Telehealth has seen significant adoption by providers during the pandemic. While it provides benefits like reducing exposure risk and improving efficiency, it also relies on patients' access to technology and may not be suitable for all cases. During the pandemic, HIPAA rules were temporarily waived to increase telehealth access, but pre-pandemic restrictions will likely return. Government funding is expanding broadband access to support long-term telehealth infrastructure, though regulatory changes may be needed for equitable healthcare.
Clinical Research Informatics Year-in-ReviewPeter Embi
Peter Embi's 2018 Clinical Research Informatics Year-in-Review. Presented as closing Keynote address at the 2018 AMIA Informatics Summit in San Francisco, CA.
Latest nationwide health report shows i.a. some improvements in infant mortalityΔρ. Γιώργος K. Κασάπης
The latest national health report is out from the CDC. Here’s what you need to know:
•Infant mortality: Overall, the infant mortality rate in 2017 was 14% lower than in 2007. At the same time, the rate was 170% higher among black infants than infants born to Asian or Pacific Islander mothers.
•Use of cigarettes: Although the number of high schoolers who used tobacco cigarettes decreased between 2011-2018, the use of e-cigarettes increased by nearly 20%.
•Prescription drugs: The proportion of Americans taking five or more prescription drugs nearly doubled between 1999-2016. In 2017, some 12% of adults who were 100%-200% below the federal poverty level reported not getting prescribed medicines due to cost.
Barbados 2012-13 Health Accounts ReportHFG Project
This report presents the findings and policy implications of Barbados’ first Health Accounts estimation, conducted for the year April 2012 to March 2013. It captures spending from all sources: the government, non-governmental organizations, external donors, private employers, private insurance companies and households. The analysis presented breaks down spending to the standard classifications, as defined by the System of Health Accounts 2011 framework, namely sources of financing, financing schemes, type of provider, type of activity and disease/health condition.
Clinical Research Informatics Year-in-ReviewPeter Embi
Peter Embi's 2018 Clinical Research Informatics Year-in-Review. Presented as closing Keynote address at the 2018 AMIA Informatics Summit in San Francisco, CA.
Latest nationwide health report shows i.a. some improvements in infant mortalityΔρ. Γιώργος K. Κασάπης
The latest national health report is out from the CDC. Here’s what you need to know:
•Infant mortality: Overall, the infant mortality rate in 2017 was 14% lower than in 2007. At the same time, the rate was 170% higher among black infants than infants born to Asian or Pacific Islander mothers.
•Use of cigarettes: Although the number of high schoolers who used tobacco cigarettes decreased between 2011-2018, the use of e-cigarettes increased by nearly 20%.
•Prescription drugs: The proportion of Americans taking five or more prescription drugs nearly doubled between 1999-2016. In 2017, some 12% of adults who were 100%-200% below the federal poverty level reported not getting prescribed medicines due to cost.
Barbados 2012-13 Health Accounts ReportHFG Project
This report presents the findings and policy implications of Barbados’ first Health Accounts estimation, conducted for the year April 2012 to March 2013. It captures spending from all sources: the government, non-governmental organizations, external donors, private employers, private insurance companies and households. The analysis presented breaks down spending to the standard classifications, as defined by the System of Health Accounts 2011 framework, namely sources of financing, financing schemes, type of provider, type of activity and disease/health condition.
Analysis of Covid-19 in the United States using Machine Learningmlaij
The unprecedented outbreak of COVID-19 also known as the coronavirus has caused a pandemic like none ever seen before this century. Its impact has been massive on a global level. The deadly virus has commanded nations around the world to increase their efforts to fight against the spread of the virus after the stress it has put on resources. With the number of new cases increasing day by day around the world, the objective of this paper is to contribute towards the analysis of the virus by leveraging machine learning models to understand its behavior and predict future patterns in the United States (US) based on data obtained from the COVID-19 Tracking Project.
Artificial intelligence (AI) is a fast-growing field and its applications to diabetes, a global pandemic, can reform the approach to diagnosis and management of this chronic condition. Principles of machine learning have been used to build algorithms to support predictive models for the risk of developing diabetes or its consequent complications. Digital therapeutics have proven to be an established intervention for lifestyle therapy in the management of diabetes. Patients are increasingly being empowered for self-management of diabetes, and both patients and health care professionals are benefitting from clinical decision support. AI allows a continuous and burden-free remote monitoring of the patient's symptoms and biomarkers. Further, social media and online communities enhance patient engagement in diabetes care. Technical advances have helped to optimize resource use in diabetes. Together, these intelligent technical reforms have produced better glycemic control with reductions in fasting and postprandial glucose levels, glucose excursions, and glycosylated hemoglobin. AI will introduce a paradigm shift in diabetes care from conventional management strategies to building targeted data-driven precision care.
Part 1 Interest RatesMacroeconomic factors that influence inter.docxssuser562afc1
Part 1: Interest Rates
Macroeconomic factors that influence interest rates in general
The variables influencing microfinance interest rates for MFIs can be characterized into two general gatherings: 1) interior – the components MFIs can impact: for example work costs, specialized help, creations; or 2) outer – political risks, full scale factors, authoritative risk, and four fundamental parts reflected in the microfinance interest rates: working costs, cost of assets, advance misfortune costs, and benefit. Working expenses speak to around 60 % of the all out MFI costs and generally rely upon the credit size, age, area and customer's appraising, and so on.
Macroeconomic factors is your industry most sensitive
Like most businesses, the carrier business is affected by the monetary cycle's pinnacles and troughs. The present development in created economies—like the U.S. that is driven by the extricating money related strategy—has brought about an ascent in business certainty, mechanical creation, and universal exchange.
Impacts on the interest rates experienced within your chosen industry
In any industry, the economy assumes a urgent job that incorporates the general development of the division, and common flight, with the ever-developing interest, is no special case. To give a major picture, Airbus GMF 2016 evaluations the 20-year interest for new traveler and cargo airplane to be a little more than 33,000 airplane comprising a market estimation of over USD $5.2 trillion underlining and setting up the effect of market development.
Part 2: Stock Valuation, Risk and Returns
Stock Valuation. As indicated by the Bureau of Economic Analysis (or BEA), the genuine total national output (or GDP) expanded 4% every year in 2Q14 in the wake of diminishing 2.1% in 1Q14. With financial and modern development, work rates have expanded. This has prompted higher genuine extra cash.
From Video
My company doesn't have stocks right now, so I'll use Costco Wholesale as an example to explain the stock valuation. Future Costco Wholesale Corp stock predictions formula:
P0 = Div1 / (r – g)
P0 = Stock Price;
Div1= Estimated dividends for the next period;
r = Required Rate of Return;
g = Growth Rate
In this formula, we need to know the value of estimated dividends for the next period; required rate and return as well as growth rate. Let’s get each number individually.
g: Growth Rate = Retention Ratio x ROE
0.52 x 0.24 = 0.1248
r: Required Rate of Return.
R = D / P0 + g
0.65 / 296.09 + 0.1248 = 0.1269
Div1: Estimated dividends for the next period is 65c. Therefore, the future Costco Wholesale Corp stock predictions are:
P0 = Div1 / (r – g)
0.65 / 0.0021 = $309.52
The present stock worth and the assessed stock worth utilizing the Dividend Discount Model is higher on account of the contenders are attempting to get into the membership segment showcase. Likewise, Amazon and Sam's club have improved their online store distribution centers. So all in all, financing an organi.
Part 1 Interest RatesMacroeconomic factors that influence inter.docxkarlhennesey
Part 1: Interest Rates
Macroeconomic factors that influence interest rates in general
The variables influencing microfinance interest rates for MFIs can be characterized into two general gatherings: 1) interior – the components MFIs can impact: for example work costs, specialized help, creations; or 2) outer – political risks, full scale factors, authoritative risk, and four fundamental parts reflected in the microfinance interest rates: working costs, cost of assets, advance misfortune costs, and benefit. Working expenses speak to around 60 % of the all out MFI costs and generally rely upon the credit size, age, area and customer's appraising, and so on.
