Business of Medicine During the COVID-19 Pandemic: A Perspective

The COVID-19 pandemic was an inevitable yet unexpected calamitythat traversed the globe with breathtaking speed. It was a true public health emergency that tested and continues to test the capabilities and expertise of our national medical and public health infrastructure. In addition, ithas been a stress test on the capacity for leadership through crisis that health care organizations must exercise as they navigate through current and future waves of a pandemic with the highest mortality rate to strike the United States in a century.

FINANCIAL IMPACT

The macroeconomical impact of the pandemic has been well documented. In a depression, rising total debtthateventuallyreachesa tippingpointis usuallytheunderlyinginstigatorofa dominoeffect that imparts a downward pressure on spending that negatively impacts the GDP. Normally, it takes all the tools in the fiscal and monetary toolboxes of the federal government and federal reserve, respectively, to reverse the trend. And those tools are appropriate for addressing the underlying problem of escalating total debt. The interesting feature in the current financial crisis is that the underlying instigator of the financial downturn is a medical and public health cause not easily under the control of these governmental agencies, and the normal tools leveraged to address the financial downturn will not solve the underlying problem. Because spending is equivalent to income in an economy, a downward trending GDP results in drasticallyreduced income for companies as well as people, leading to cost cutting, salary reductions, and ultimately higher unemployment and furloughs. While times of medical crisis may present themselves as business opportunities for health care organizations, the nature of the pandemic has been the opposite, as patient volumes and health care transactions have been depressed by approximately 50% -- a seismic shock to statements of operations across the country. In this fashion, the pandemic has demonstrated in a painful way that fee for service still rules the day.

CRISIS LEADERSHIP AMIDST THE FALLOUT

A crisis goes to the heart of what leadership is. Leadership is setting a vision and direction for where the team, company, or organization needs to go. It includes explaining why this direction is important, and what steps can be taken to get

there. It also includes soliciting help and securing buy in from the team. Traversing this often treacherous and uncertain path requires fortitude, confidence, and creativity. These characteristics can inspire confidence and creativity amongst the team, as great ideas and momentum cannot come from one person alone. While leadership can come from any level in a company, it is a requirement for optimal outcomes that great leadership is demonstrated at the top. At our organization during the first blows of a crisis, our communications during our morning huddles routinely included answers to these four questions answered:

• What is going on? • What are we doing about it now? • How do we get out ofit? • What is the ask from the team?

These questions will effectively fill in the gaps in the minds ofthe team, and thereby minimize the anxiety so that we can all move on together. People management is already complex and a challenge during the best of times, much less during a crisis. To move on is critical for the functions of adaptation, innovation, and taking advantage ofopportunities for potential growth.

EXPLOIT AND EXPLORE

Exploitation refers to using the resources, capabilities, and current market conditions to maximize value to the organization. Exploring refers to the innovative and creative aspect of an organization that considers new services and new markets that are keys to a companyevolving. Kodakis a good example ofa company that exploited, but did not adequately explore. Companies that have not struck the proper balance between exploiting and exploring are vulnerable to disruptive innovations, which are often fueled by new technologies as well as creative processes. Despite this prospect and because of a lack of incentives, the balance is often shifted in favor ofexploiting during normal times.

The COVID-19 pandemic however has provided powerful incentives for health care organizations to leverage the long available technologies of telemedicine, to familiarize themselves with the alreadypublished guidelines on codingforthese visits, and to consider vendors who will interface with their electronic health records to improve communication with patients in forms such as texting, as well as to better monitor and improve quality measures. Companies that take advantage of these times to improve their infrastructure for quality and population health may emerge from this existential crisis better primed and positioned than their peers for value based reimbursements in the future. And like in other industries suffering financial hardship, such as auto industry after the 2008financial crisis, health care organizationswill likelybecome leaner companies.

PULLING IT ALL TOGETHER: PUBLIC AND PRIVATE PARTNERSHIPS

My organization is one of over 1300 federally qualified health centers in the United States. As such we are a captive audience for the federal government as it communicates its priorities during this pandemic and provides funding. Opportunities exist to continue to improve the alignment of the public health goals of our nation and the population health incentives of health care organizations. While the federal government has capabilities to address rising debt and its consequences it is less equipped to directly mitigate the spread of a pandemic with our public health infrastructure’s current state. This infrastructure needs to be as robust as our financial crisis management infrastructure in terms of responding to crises. Just like there is coordination between the governmental agencies and banks, there needs to be the same degree ofintimate coordination and alignment ofincentives and goals between public health agencies and health care organizations. This coordination can onlycome from leaders, who can projecta vision forpopulation health outcomes, adoption of new technologies, reducing racial inequities, and enhancement of public health preparedness. This direction to guide how federal funding and stimulus programs are implemented is needed to ensure that funding is directed towards activitiesthatbringthemostvaluetoourpatientsand communities.