Gabriel Perna | March 24, 2020
On March 16, Oregon Governor Kate Brown made an announcement that would have seemed improbable, even a few weeks prior.
“Metro hospitals will act as one, large unified hospital system for the treatment of COVID-19,” Brown said at a press conference. “There will be a centralized, coordinated center for managing hospital bed inventory. We will expand bed capacity by adding beds in non-hospital settings.”
For the sake of COVID-19 patients, Oregon Health & Science University, Providence Health and Services-Oregon, Kaiser Permanente and Legacy Health are not individual health systems in competition with each other. They are a single unit working together to push back against a deadly disease.
Brown’s remarks are not shocking in this new era of Coronavirus. As COVID-19 cases surge in America and threaten ICU bed capacity in every single state, local health care communities are figuring out the best way to contain and combat the pandemic by collaborating like they’ve rarely done before. With medical resources getting strained to the limit, it’s all hands-on deck (as long as those hands aren’t touching each other).
Temporarily pushed aside is the cutthroat, competitive health care environment that emerged in the late 2010s, where new health care players in retail outfits like Walmart and CVS and big tech companies emerged in full force and M&A activity between provider and payer organizations was the norm. Hospitals are cancelling elective surgeries and non-essential care, despite the potential downstream revenue impact, at the request of the federal government, state health departments, and industry associations. They are sharing best practices and resources.
“What we’re seeing is, and we’re seeing it in organizations that are strong at the highest level, we’re seeing organization over individual, society over organization. This is promoting a level of teamwork unlike everything anything I’ve seen within the organization, across organizations and across populations,” says Lou Shapiro, CEO of Hospital for Special Surgery (HSS) in New York City.
Fighting a common enemy
In parts of the country where the coronavirus has taken the region by storm, health care organizations have had to collaborate quickly and often. In the war against the disease, there is a common enemy and as Shapiro says, no one is excused from participating in this fight. He says that in NYC, HSS, NewYork-Presbyterian, Weill Cornell Medical Center and Memorial Sloan Kettering are joined at the hip. “Those organizations are collaborating right now as if we’re one,” Shapiro says.
It’s a similar situation in Washington state as well, says Providence St. Joseph Health’s Chief Digital Strategy Officer Sara Vaezy. The health system is taking its investments into AI, machine learning, and virtual health and repurposing those innovations to help the battle against COVID-19. Providence St. Joseph Health (PSJH) is using its capabilities to spread the wealth across the region and the country.
PSJH is giving other health care organizations access to its AI-enabled triage tool and working to integrate a capability within that allows patients to follow-up with their own provider. Moreover, with temporary federal waivers allowing for cross-state practice via telehealth, they are also talking about helping out other health systems with their virtual health technology as well.
“What’s essential right now is we have a partnership and legal framework to support the technology [PSJH] has built, so we can make it widely available knowing that we’re making continuous changes and other health systems are going to be in that same ecosystem with those changes,” says Vaezy. “We’re rapidly working through that and requests have gone up [significantly].”
Mark Simon, MD, OB Hospitalist Group
PSJH’s Aaron Martin, chief digital officer, says the organization is benefiting from its investments into developing relationships with other health systems. In the past 12 months, 130 health systems visited PSJH over the past two years to learn about its digital capabilities and investments. This has come in handy, especially with the Seattle region being ahead of the rest of country when it comes to coronavirus outbreak.
“We’re telling them how we’ve responded and gotten a critique of that. Give them a head start in terms of thinking through what their digital response is going to be. And then we’re getting great ideas from them as well. Some folks in some regions are going to have a little more time to think through than we did, so we’re leveraging the benefit of the community,” Martin says.
A willingness to help and collaborate
In Michigan, Spectrum Health CMO Darryl Elmouchi, MD, says that the health system is in constant contact with other health care providers in the area at the highest levels — CEO to CEO, CMO to CMO. Spectrum stood up a virtual screening capability in a matter of days and its collaborating to help ensure patients are being seen by the right provider.
“None of this is competitive in any way. We’re all trying to coordinate and assist each other. For this virtual capability, it turns out we have the most advanced technology locally. It’s very clear that when we see someone on a virtual screening visit, our goal is to hand them back to their health system or provider. This isn’t a mechanism to increase patients to our system. The amount of collaboration across state—I’ve talked to leaders at five different systems within Michigan in the last 48 hours—has been really good,” says Elmouchi.
Since capacity is such a major problem, health systems are looking to move non-essential care into virtual health settings, or in the case of HSS, another care setting altogether. But what about services that can’t wait? For instance, labor and delivery can’t stop for obvious reasons.
Mark Simon, MD, CMO of OB Hospitalist Group, a company that provides OB/GYN hospitalists across 32 states and 180-plus hospitals, says that it’s shifting a lot of pre-natal care to telemedicine visits. And while labor and delivery are set aside from the emergency department, on-site program directors are working in hospitals to ensure that these patients have minimum exposure to COVID-positive patients and staff.
“Our health care system runs close to capacity a lot of the year. Adding a whole lot of new patients into this system creates a lot of strain—bed space, equipment, personnel. I’ve seen a lot of clinicians, ours and others, who are stepping up to the plate. ‘What can I do?’ Even if it’s not directly caring for COVID patients, there are still plenty of other atients that need routine care,” Simon says.
There is also a concerted effort to reduce waste, Simon says, to help save resources for clinicians fighting COVID-19. They’re asking OB-GYN physicians doing C-sections, one of the most common surgeries in the country, to be very resourceful and not waste any equipment.
“There is a lot of excess waste of resources in health care, day in and day out. It’s a situation like this where we raise the awareness for physicians, nurses, other health care workers who would have typically done something, but in this situation, they have to do it differently and then they see everything worked out OK,” Simon says.