Macroeconomic factors is your industry most sensitive
Like most businesses, the carrier business is affected by the monetary cycle's pinnacles and troughs. The present development in created economies—like the U.S. that is driven by the extricating money related strategy—has brought about an ascent in business certainty, mechanical creation, and universal exchange.
Impacts on the interest rates experienced within your chosen industry
In any industry, the economy assumes a urgent job that incorporates the general development of the division, and common flight, with the ever-developing interest, is no special case. To give a major picture, Airbus GMF 2016 evaluations the 20-year interest for new traveler and cargo airplane to be a little more than 33,000 airplane comprising a market estimation of over USD $5.2 trillion underlining and setting up the effect of market development.
Part 2: Stock Valuation, Risk and Returns
Stock Valuation. As indicated by the Bureau of Economic Analysis (or BEA), the genuine total national output (or GDP) expanded 4% every year in 2Q14 in the wake of diminishing 2.1% in 1Q14. With financial and modern development, work rates have expanded. This has prompted higher genuine extra cash.
From Video
My company doesn't have stocks right now, so I'll use Costco Wholesale as an example to explain the stock valuation. Future Costco Wholesale Corp stock predictions formula:
P0 = Div1 / (r – g)
P0 = Stock Price;
Div1= Estimated dividends for the next period;
r = Required Rate of Return;
g = Growth Rate
In this formula, we need to know the value of estimated dividends for the next period; required rate and return as well as growth rate. Let’s get each number individually.
g: Growth Rate = Retention Ratio x ROE
0.52 x 0.24 = 0.1248
r: Required Rate of Return.
R = D / P0 + g
0.65 / 296.09 + 0.1248 = 0.1269
Div1: Estimated dividends for the next period is 65c. Therefore, the future Costco Wholesale Corp stock predictions are:
P0 = Div1 / (r – g)
0.65 / 0.0021 = $309.52
The present stock worth and the assessed stock worth utilizing the Dividend Discount Model is higher on account of the contenders are attempting to get into the membership segment showcase. Likewise, Amazon and Sam's club have improved their online store distribution centers. So all in all, financing an organi ...
Assignment 1 Legal Aspects of U.S. Health Care System Administrat.docxbraycarissa250
Assignment 1: Legal Aspects of U.S. Health Care System Administration
Due Week 3 and worth 200 points
Prevailing wisdom reinforces the fact that working in U.S. health care administration in the 21st Century requires knowledge of the various aspects of health laws as they apply to dealing with medical professionals. Further, because U.S. health care administrators must potentially interact with many levels of professionals beyond the medical profession, it is prudent that they be aware of any federal, state, and local laws that may be applicable to their organizations. Thus, their conduct is also subject to the letter of the law. They must evaluate the quality of their professional interactions and be mindful of the implications and ramifications of their decisions.
Nearly 65 million surgical operations were performed in 2015 in the U.S. resulting in an estimated 200,000 deaths from complications or other post-operative issues (Ghaferi, Myers, Sutcliffe, & Pronovost, 2016). Ongoing innovation in healthcare can improve patient outcomes. According to the Harvard Business Review article, The Next Wave of Hospital Innovation to Make Patients Safer, over the past several decades, there have been three distinct waves of surgical improvement: technical advancements, standardizing procedures, and high reliability organizing.
Assume the role of a top health administrator at We Care Hospital. You are interested in propelling the hospital to the next level by applying for the Malcolm Baldrige National Quality Award. However, you want to ensure surgical outcomes for patient morbidity and mortality rates. You begin by researching the Surgical Care Improvement Project (SCIP) aimed to improve adherence to quality protocols. You need to ensure the hospital policy is consistent with the law and that the hospital is correctly reporting Sentinel Events to the Joint Commission, a hospital regulatory agency.
Note: You may create and / or make all necessary assumptions needed for the completion of this assignment.
Write a three to four (3-4) page paper in which you:
1. Analyze how standardizing procedures and documenting steps can improve outcomes when performing a complex procedure. Review the peer-reviewed journal article, The Next Wave of Hospital Innovation to Make Patients Safer. Articulate your position as the top administrator concerned about the importance of professional conduct and negligence in SCIP quality guidelines.
2. High Reliability Organizing emphasizes the varying actions that can affect patient safety given that standardized systems ignore the fact that each patient is different. Ascertain the major ramifications when the health care team “fails to rescue” the patient. Identify what hospital policies should be in place and identify previous case laws.
3. Analyze the four (4) elements required of a plaintiff to prove medical negligence.
4. Discuss the overarching duties of the health care governing board in mitigating the effects of medical non- ...
1 IHP 501 Final Project One Guidelines and Rubric Coun.docxteresehearn
1
IHP 501 Final Project One Guidelines and Rubric
Country Profile
Overview
As a healthcare professional driven to advocacy, you must be aware of disparities of healthcare systems within and across borders. This course has prepared you
to critically analyze a variety of health issues in countries around the world and to assess the role healthcare professionals and institutions or organizations play
in both the delivery and improvement (or detriment) of a system. Ultimately, as an advocate for population health and promotion of service delivery, you will
craft an analysis of health issues that will lead you to make recommendations on how to effect positive change regarding healthcare access, equity, and
outcomes in a country.
Final Project One for this course is the creation of a country profile that provides a detailed assessment of the chosen population and its healthcare system. The
final product represents an authentic demonstration of competency because by exploring healthcare across borders to better understand disparities and the
impacts of economics, culture, and social factors on population health, you will gain a global view of healthcare necessary for impactful advocacy. The project is
divided into two milestones, which will be submitted at various points throughout the course to scaffold learning and ensure quality final submissions. These
milestones will be submitted in Modules Two and Four. The final product will be submitted in Module Six.
In this assignment, you will demonstrate your mastery of the following course outcomes:
Assess the impact of economic, social, and cultural factors on communities and healthcare organizations in the United States and internationally
Determine the role and influence of key international organizations and stakeholders in promoting global health, service delivery, and healthcare policy
Analyze data from global and local health organizations for informing health initiative recommendations
Prompt
For this project, choose a country (other than the United States) and assess its population health and healthcare system. Your country profile should address the
impacts of economics, culture, and social factors on population health. You will choose three areas of health study to examine in detail for your country. These
areas must be approved by your instructor.
2
Specifically, the following critical elements must be addressed:
I. Introduction
A. State the purpose of the country profile and explain why you chose to write about this country in particular.
B. Identify appropriate details needed for an analysis of the state of healthcare in your chosen country. Your discussion should include but is not
limited to population, type of government and the state of governmental affairs, geographic location, and climate.
II. General State of Healthcare
A. Determine the main health-related issues in the country through an assessment of its recent h.
Chapter 31 Future Directions and Future Research in Health Informa.docxchristinemaritza
Chapter 31 Future Directions and Future Research in Health Informatics
Nancy Staggers
Ramona Nelson
David E. Jones
Health informatics can be described as an interprofessional discipline that is grounded in the present while planning for the future.
Objectives
At the completion of this chapter the reader will be prepared to:
1.Explore major trends and their implications for future developments in healthcare, health informatics, and informatics research
2.Analyze techniques and challenges of planning for future directions and trends
3.Apply futurology methodologies in identifying trends and possible, probable, and preferred futures
4.Describe the field of nanotechnology and its subdisciplines, the role of informatics in nanotechnology, and implications for healthcare
5.Analyze the advantages and disadvantages of nanotechnology in health and health informatics
Key Terms
Backcasting, 499
Cytotoxicity, 505
Data visualization, 502
Extrapolation, 497
Futures research, 495
Nanofabrication, 503
Nanoinformatics, 505
Nanomedicine, 504
Nanotechnology, 502
Trend analysis, 497
Abstract
This chapter expands on the future directions sections included in the individual chapters to provide broad guidance about the future of informatics. First, healthcare trends in society are outlined. Second, futures studies or futurology (methods to analyze probable future directions in any field) is discussed. Third, an overview of potential future directions in informatics are discussed, including the following informatics trends: (1) patient engagement, consumerism, and informatics; (2) electronic health records (EHRs) 2.0; (3) usability and improving the user health information technology (health IT) experience; (4) big data and data visualization; and (5) nanotechnology and nanoinformatics. The last trend is discussed in more detail as an example of the major influence each of these trends will likely have on the future of healthcare and society as a whole. The organization and depth of the nanotechnology-related content also provides a guide for readers to develop similar material in informatics areas of specific interest.
