improve both our public health and data infrastructure," Grealy said. "I think there is an opportunity in the short term to move quickly on this."
While the gaps are glaring, an appetite to change the status quo seems to be a growing in both the public and private sector. McClellan, who previously served as administrator of the Centers for Medicare & Medicaid Services and commissioner of the U.S. Food and Drug Administration, has been heartened by the information sharing and cooperation seen during the pandemic. "A positive sign was the organizations and people in the healthcare space who typically are competitors showing willingness to work together for the good of all Americans."
Grealy agreed, "There is a commitment on the part of the private sector to work with the government. We need to begin preparing now for what my come in the future."
Links to the recommendations and to a compendium of best practices and lessons learned by HLC members are available on the home page of the Birmingham Medical News website at www.birminghammedicalnews.com
Among the report's recommendations, experts highlighted the following essential changes:
- Launching a standing disaster preparedness group, appointed by and working with the White House, that will include private sector expertise in areas such as production capacity, supply chain and distribution, data exchange, financing and acute care delivery.
- Modernizing the healthcare supply chain through digitalization, automation, and predictive analytics, with standardized approaches for allocating resources based on need and equity to prevent bidding wars between states and healthcare providers.
- Creating measures to ensure health equity and address disparities, identifying high-risk vulnerable populations and directing resources accordingly.
- Improving economic resilience with strategic incentives such as zero percent loans, federally guaranteed purchase commitments, and geographic diversification of production for critical medical products.
- Building a 21st century public health early warning system that will utilize all available electronic health records and public health data collection.
- Passing legislation and regulatory reform to create rapid response capabilities in areas such as medical licensure portability, telehealth accessibility, and swift access to PPE stockpiles.
- Making it easier and more secure for private industry and government to share data by updating anti-trust laws, enacting strong privacy protections, and ensuring broad access to the data.