Right now, our hospitals and health systems are facing far more than a public health crisis; they are facing a financial crisis that could threaten their very survival. It is estimated that hospitals and health systems are losing 25 to 40 percent of their revenue as a result of the pandemic (Becker’s, April 2020). How will these organizations recover and how can their marketing departments help? COVID-19 may be with us for a while, but the surge is gradually winding down and hospitals must be prepared to hit the ground running with marketing that drives patient volume to profitable services In recent years, we have written extensively about disruptions in healthcare, including the profound disruptions of the internet economy, the rise of consumerism, and the threat of new competition from tech- and retail-savvy competitors. We now face a new disruption with the COVID-19 pandemic that has come upon healthcare and the global economy as a whole with incredible speed and enormous impact.

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Post Pandemic Strategies for Hospitals Near and Far
By Dr.Mahboob Ali Khan
Right now, our hospitals and health systems are facing far more than a public
health crisis; they are facing a financial crisis that could threaten their very
survival.
It is estimated that hospitals and health systems are losing 25 to 40 percent of
their revenue as a result of the pandemic (Becker’s, April 2020). How will these
organizations recover and how can their marketing departments help?
COVID-19 may be with us for a while, but the surge is gradually winding down
and hospitals must be prepared to hit the ground running with marketing that
drives patient volume to profitable services.

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In recent years, we have written extensively about disruptions in healthcare, including
the profound disruptions of the internet economy, the rise of consumerism, and the
threat of new competition from tech- and retail-savvy competitors. We now face a new
disruption with the COVID-19 pandemic that has come upon healthcare and the global
economy as a whole with incredible speed and enormous impact.
Strategic planning has been upended, at least in the short term. Where there had been
a focus on pruning underperforming service lines, there is now a suspension of most
surgical procedures to prepare for surges of patients infected by the coronavirus.
Where there had been a focus on reducing excess inpatient capacity, there is now an
effort to find additional beds wherever possible, in previously closed facilities, now-
vacant hotels, and exhibition halls and convention centers converted into temporary
hospitals. Hospitals and healthcare professionals have been recognized as vital not
only to the safety and well-being of their local communities, but also to the security
and economic health of the nation.
It is too early to speculate on how this crisis will change our national conversation on
healthcare; that debate will unfold over the coming months and years. But it is certain
that hospitals and health systems are now looking at a “now,” “near,” and “far” that
differ in major ways from only a few months ago:
• Now has become a time of dramatic action and financial peril. Cash reserves are
being depleted as revenue from surgical procedures has been turned off, and hospitals
and health systems devote all available resources to the care of COVID-19 patients.
Depending on the duration of the pandemic (and whether the virus resurges after its
initial peak this spring), this “now” could be prolonged until a vaccine or effective
treatments for the disease are developed.
• Near will be a radically reconfigured healthcare landscape. A host of factors—local
severity of the pandemic, impact on local employers, the strength of pre-crisis financial

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reserves—will stratify hospitals and health systems along a continuum ranging from
lightly to heavily damaged. For some organizations, there will be a heightened need
to seek partnerships or affiliations.
• Far may be the least affected, to the extent the pandemic has revealed the advantages
of larger, integrated systems of care and has demonstrated to consumers and
healthcare organizations the benefits of virtual care and more accessible treatment
options. But the scale of this crisis is such that our previous understanding of the “far”
is likely to be transformed in the months ahead.
This discussion focuses first on how hospitals and health systems will find a path out
of the “now,” and then considers where they may find themselves on the “near” side
of the COVID-19 pandemic. It then considers the questions these organizations will
need to ask to reposition themselves for a “far” that may be changing faster than we
currently understand.
Climbing Out of the “Now”
Most hospitals and health systems are almost totally focused on getting through the
“now,” but are starting to ask questions about what the path out of the crisis will look
like. How much support will federal and state governments ultimately provide to
compensate for the heavy losses incurred as hospitals and health systems shut down
service lines to open capacity for COVID-19 patients? How long before the coronavirus
is fully contained? What will be the impacts of an almost certain recession and high
unemployment on future volumes and payer mix?
The difficulties inherent in answering any of these questions are illustrated by
considering what is perhaps the biggest question: When can we start surgical
procedures again? First and foremost, this will be a safety issue. One strategy might