Introduction
Informatics will play a large role in the future of healthcare. Which informatics trends will prevail and in what depth is unclear. In each of the chapters in this book authors outlined expanding areas of influence, from knowledge discovery to the epatient, from cloud computing to standards integration with public health data sharing, and from initial EHR installations to mobile health. In this chapter unequivocal healthcare trends are listed, followed by methods that readers may use to predict likely trends in the future. These techniques are called futurology or futures research methods. Subsequently, five major trends are discussed: (1) patient engagement, consumerism, and informatics; (2) EHRs 2.0; (3) usability and improving the user experience for health IT; (4) big data and data visualization; and (5) na ...
20 tendencias digitales en salud digital_ The Medical FuturistRichard Canabate
Resaltado de las tendencias que darán forma a la atención médica post COVID19.
No se trata de enumerar estas tendencias, sino de dar una valiosa visión de los factores de conducción detrás de ellas mientras que es muy específico. Se trata de mostrar cuáles son las áreas exactas que deben destacarse entre todas las áreas en el tema "IA en la atención médica", por ejemplo.
Advances in information and communication technologies have led to the emergence of Internet of Things
(IoT). In the modern health care environment, the usage of IoT technologies brings convenience to physicians and
patients since they are applied to various medical areas (such as real-time monitoring, patient information and healthcare
management). The body sensor network (BSN) technology is one of the core technologies of IoT developments in
healthcare system, where a patient can be monitored using a collection of tiny-powered and lightweight wireless sensor
nodes
Collaborated with the Mayo Clinic's Centre for Innovation on a team project to envision a 2035 future for specialized healthcare providers. Researched trends and drivers from a social, technological, economic, political, environment and values perspective and applied strategic foresight/futures methods to create possible future outcomes. Designed strategies to influence a positive future and mitigate against negative outcomes. The final report was used by the clinic as an innovation input for their multi-year strategic planning activities.
The World Remade by COVID-19 offers a view of how businesses and society may develop over the next three to five years as the world navigates the potential long-term implications of the global pandemic.
Our view is based on scenarios—stories about the future designed to spark insight and spot opportunity—created by some of the world’s best-known scenario thinkers. The collaborative dialogue hosted by Deloitte and Salesforce continues the companies’ tradition of providing foresight and insight that inform resilient leaders:
Explore how trends we see during the pandemic could shape what the world may look like in the long-term
Have productive conversations around the lasting implications and impacts of the crisis
Identify decisions and actions that will improve resilience to the rapidly changing landscape
Move beyond “recovering” from the crisis, and towards “thriving” in the long run
We are in uncharted waters, yet leaders must take decisive action to ensure their organizations are resilient. We’ve outlined four COVID-19 scenarios for society and business that illustrate different ways we could emerge from the crisis—and what’s required to thrive in a world remade.
Analysis of Covid-19 in the United States using Machine Learningmlaij
The unprecedented outbreak of COVID-19 also known as the coronavirus has caused a pandemic like none ever seen before this century. Its impact has been massive on a global level. The deadly virus has commanded nations around the world to increase their efforts to fight against the spread of the virus after the stress it has put on resources. With the number of new cases increasing day by day around the world, the objective of this paper is to contribute towards the analysis of the virus by leveraging machine learning models to understand its behavior and predict future patterns in the United States (US) based on data obtained from the COVID-19 Tracking Project.
Artificial intelligence (AI) is a fast-growing field and its applications to diabetes, a global pandemic, can reform the approach to diagnosis and management of this chronic condition. Principles of machine learning have been used to build algorithms to support predictive models for the risk of developing diabetes or its consequent complications. Digital therapeutics have proven to be an established intervention for lifestyle therapy in the management of diabetes. Patients are increasingly being empowered for self-management of diabetes, and both patients and health care professionals are benefitting from clinical decision support. AI allows a continuous and burden-free remote monitoring of the patient's symptoms and biomarkers. Further, social media and online communities enhance patient engagement in diabetes care. Technical advances have helped to optimize resource use in diabetes. Together, these intelligent technical reforms have produced better glycemic control with reductions in fasting and postprandial glucose levels, glucose excursions, and glycosylated hemoglobin. AI will introduce a paradigm shift in diabetes care from conventional management strategies to building targeted data-driven precision care.
Part 1 Interest RatesMacroeconomic factors that influence inter.docxssuser562afc1
Part 1: Interest Rates
Macroeconomic factors that influence interest rates in general
The variables influencing microfinance interest rates for MFIs can be characterized into two general gatherings: 1) interior – the components MFIs can impact: for example work costs, specialized help, creations; or 2) outer – political risks, full scale factors, authoritative risk, and four fundamental parts reflected in the microfinance interest rates: working costs, cost of assets, advance misfortune costs, and benefit. Working expenses speak to around 60 % of the all out MFI costs and generally rely upon the credit size, age, area and customer's appraising, and so on.
Macroeconomic factors is your industry most sensitive
Like most businesses, the carrier business is affected by the monetary cycle's pinnacles and troughs. The present development in created economies—like the U.S. that is driven by the extricating money related strategy—has brought about an ascent in business certainty, mechanical creation, and universal exchange.
Impacts on the interest rates experienced within your chosen industry
In any industry, the economy assumes a urgent job that incorporates the general development of the division, and common flight, with the ever-developing interest, is no special case. To give a major picture, Airbus GMF 2016 evaluations the 20-year interest for new traveler and cargo airplane to be a little more than 33,000 airplane comprising a market estimation of over USD $5.2 trillion underlining and setting up the effect of market development.
Part 2: Stock Valuation, Risk and Returns
Stock Valuation. As indicated by the Bureau of Economic Analysis (or BEA), the genuine total national output (or GDP) expanded 4% every year in 2Q14 in the wake of diminishing 2.1% in 1Q14. With financial and modern development, work rates have expanded. This has prompted higher genuine extra cash.
From Video
My company doesn't have stocks right now, so I'll use Costco Wholesale as an example to explain the stock valuation. Future Costco Wholesale Corp stock predictions formula:
P0 = Div1 / (r – g)
P0 = Stock Price;
Div1= Estimated dividends for the next period;
r = Required Rate of Return;
g = Growth Rate
In this formula, we need to know the value of estimated dividends for the next period; required rate and return as well as growth rate. Let’s get each number individually.
g: Growth Rate = Retention Ratio x ROE
0.52 x 0.24 = 0.1248
r: Required Rate of Return.
R = D / P0 + g
0.65 / 296.09 + 0.1248 = 0.1269
Div1: Estimated dividends for the next period is 65c. Therefore, the future Costco Wholesale Corp stock predictions are:
P0 = Div1 / (r – g)
0.65 / 0.0021 = $309.52
The present stock worth and the assessed stock worth utilizing the Dividend Discount Model is higher on account of the contenders are attempting to get into the membership segment showcase. Likewise, Amazon and Sam's club have improved their online store distribution centers. So all in all, financing an organi.
Part 1 Interest RatesMacroeconomic factors that influence inter.docxkarlhennesey
Part 1: Interest Rates
Macroeconomic factors that influence interest rates in general
The variables influencing microfinance interest rates for MFIs can be characterized into two general gatherings: 1) interior – the components MFIs can impact: for example work costs, specialized help, creations; or 2) outer – political risks, full scale factors, authoritative risk, and four fundamental parts reflected in the microfinance interest rates: working costs, cost of assets, advance misfortune costs, and benefit. Working expenses speak to around 60 % of the all out MFI costs and generally rely upon the credit size, age, area and customer's appraising, and so on.
