How healthcare reform changes urgent care

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Outside of hospitals, the sudden need to collect and process samples for Covid tests has caused a spike in demand for these diagnostic services and the clinical staff required to administer them. Further, nonprofit and military organizations have deployed staff and volunteers to support clinical efforts around the country. Considering that patients who are recovering from Covid or other health care ailments may increasingly be directed away from skilled nursing facilities, the need for additional home health workers will eventually skyrocket.

Some might logically assume that the need for this additional staff will decrease once this crisis subsides. Yet while the need to staff the specific hospital and testing needs of this crisis might decline, there will remain the numerous issues of public health and social needs that have been beyond the capacity of current providers for years.

This raises the question of how the U. We can only hope that this crisis will convince our system — and those who regulate it — that important aspects of care can be provided by those without advanced clinical degrees.

These new caregivers could be retail associates who have been displaced from store positions and are able to obtain the needed training to enter basic health professions. Alternatively, these new health care workers could come from a to-be-established public health workforce.

Taking inspiration from well-known models, such as the Peace Corps or Teach For America, this workforce could offer recent high school or college graduates an opportunity to gain a few years of experience before beginning the next step in their educational journey. This group would not only be able to mobilize in acute moments of national crisis but would, during calmer periods, be available to support the efforts of the health care system to address the social needs of patients suffering from undertreated chronic illness.

Even before the passage of the Affordable Care Act ACA in , the debate about health care reform centered on two topics: 1 how we should expand access to insurance coverage, and 2 how providers should be paid for their work. The second revolved around whether the prevailing and flawed system of fee-for-service reimbursement should be replaced by approaches that pay providers based on their performance in meeting the overall health needs of the patients they serve.

Ten years after the passage of the ACA, the U. The current crisis has exposed yet another inadequacy of our current system of health insurance: It is built on the assumption that, at any given time, a limited and predictable portion of the population will need a relatively known mix of health care services.

Predicting health care needs is thus assumed to be a stable and straightforward actuarial exercise. Our health insurance model is not built to cover health care spending during a novel, mass pandemic, when patients with urgent needs descend upon providers at unprecedented rates.

While insurance companies continue to collect premium payments from covered enrollees, massive reductions in elective procedures and office visits have eliminated a major source of their cash outflows. Most insurers are moving to models that temporarily relieve patients of copayments and deductibles while also guaranteeing coverage for Covid related costs.

But what about the costs that hospitals face that cannot be cleanly attributed to any single patient? A recent proposal suggests a very sensible approach: for insurers to provide hospitals with global payments that roughly reflect the historical monthly amounts that they have paid those hospitals in recent years.

Such an effort would put much needed cash in the hands of hospitals whose normal sources of revenue have evaporated at a time when they have been asked to operate well beyond their capacity. While such approaches may help offset some of the financial pain facing hospitals in the current crisis, they are a band-aid placed over the larger wound of a health insurance model that does not insure patients in moments when the risks to their health are at a peak.

Addressing this vulnerability does not necessarily require a shift to universal coverage such as Medicare for All. There are, no doubt, major changes that are coming to the overall economy — and to society as a whole — as a result of this crisis. Hopefully, the health care system will evolve as well. For those in the thick of this current battle, there is no doubt that the immediate priorities are clear: care for the sick and comfort those in need.

But for those of us who are not on the front lines, it is critical to start considering how the lessons of this crisis can be captured not only to make the next crisis easier to manage but also to ensure that the ongoing operation of our health care system is improved in a fundamental manner.

Disclosure: The author serves as an advisory board member to three private health care companies — Arena, Carrum Health, and RubiconMD — that operate in areas related to topics discussed in this article. If our content helps you to contend with coronavirus and other challenges, please consider subscribing to HBR. A subscription purchase is the best way to support the creation of these resources.

You have 1 free article s left this month. You are reading your last free article for this month. Subscribe for unlimited access. Create an account to read 2 more. Business and society. What Will U. Read this fact sheet on why we still need the Affordable Care Act.

The ACA is an important step forward. What is Public Health? Professional Development. APHA Communities. APHA Membership. About APHA. Annual Meeting. Contact Us. Health Reform. Why is the ACA so important?

Millions still need insurance: Though the ACA has helped about 20 million get health insurance, about 29 million people still lack coverage. Unsustainable spending: Health care spending represented Lack of emphasis on prevention: Today, seven in 10 deaths in the U. However, only three cents of each health care dollar spent in the U. Poor health outcomes: The U.