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be to shift procedures that were scheduled for a hospital to ambulatory surgery centers
(ASCs). This has the advantage of being a fairly easy way to restart procedures, but
patients may well ask why a procedure that was not considered appropriate for an
ASC three months ago is so now. Health systems might also try to establish a “clean”
hospital for elective procedures only, with no COVID-19 patients on site. But will a
health system be better able to create a safe environment in a large hospital than in a
smaller ASC? Perhaps so, especially if the alternative is to use multiple ASCs, which
will make control more difficult. The point is that no answer will be easy and will be
accompanied by multiple additional issues that need to be addressed.
The Healthcare Landscape in a Post-Pandemic
“Near”
Hospitals and health systems will emerge from the COVID-19 pandemic somewhere
along a continuum that ranges from heavily, to moderately, to lightly affected by the
pandemic’s impact. Key factors in determining the force of the impact will include:
• Local economy. Have major employers gone out of business or made major
workforce reductions? How has payer mix been affected?
• Market situation. Have competitive dynamics shifted as a result of the pandemic?
Have there been significant changes in access to healthcare in the market (e.g.,
increased use of telehealth, non-hospital-based services, etc.)?
• Clinical impact. Has the organization’s response to the pandemic changed its
relationship with its physicians, nurses, and other clinicians?
• Financial impact. How much, and for how long, were revenues from surgical
procedures reduced? What were the organization’s financial resources going into the
pandemic and to what extent have they been reduced? Was the organization already
heavily leveraged? How much more debt has it taken on?
• Operational impact. To what extent have operational stress points been revealed
(e.g., in supply chain, workforce, leadership, etc.)?
Significant impact in just one of these factors may be enough to heavily damage an
institution; in other cases, organizations will be affected by the cumulative effects of a

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number of factors. Some organizations will emerge relatively unscathed.
Organizations will have to realistically assess where they have ended up on the impact
continuum, because understanding that position will clarify the choices they have
going forward.
Heavily affected organizations will have limited choices. Although damaged, they
may still be an attractive acquisition for a stronger organization, depending on their
market position or attributes that could be enhanced or rebuilt with some investment.
Without a partner, their position will be more tenuous. Political pressures against
hospital closures may intensify following the pandemic, but investments (potentially
from state or local governments) needed to keep the organization running will unlikely
be sufficient to invest in future growth.
Moderately affected organizations may have an opportunity to rebuild with a well-
executed recovery strategy and remain viable as an independent organization. If they
do seek a partner, they will be able to be more selective and have a stronger
negotiating position to determine their future course.
Lightly affected organizations will be in a strong position to build scale and invest in
capabilities that build competitive strength in their markets. There likely will be
numerous opportunities for growth; however, health systems will be competing against
other organizations to secure these opportunities and will need to move quickly and
strategically.
The question that will emerge, however, is what healthcare organizations should be
moving toward—what, in other words, is the “far”? Although many hospitals and health
systems might be asking how they can get back to their pre-pandemic normal, given
the level of damage they have sustained, a more appropriate question might be
whether they want to go back to the pre-pandemic normal? And if not, what do they
need to do to restructure and reposition themselves for the “far”?

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A Transformed Vision of the “Far”?
In our past writing on healthcare’s “now,” “near,” and “far,” we have emphasized the
inevitable push of the internet economy into the healthcare space, a disruption that
was occurring before the COVID-19 pandemic began. A much wider swath of the
population has now been introduced to the ease of access and convenience that digital
healthcare services can provide. In the near future, it is difficult to imagine that
consumers will want to return to waiting rooms crowded with other sick people. In the
longer term, it is likely that consumers’ shift toward and preference for digital services
wherever possible will become permanent.
We have also emphasized the need for scale, calling attention to a new class of tech-
enabled and retail-savvy competitors (e.g., Amazon, Walmart, CVS Health) whose
size dwarfs that of the largest health systems today. Apart from these competitive
threats, the pandemic has demonstrated other advantages of scale: the ability to
leverage different facilities for different purposes, dispersion of risk across multiple
markets or geographies, and depths of intellectual talent that can be deployed in
different directions (e.g., responding to the immediate needs of the crisis versus
forecasting and planning for the future).
We think, in other words, that certain elements of the “far” still pertain, but like everyone
else at this time, we have more questions than answers. Some of the questions we
find most relevant right now include:
• Will “safety” replace “quality” as the new table stakes, and if so, what will the proof of
concept for hospitals and health systems be?
• How might consumer concerns and demand have changed? Will consumers have a
stronger point of view on what kind of care they will accept, and what they will not?
What does this mean for new care models and delivery and for competitive dynamics
in healthcare?
• How might use of new and emerging technologies (e.g. remote monitoring devices)
be enhanced and accelerated to evolve care delivery models?

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• How have your clinicians (employed and independent) been affected by the crisis, and
what does that mean for your go-forward strategy?
• How will assets need to be repurposed or restructured to address concerns over safety
or access, or the new competitive environment?
• What role will the supply chain play in supporting your go-forward strategy, and what
will be the essential links in the chain?
• What new metrics will be needed to determine if you are successfully positioning your
organization for the “far”?
We have lived through many crises, but rarely have we seen so many impacts on
society and the economy inflicted in so short a time, here and around the globe. Major
crises can cause major transformations. Healthcare, front and center in the current
crisis, is unlikely to emerge unchanged. We will be seeking answers to these questions
along with you and will do everything we can to help you and your organization find
the right path forward.