Macroeconomic factors is your industry most sensitive
Like most businesses, the carrier business is affected by the monetary cycle's pinnacles and troughs. The present development in created economies—like the U.S. that is driven by the extricating money related strategy—has brought about an ascent in business certainty, mechanical creation, and universal exchange.
Impacts on the interest rates experienced within your chosen industry
In any industry, the economy assumes a urgent job that incorporates the general development of the division, and common flight, with the ever-developing interest, is no special case. To give a major picture, Airbus GMF 2016 evaluations the 20-year interest for new traveler and cargo airplane to be a little more than 33,000 airplane comprising a market estimation of over USD $5.2 trillion underlining and setting up the effect of market development.
Part 2: Stock Valuation, Risk and Returns
Stock Valuation. As indicated by the Bureau of Economic Analysis (or BEA), the genuine total national output (or GDP) expanded 4% every year in 2Q14 in the wake of diminishing 2.1% in 1Q14. With financial and modern development, work rates have expanded. This has prompted higher genuine extra cash.
From Video
My company doesn't have stocks right now, so I'll use Costco Wholesale as an example to explain the stock valuation. Future Costco Wholesale Corp stock predictions formula:
P0 = Div1 / (r – g)
P0 = Stock Price;
Div1= Estimated dividends for the next period;
r = Required Rate of Return;
g = Growth Rate
In this formula, we need to know the value of estimated dividends for the next period; required rate and return as well as growth rate. Let’s get each number individually.
g: Growth Rate = Retention Ratio x ROE
0.52 x 0.24 = 0.1248
r: Required Rate of Return.
R = D / P0 + g
0.65 / 296.09 + 0.1248 = 0.1269
Div1: Estimated dividends for the next period is 65c. Therefore, the future Costco Wholesale Corp stock predictions are:
P0 = Div1 / (r – g)
0.65 / 0.0021 = $309.52
The present stock worth and the assessed stock worth utilizing the Dividend Discount Model is higher on account of the contenders are attempting to get into the membership segment showcase. Likewise, Amazon and Sam's club have improved their online store distribution centers. So all in all, financing an organi ...
Assignment 1 Legal Aspects of U.S. Health Care System Administrat.docxbraycarissa250
Assignment 1: Legal Aspects of U.S. Health Care System Administration
Due Week 3 and worth 200 points
Prevailing wisdom reinforces the fact that working in U.S. health care administration in the 21st Century requires knowledge of the various aspects of health laws as they apply to dealing with medical professionals. Further, because U.S. health care administrators must potentially interact with many levels of professionals beyond the medical profession, it is prudent that they be aware of any federal, state, and local laws that may be applicable to their organizations. Thus, their conduct is also subject to the letter of the law. They must evaluate the quality of their professional interactions and be mindful of the implications and ramifications of their decisions.
Nearly 65 million surgical operations were performed in 2015 in the U.S. resulting in an estimated 200,000 deaths from complications or other post-operative issues (Ghaferi, Myers, Sutcliffe, & Pronovost, 2016). Ongoing innovation in healthcare can improve patient outcomes. According to the Harvard Business Review article, The Next Wave of Hospital Innovation to Make Patients Safer, over the past several decades, there have been three distinct waves of surgical improvement: technical advancements, standardizing procedures, and high reliability organizing.
Assume the role of a top health administrator at We Care Hospital. You are interested in propelling the hospital to the next level by applying for the Malcolm Baldrige National Quality Award. However, you want to ensure surgical outcomes for patient morbidity and mortality rates. You begin by researching the Surgical Care Improvement Project (SCIP) aimed to improve adherence to quality protocols. You need to ensure the hospital policy is consistent with the law and that the hospital is correctly reporting Sentinel Events to the Joint Commission, a hospital regulatory agency.
Note: You may create and / or make all necessary assumptions needed for the completion of this assignment.
Write a three to four (3-4) page paper in which you:
1. Analyze how standardizing procedures and documenting steps can improve outcomes when performing a complex procedure. Review the peer-reviewed journal article, The Next Wave of Hospital Innovation to Make Patients Safer. Articulate your position as the top administrator concerned about the importance of professional conduct and negligence in SCIP quality guidelines.
2. High Reliability Organizing emphasizes the varying actions that can affect patient safety given that standardized systems ignore the fact that each patient is different. Ascertain the major ramifications when the health care team “fails to rescue” the patient. Identify what hospital policies should be in place and identify previous case laws.
3. Analyze the four (4) elements required of a plaintiff to prove medical negligence.
4. Discuss the overarching duties of the health care governing board in mitigating the effects of medical non- ...
1 IHP 501 Final Project One Guidelines and Rubric Coun.docxteresehearn
1
IHP 501 Final Project One Guidelines and Rubric
Country Profile
Overview
As a healthcare professional driven to advocacy, you must be aware of disparities of healthcare systems within and across borders. This course has prepared you
to critically analyze a variety of health issues in countries around the world and to assess the role healthcare professionals and institutions or organizations play
in both the delivery and improvement (or detriment) of a system. Ultimately, as an advocate for population health and promotion of service delivery, you will
craft an analysis of health issues that will lead you to make recommendations on how to effect positive change regarding healthcare access, equity, and
outcomes in a country.
Final Project One for this course is the creation of a country profile that provides a detailed assessment of the chosen population and its healthcare system. The
final product represents an authentic demonstration of competency because by exploring healthcare across borders to better understand disparities and the
impacts of economics, culture, and social factors on population health, you will gain a global view of healthcare necessary for impactful advocacy. The project is
divided into two milestones, which will be submitted at various points throughout the course to scaffold learning and ensure quality final submissions. These
milestones will be submitted in Modules Two and Four. The final product will be submitted in Module Six.
In this assignment, you will demonstrate your mastery of the following course outcomes:
Assess the impact of economic, social, and cultural factors on communities and healthcare organizations in the United States and internationally
Determine the role and influence of key international organizations and stakeholders in promoting global health, service delivery, and healthcare policy
Analyze data from global and local health organizations for informing health initiative recommendations
Prompt
For this project, choose a country (other than the United States) and assess its population health and healthcare system. Your country profile should address the
impacts of economics, culture, and social factors on population health. You will choose three areas of health study to examine in detail for your country. These
areas must be approved by your instructor.
2
Specifically, the following critical elements must be addressed:
I. Introduction
A. State the purpose of the country profile and explain why you chose to write about this country in particular.
B. Identify appropriate details needed for an analysis of the state of healthcare in your chosen country. Your discussion should include but is not
limited to population, type of government and the state of governmental affairs, geographic location, and climate.
II. General State of Healthcare
A. Determine the main health-related issues in the country through an assessment of its recent h.
Chapter 31 Future Directions and Future Research in Health Informa.docxchristinemaritza
Chapter 31 Future Directions and Future Research in Health Informatics
Nancy Staggers
Ramona Nelson
David E. Jones
Health informatics can be described as an interprofessional discipline that is grounded in the present while planning for the future.
Objectives
At the completion of this chapter the reader will be prepared to:
1.Explore major trends and their implications for future developments in healthcare, health informatics, and informatics research
2.Analyze techniques and challenges of planning for future directions and trends
3.Apply futurology methodologies in identifying trends and possible, probable, and preferred futures
4.Describe the field of nanotechnology and its subdisciplines, the role of informatics in nanotechnology, and implications for healthcare
5.Analyze the advantages and disadvantages of nanotechnology in health and health informatics
Key Terms
Backcasting, 499
Cytotoxicity, 505
Data visualization, 502
Extrapolation, 497
Futures research, 495
Nanofabrication, 503
Nanoinformatics, 505
Nanomedicine, 504
Nanotechnology, 502
Trend analysis, 497
Abstract
This chapter expands on the future directions sections included in the individual chapters to provide broad guidance about the future of informatics. First, healthcare trends in society are outlined. Second, futures studies or futurology (methods to analyze probable future directions in any field) is discussed. Third, an overview of potential future directions in informatics are discussed, including the following informatics trends: (1) patient engagement, consumerism, and informatics; (2) electronic health records (EHRs) 2.0; (3) usability and improving the user health information technology (health IT) experience; (4) big data and data visualization; and (5) nanotechnology and nanoinformatics. The last trend is discussed in more detail as an example of the major influence each of these trends will likely have on the future of healthcare and society as a whole. The organization and depth of the nanotechnology-related content also provides a guide for readers to develop similar material in informatics areas of specific interest.
Introduction
Informatics will play a large role in the future of healthcare. Which informatics trends will prevail and in what depth is unclear. In each of the chapters in this book authors outlined expanding areas of influence, from knowledge discovery to the epatient, from cloud computing to standards integration with public health data sharing, and from initial EHR installations to mobile health. In this chapter unequivocal healthcare trends are listed, followed by methods that readers may use to predict likely trends in the future. These techniques are called futurology or futures research methods. Subsequently, five major trends are discussed: (1) patient engagement, consumerism, and informatics; (2) EHRs 2.0; (3) usability and improving the user experience for health IT; (4) big data and data visualization; and (5) na ...
20 tendencias digitales en salud digital_ The Medical FuturistRichard Canabate
Resaltado de las tendencias que darán forma a la atención médica post COVID19.
No se trata de enumerar estas tendencias, sino de dar una valiosa visión de los factores de conducción detrás de ellas mientras que es muy específico. Se trata de mostrar cuáles son las áreas exactas que deben destacarse entre todas las áreas en el tema "IA en la atención médica", por ejemplo.
Advances in information and communication technologies have led to the emergence of Internet of Things
(IoT). In the modern health care environment, the usage of IoT technologies brings convenience to physicians and
patients since they are applied to various medical areas (such as real-time monitoring, patient information and healthcare
management). The body sensor network (BSN) technology is one of the core technologies of IoT developments in
healthcare system, where a patient can be monitored using a collection of tiny-powered and lightweight wireless sensor
nodes
Collaborated with the Mayo Clinic's Centre for Innovation on a team project to envision a 2035 future for specialized healthcare providers. Researched trends and drivers from a social, technological, economic, political, environment and values perspective and applied strategic foresight/futures methods to create possible future outcomes. Designed strategies to influence a positive future and mitigate against negative outcomes. The final report was used by the clinic as an innovation input for their multi-year strategic planning activities.
The World Remade by COVID-19 offers a view of how businesses and society may develop over the next three to five years as the world navigates the potential long-term implications of the global pandemic.
Our view is based on scenarios—stories about the future designed to spark insight and spot opportunity—created by some of the world’s best-known scenario thinkers. The collaborative dialogue hosted by Deloitte and Salesforce continues the companies’ tradition of providing foresight and insight that inform resilient leaders:
Explore how trends we see during the pandemic could shape what the world may look like in the long-term
Have productive conversations around the lasting implications and impacts of the crisis
Identify decisions and actions that will improve resilience to the rapidly changing landscape
Move beyond “recovering” from the crisis, and towards “thriving” in the long run
We are in uncharted waters, yet leaders must take decisive action to ensure their organizations are resilient. We’ve outlined four COVID-19 scenarios for society and business that illustrate different ways we could emerge from the crisis—and what’s required to thrive in a world remade.
The world remade by COVID-19
Planning scenarios for resilient leaders
In the wake of COVID-19, Deloitte and Salesforce hosted a dialogue among some of the world's best-known scenario thinkers to consider the societal and business impact of the pandemic. What might life be like after the crisis passes, and what will it take to thrive in a world remade? Let’s explore four possible scenarios.
The World Remade by COVID-19 offers a view of how businesses and society may develop over the next three to five years as the world navigates the potential long-term implications of the global pandemic.
Our view is based on scenarios—stories about the future designed to spark insight and spot opportunity—created by some of the world’s best-known scenario thinkers. The collaborative dialogue hosted by Deloitte and Salesforce continues the companies’ tradition of providing foresight and insight that inform resilient leaders:
Explore how trends we see during the pandemic could shape what the world may look like in the long-term
Have productive conversations around the lasting implications and impacts of the crisis
Identify decisions and actions that will improve resilience to the rapidly changing landscape
Move beyond “recovering” from the crisis, and towards “thriving” in the long run
Phase 1 - Research Data CollectionName Points.docxkarlhennesey
Phase 1 - Research Data Collection
Name:
Points: 50
States:
Due: Week 5
Country:
Source
Topics Covered (bulleted list)
Citation Information (MLA Style)
1.Journal articles
(Press enter if you reach the bottom of the cell and need more space.)
· Financial aspect to the health care services and delivery.
· Shortages of health professionals.
· Main source of finance to health care services
· Linkage with other organization.
(Press tab to move to next row.)
Reagan, Michael D. The accidental system: health care policy in America. Routledge, 2018.
2.Videos
· Health care delivery checks on the personnel and facilities available for use.
· Poor teamwork in the health sector by health providers.
· Health professionals at the delivery of services.
Khan Academy. “Healthcare system overview | Health care system | Heatlh & Medicine | Khan Academy” Youtube. Retrieved at https://www.youtube.com/watch?v=LMHxxvbzFqc
3.Government Data
· Environmental impact on the health care services delivery.
· Details on the socio-economic and political aspect to health care system.
· Marginalize areas in terms of health provision.
United States Census Bureau. “Health Insurance Coverage in the United States” 2017
4.Insurance Data
· Payment mode in private and public health care system.
· Implementation of laws in the health sectors
· Need for worker compensation.
United States Census Bureau. “Health Insurance Coverage in the United States” 2017
5.Related articles of professionals organizations
· Rural access to health care services systems.
· Outdoor-Community health care.
· Good road networks to allow health services reach.
· Challenges of the health care delivery in rural areas.
Osman, Ferdous Arfina, and Sara Bennett. "Political Economy and Quality of Primary Health Service in Rural Bangladesh and the United States of America: A Comparative Analysis." Journal of International Development (2018).
6. Shi and Singh textbook
· Health services financing.
· Health care delivery policies and priorities.
· Proper health organization management.
. Shi, Leiyu. Delivering Health Care in America : a Systems Approach. Sudbury, Mass. :Jones & Bartlett Learning, 2012.
Phase 2:
Comparison-contrast chart
Name Adedotun Adereti
The U.S. / UK comparison-contrast chart.
U.S
U.K
· In U.S Healthcare payment is catered for highly by government initiated programmes for example Medicaid.
· In the U.K healthcare is funded highly by taxation through the National Health Services.
· Here there is no shortage of health staff as there are adequate doctors, nurses, and other medical practitioners.
· There is a shortage of health workers in the UK a thing that has led to the vast advertising of job opportunities for health practitioners.
· The medical practitioners are highly train ...
Machine learning and operations research to find diabetics at risk for readmisison.
A team of researchers was able to apply machine learning to reduce readmissions for diabetics, see "Identifying diabetic patients with high risk of readmission" (Bhuvan,Kumar, Zafar, Aand Kishore, 2016).
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
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2 Case Reports of Gastric Ultrasound
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
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Ocular injury ppt Upendra pal optometrist upums saifai etawah
Healthcare in a Post Covid19 World
1. Healthcare in a Post COVID-19 World
Harvard College Consulting Group
August 2020
2. 2Harvard College Consulting Group
Cambridge, MA 02138
www.harvardconsulting.org
info@harvardconsulting.org
1. Executive Summary
Dr. Joe Kvedar
American Telehealth Association
3. 3Harvard College Consulting Group
Cambridge, MA 02138
www.harvardconsulting.org
info@harvardconsulting.org
2. Table of Contents
1. Executive Summary .............................................................................................................2
2. Table of Contents.................................................................................................................3
3. Introduction ..........................................................................................................................4
3.1 Predicting the Future................................................................................................................. 4
3.2 Related Work .............................................................................................................................. 4
3.3 How To Read This Paper ........................................................................................................... 5
4. Providers ...............................................................................................................................6
4.1 Telehealth Pros and Cons......................................................................................................... 6
4.2 HIPAA Regulations..................................................................................................................... 7
4.3 Telehealth Infrastructure ........................................................................................................... 8
4.4 Healthcare Infrastructure........................................................................................................... 9
4.5 Telehealth Implementation Strategies..................................................................................12
4.6 Nonphysician Providers ..........................................................................................................13
4.7 Equitable Healthcare Guidance .............................................................................................14
5. Patients............................................................................................................................... 16
5.1 Inequalities Exacerbated by COVID-19 ................................................................................16
5.2 Telehealth’s Impact on Accessibility......................................................................................17
5.3 Willingness to Accept Home-Based Model..........................................................................18
5.4 Telehealth Adoption and Experience ...................................................................................18
6. Policy Makers..................................................................................................................... 21
6.1 Public Healthcare with respect to Telehealth.......................................................................21
6.2 Telehealth Policy ......................................................................................................................22
6.3 Public Healthcare in General..................................................................................................25
6.4 Vaccines ....................................................................................................................................27
6.5 Supply Chains...........................................................................................................................29
6.6 Drug Development Regulation..............................................................................................31
6.7 Shift to Home-Based Care ......................................................................................................32
7. Survey Data and Analysis................................................................................................. 34
8. Conclusion.......................................................................................................................... 37
4. 4Harvard College Consulting Group
Cambridge, MA 02138
www.harvardconsulting.org
info@harvardconsulting.org
3. Introduction
There are few industries that are as universal or as hotly debated as the healthcare industry,
and for good reason – at some point in nearly all of our lives, we will have to directly interact
with it, and the experience is often unsatisfying. With the COVID-19 pandemic, these issues
have been further inserted into public discussion, and clearly there will be changes and fallout
for the industry as a whole – but it’s certainly not immediately obvious what these changes will
be, or what their impact will be. Throughout this paper, we discuss three main stakeholders
that contribute to (and are impacted by) the healthcare system – providers, patients, and
policy makers – and examine the impact of COVID-19 as well as interactions between each
group.
3.1 Predicting the Future
Our main goal, as the title of this section suggests, is predicting the future – accurately
describing what healthcare systems will look like in both short-term and long-term. To do so,
we draw on three main forms of evidence: survey results, written literature (both academic
and journalistic), and the collected opinions of experts who are currently working on future
responses. Survey results used throughout this paper include large external surveys (widely
cited throughout other work, see §3.2) and the HCCG July 2020 Healthcare Survey, which was
designed to answer particular questions that came up consistently throughout our research
and provide tailored, directed statistics for further analysis (see §7 for the survey results and
analysis). Interviews cited throughout this paper include physicians, public policy experts, and
industry leaders. Throughout all of this, however, it is important to note that responses to the
virus are likely to be heterogeneous, and thus consequences will be highly nonuniform. There
are two types of predictions we make throughout this paper: those on the state of the world,
and those on how people can influence the outcomes. Predictions on the state in the future
necessarily get less accurate the further out we project, since they only reflect our current
knowledge of what has happened and what is planned. However, it is much easier (and
therefore much more impactful) to be confident in predictions about direct consequences of
changes made now – for example, new healthcare policy changes, or decisions made during
the implementation of telehealth. Here we provide both types of analysis, in the hopes that
the former will contribute to the broader discussion around the healthcare system’s responses
to COVID-19, and the latter will provide actionable steps to improve the many impacted lives.
3.2 Related Work
Healthcare in a post COVID-19 world has been examined extensively throughout the past few
months. In particular, digital healthcare increased in both adoption and academic scrutiny,1
as
has analysis of healthcare supply chains.2
Additionally, policy reviews have taken place,
1
For a comprehensive example, see Mosnaim et al., “The Adoption and Implementation of Digital Health Care in the
Post–COVID-19 Era.”
2
Mirchandani, “Health Care Supply Chains.”
5. 5Harvard College Consulting Group
Cambridge, MA 02138
www.harvardconsulting.org
info@harvardconsulting.org
notably through the U.S. Government Accountability Office3
and some have drilled into
specific issues like the future of nursing homes, which we address in this paper.4
Finally,
economic analyses have been done in both academia5
and industry, including industry
reports from other consultancies.6 7
These resources comprise a nearly negligible minority of
research published on the various impacts of COVID-19 on the healthcare system; this work
intends to provide a more concise, actionable narrative in light of the overwhelming amount
of information.
3.3 How To Read This Paper
This paper has three main sections intended for three different groups. In section 4, we
discuss telehealth’s impact from the point of view of healthcare providers, examine some
regulatory consequences, and provide some strategies that practitioners can use to adapt to
the changing landscape. In section 5, we discuss healthcare from the point of view of patients,
highlighting disparity in access to healthcare, and discussing how to best make use of home-
based care and telehealth. Finally, in section 6, we discuss the numerous challenges that
policy makers have faced and will likely face in the coming months, analyze outcomes of
decisions made earlier during the pandemic, and provide recommendations for future
considerations. This structure likely means that providers will find section 4 most applicable,
the general population section 5, and policy makers section 6, but it may be helpful to look
through considerations that the other groups are facing when trying to form an opinion on the
future. To that end, each section begins with a teal “Key Takeaway” which summarizes the
principal insights from the section and highlights their relevance to the other two sections. We
recommend that readers first read the section most relevant to them, and then skim the Key
Takeaways for any other ideas they find interesting – but each larger section is intended to be
self-contained.
3
United States Government Accountability Office, “COVID-19: Opportunities to Improve Federal Response and
Recovery Efforts.”
4
Werner, Hoffman, and Coe, “Long-Term Care Policy after Covid-19 — Solving the Nursing Home Crisis.”
5
Gannotta, “How the Healthcare Industry Will Change Post-COVID-19.”
6
McKinsey, “Coronavirus’ Business Impact.”
7
Boston Consulting Group, “COVID-19.”
6. 6Harvard College Consulting Group
Cambridge, MA 02138
www.harvardconsulting.org
info@harvardconsulting.org
4. Providers
4.1 Telehealth Pros and Cons
The most significant shift in healthcare delivery during the pandemic for many providers has
been the adoption of telehealth services. “When you’re able to do quality, convenience, and
access and not leave your home, people like that. So, I think we’re going to get a lot of ‘Wait a
minute, we did that by telehealth and I liked it, why can’t we continue?’” says Dr. Joe Kvedar,
president of the American Telemedicine Association and Vice President of Connected Health
at Mass General Brigham.8
For providers, telehealth has many clear benefits. Firstly, using
technology to deliver healthcare mediates the shortages and imbalances of physicians that
have arisen during the pandemic by redistributing hospital resources to focus on the most
critical cases. For example, virtual visits can
reduce waiting room congestion and free
up hospital beds.9
Telehealth can improve
patient outcomes by preventing
readmissions and reducing emergency
department visits. In particular, remote
patient monitoring devices and software can
decrease hospital readmissions by alerting
doctors to specific concerning symptoms
before the patient is aware.10
Secondly,
virtual visits reduce the potential risk of
exposure to any illnesses, which is
particularly crucial during COVID-19. Finally, telehealth technology creates a new opportunity
for providers to generate a new revenue stream by reaching new patient markets with a new
service.11
Overall, telehealth can improve workflow efficiency by improving communication,
allowing for prioritization of care delivery, and facilitating the use of patient data for better
decision making.
8
Interview with Dr. Joe Kvedar, American Telemedicine Association
9
MedicalNewsToday, “Telemedicine Benefits: For Patients and Professionals.”
10
Healthcare Information and Management Systems Society, “Remote Patient Monitoring: COVID:19 Applications
and Policy Challenges.”
11
MedicalNewsToday, “Telemedicine Benefits: For Patients and Professionals.”
Telehealth benefits providers by allowing them to treat patients while improving
hospital efficiency, prioritizing care delivery, and mitigating chance of exposure to
COVID-19. However, telemedicine is not appropriate for all situations that don’t
require in-person interaction; it requires patients to have access to and familiarity
with the necessary technologies and may raise security concerns.
KEY TAKEAWAY
CONSPROS
Reduces hospital
congestion
Prevents
readmissions
Decreases
exposure risk
Creates new
revenue stream
Relies on patient
reporting
Applies only in
certain cases
Requires tech
access
Relies on data
security/privacy
7. 7Harvard College Consulting Group
Cambridge, MA 02138
www.harvardconsulting.org
info@harvardconsulting.org
However, as with any disruptive innovation, telemedicine technologies also have drawbacks.
During a virtual visit, providers must rely on patient self-reports when making treatment and
diagnosis decisions rather than their own assessments. Dr. Kvedar notes that there are specific
use cases that are not appropriate for telemedicine: “There are things like breaking the news
that you have cancer; I think that’s probably better done in person. What’s the emotional
overhead involved with this medical translation? If it’s low, then you don’t need to touch the
patient, then telehealth is perfect.”12
Additionally, doctors may face difficulties with patient
adoption. Patients without access to smartphones, computers, or internet connections will not
be able to use telemedicine services; these issues are particularly relevant to rural and low-
income populations. Patients with a lack of technological literacy, certain disabilities, or poor
English proficiency may also face difficulties with virtual visits or other forms of telemedicine.
Finally, some doctors may have concerns regarding data security and HIPAA compliance
when implementing telemedicine for their practices.13
These adoption and access issues are
discussed at length in this paper.
4.2 HIPAA Regulations
Prior to the pandemic, patient and data privacy was a major concern for telehealth; however,
during the pandemic, these concerns have been sidelined in order to prioritize the accessibility
of healthcare. In turn, the Office of Civil Rights and the Department of Health and Human
Services have waived penalties for violations of the HIPAA Privacy, Security, and Breach
Notification Rules.14
This waiver allows providers to deliver telehealth care to patients using any
non-public communication platform, such as Zoom or Facetime. However, experts like Dr.
12
Interview with Dr. Joe Kvedar, American Telemedicine Association
13
Calton, Abedini, and Fratkin, “Telemedicine in the Time of Coronavirus.”
14
U.S. Department of Health & Human Services, “Notification of Enforcement Discretion for Telehealth Remote
Communications During the COVID-19 Nationwide Public Health Emergency.”
There are things like breaking the news that you have cancer; I think that’s probably better done
in person. What’s the emotional overhead involved with this medical translation? If it’s low, and
you don’t need to touch the patient, then telehealth is perfect.
During the pandemic, HIPAA Rules were waived for telemedicine, allowing patients
to access care using familiar platforms and increasing patient comfort with
telemedicine – but blanket regulation overhauls are unlikely to endure in the long
run.
KEY TAKEAWAY
8. 8Harvard College Consulting Group
Cambridge, MA 02138
www.harvardconsulting.org
info@harvardconsulting.org
Kvedar and Thomas (TJ) Ferrante, senior counsel and member of the Telemedicine and Digital
Health Industry Team at Foley & Lardner LLP, think that these policy changes will be temporary
and that the typical HIPAA Rules will be reinstated following the pandemic. “I’m sure that we will
go back to some tight restrictions around what platforms we can use,” says Dr. Kvedar.
Generally, experts believe that it is important for platforms and providers to follow the
established regulations for HIPAA and data security in order to protect patients and their
privacy, and therefore expect a return to pre-pandemic measures.15
In turn, there are steps that
providers can take to prepare for the reinstatement of these regulations in the future in addition
to transitioning to a HIPAA compliant communication platform. Ferrante makes the following
suggestions: “Doctors would want to make sure that the way they’re collecting their patients’
data meets security standards under the law and that they disclose what they're doing with
patient data. They were forced to jump in the deep end of the pool because of COVID, but they
should take a breath and try to reassess what they’re actually operationalizing and make sure
that they understand the rules and that they’re compliant with them.”16
In order to assess their
compliance, doctors should make sure that any telemedicine services they implement during
the pandemic can be adjusted to meet the traditional security measures and, where applicable,
reevaluate the use of specific videoconferencing services. In the meantime, the alleviated
restrictions on HIPAA rules allows patients to use familiar platforms for telehealth services,
increasing their comfort and encouraging integration of telehealth into healthcare infrastructure.
4.3 Telehealth Infrastructure
With adoption accelerating throughout COVID-19, telehealth is expected to remain an
everyday tool even after the pandemic. According to Neil Gomes, Executive Vice President for
technology innovation at Thomas Jefferson University, telehealth usage increased from
approximately 40 visits a day to over 4,000 visits a day at the Thomas Jefferson University
Hospital.17
Apart from faster and more efficient care delivery, increased telehealth usage
allows for improved data gathering and reporting capabilities as well as enhanced physician
workflow management.18
Telehealth usage has also spurred innovation and adoption of new
technologies. For instance, virtual telehealth visits are being integrated with electronic health
15
mHealth Intelligence, “Experts Weigh in on Post-COVID-19 Telehealth Rules and Policies.”
16
Interview with Thomas (TJ) Ferrante, Foley & Lardner LLP
17
Interview with Neil Gomes, Thomas Jefferson University
18
Laura Dyrda, “The Legacy of COVID-19: How Key Innovations Will Outlive the Pandemic. Uncertainty Breeds
Innovation, and These Are among the Most Uncertain Times in Healthcare.,” Becker's Hospital Review, 2020
Government agencies have increased funding for telemedicine during the
pandemic, which will play a major role in expanding access to internet and
technology for underserved patients.
KEY TAKEAWAY
9. 9Harvard College Consulting Group
Cambridge, MA 02138
www.harvardconsulting.org
info@harvardconsulting.org
record systems, which can reduce physicians’ time and energy typically spent navigating
between platforms.19
Similarly, chatbots are experiencing increased usage, according to
Gomes. Chatbots are able to answer general patient questions as well as screen individuals
with certain symptoms. Melissa Buckley, director of the CHCF Health Innovation Fund,
predicts investments in such telehealth innovations will continue occurring given the current
necessity of telehealth and its expected continued relevance.20
In addition to the adjustments to the HIPAA rules,
the Federal Communications Commission
announced a $200 million dollar program to
support healthcare providers in purchasing
telecommunications services and devices necessary
for telemedicine.21
Ferrante notes that this program
will be instrumental in helping healthcare providers
implement the technological infrastructure needed
for the widespread adoption of telehealth. In
particular, this funding will be used to increase
access to broadband and Wi-Fi for patients in their
homes. “If people who live in rural America don’t
have access to that kind of infrastructure, they lose out on a lot of the access to some of these
technologies that really do rely on internet service, whether that be connected to Ethernet or
WiFi. What is going to need to happen is to have a national investment into broadband
infrastructure,” he says.22
As the healthcare industry shifts to incorporate greater use of
telehealth services, it is likely that there will be further expansion of broadband access in order
to make virtual care available for all Americans.
4.4 Healthcare Infrastructure
While healthtech has grown rapidly in recent years, the COVID-19 pandemic may accelerate
adoption of healthcare technologies. Specifically, technologies that increase patient and
population safety (as opposed to technology related to the payment and productivity of care)
19
Melissa Buckley, “Technology's Emerging Role in the COVID-19 Response,” California Health Care Foundation
20
Interview with Melissa Buckley, California Health Care Foundation
21
Federal Communications Commision, “COVID-19 Telehealth Program.”
22
Interview with Thomas (TJ) Ferrante, Foley & Lardner LLP
$200M
from FCC
Wi-fi
Access
Broadband
Access
Video-
communication
Devices
Patients are willing to pay for risk-mitigating healthcare technologies that address
safety concerns. Such technologies, along with technologies that fill current gaps in
infrastructure (e.g. tracking hospital bed availability) will experience increased
adoption.
KEY TAKEAWAY
10. 10Harvard College Consulting Group
Cambridge, MA 02138
www.harvardconsulting.org
info@harvardconsulting.org
are expected to play a larger role in the healthcare system. These can be grouped into two
categories: risk-reducing and predictive technologies.
The public health emergency has influenced a number of patient behaviors, including risk
perception. Patients are more aware of public health risks, making them more willing to pay
for risk-mitigating technologies.23
Over 56% of respondents in HCCG’s July 2020 healthcare
survey reported that healthcare clinics should incorporate technologies to address public
health concerns despite increased costs.24
In turn, providers have a greater incentive to
develop and deploy technologies that satisfy newfound safety demands. For instance,
according to Gomes, a number of hospitals are implementing hands-free temperature sensors
and health questionnaires on smartphones to quickly screen for COVID-19.25
However, in
order to spur widespread adoption, upcoming healthcare technologies cannot simply satisfy
new demands for safety; they must also fulfill a basic, unmet need. The pandemic has revealed
massive gaps within general healthcare availability, such as tracking hospital bed availability.
In the near future, it can be expected that central dashboards to better manage bed and
doctor availability will be implemented. Similar systems are already running in German
23
Hong Luo and Alberto Galassco, “The One Good Thing Caused by COVID-19: Innovation,” HBS Working
Knowledge, May 7, 2020
24
Result from HCCG’s July 2020 Healthcare Survey
25
Interview with Neil Gomes, Thomas Jefferson University
11. 11Harvard College Consulting Group
Cambridge, MA 02138
www.harvardconsulting.org
info@harvardconsulting.org
hospitals and have not only demonstrated improved hospital bed utilization, but also
decreased cramped conditions, improving patient safety.26
Another technology that fulfills
safety demands and offloads hospital staff are robots designed to collect trash, deliver meals,
and administer medicine. Although such robots and drones are increasingly being used in
China, this particular technology is not currently deemed essential enough to warrant huge
investment and may require additional years before complete adoption.27
Overall, healthcare
is experiencing a shift towards increased automation, in hopes of increasing safety and
efficacy in the system.
Meanwhile, predictive health driven by data and algorithms is increasingly being adopted to
monitor disease spread within populations. In order to create such models, a number of
technologies including Internet of Things (IoT), big data analytics, machine learning, and
blockchain technology, must seamlessly interconnect.28
Increased surveillance via IoT
provides the data that can be used for predictive health. The large collected data sets are then
processed and analyzed in order to model disease transmission, forecast spread, or predict
preparedness of countries to fight an outbreak. Meanwhile, artificial intelligence and machine
learning can be used as a screening tool to improve disease diagnosis and assist in
therapeutic development. Finally, this entire process is enhanced by blockchain technologies
to ensure security and traceability of data. All in all, predictive health can be used to
understand and enhance the safety of larger population groups.29
There is a general
consensus among HCCG’s survey respondents, with over 73% of responses indicating
agreement towards increased collection and use of data to monitor and model disease
activity.30
Although such technologies require transparent communication regarding data
access and processing to prevent overstepping personal data, we can expect to see more and
more predictive health tools used in healthcare settings.
26
Laura Dyrda, “The Legacy of COVID-19: How Key Innovations Will Outlive the Pandemic. Uncertainty Breeds
Innovation, and These Are among the Most Uncertain Times in Healthcare.,” Becker's Hospital Review, 2020
27
Hong Luo and Alberto Galassco
28
Muin Khoury, “Using Digital Technologies in Precision Public Health: COVID-19 and Beyond”
29
Daniel Shu Wei Ting et al., “Digital Technology and COVID-19”
30
Result from HCCG’s July 2020 Healthcare Survey
12. 12Harvard College Consulting Group
Cambridge, MA 02138
www.harvardconsulting.org
info@harvardconsulting.org
4.5 Telehealth Implementation Strategies
Telehealth is a two way street – both the doctor and patient must be comfortable with the
technology for implementation to be successful. Ferrante substantiates this: “You have to
make sure that patients are going to be on board with it and you have to make sure that the
actual healthcare providers are on board with it. If either of those two segments aren't aligned
then you won’t have a product,” he says.31
In order to provide the greatest benefit for both
patients and providers, doctors must take a number of steps when implementing telehealth
technologies. First, providers can encourage patients to adopt virtual care services through in-
depth patient preparation and education. Patients should be made aware of their
telemedicine options and which are best suited for their specific conditions.32
“You probably
need to do a little bit of marketing around it, that you’re offering the services and what they
are, and make sure there’s coverage so that someone is available to take those calls when they
come in,” Dr. Kvedar says.33
Patients should be provided with step by step instructions on how
31
Interview with Thomas (TJ) Ferrante, Foley & Lardner LLP
32
Portnoy, Waller, and Elliot, “Telemedicine in the Era of COVID-19.”
33
Interview with Dr. Joe Kvedar, American Telemedicine Association
Doctors can market telehealth directly to patients through education and coaching
on the involved benefits and expectations. Additionally, providers can prepare for
further integration of telehealth by organizing a triage system, focusing on target
patient populations, and responding to patient feedback.
KEY TAKEAWAY
13. 13Harvard College Consulting Group
Cambridge, MA 02138
www.harvardconsulting.org
info@harvardconsulting.org
to use any necessary software or devices, with the value and benefits of telehealth
being emphasized throughout. Before the visit, patients should be informed on guidelines for
the visit, such as video communication etiquette. Doctors should have a contingency plan if
the patient is late for a virtual visit or has problems with technology; for example, patients can
connect using a phone call in the event of technological issues. Following each visit, it is
crucial to measure both patient and provider satisfaction by offering a feedback survey.34
After the pandemic, more patients will seek in-person visits, but doctors can still take
advantage of telemedicine to reduce congestion and increase efficiency. Dr. Kvedar
emphasizes the importance of triaging when implementing telehealth, including determining
which patients are best suited for virtual care, reducing backlog, and communicating with
office and nursing staff.35
The future of telemedicine is likely to be determined by insurance
coverage and patient demand. In order to capitalize upon the acceleration of telehealth that
has occurred during the pandemic, doctors will need to take a number of steps. Providers can
focus on implementing telemedicine for target patient populations such as elderly patients,
patients with chronic conditions, and patients seeking therapy or behavioral counseling.
Additionally, doctors can study outcomes during the pandemic using thorough evaluation
and research to guide best practices in the future.36
These insights can help inform patients
and policymakers on the advantages of telemedicine and promote its continued use.
4.6 Nonphysician Providers
Nonphysician providers, or NPPs, are increasingly becoming the primary point of contact for
patients (the most common kind of NPPs are nurse practitioners or physicians’ assistants, but
other non-doctor providers fall into the category as well). Expanding the use of NPPs confers
34
MedCityNews, “8 tips from a nurse to make telehealth take off at your organization.”
35
Interview with Dr. Joe Kvedar, American Telemedicine Association
36
Calton, Abedini, and Fratkin, “Telemedicine in the Time of Coronavirus.”
Despite policy changes in the short run, the use of nonphysician providers is unlikely
to dramatically accelerate due to COVID-19. Instead their role can be expanded to
confer the benefits of lower costs and more efficient care to areas where the need
for adaptability is minimal.
KEY TAKEAWAY
You have to make sure that patients are going to be on board with it and you have to make sure
that the actual healthcare providers are on board with it. If either of those two segments aren’t
aligned, then you won’t have a product.
14. 14Harvard College Consulting Group
Cambridge, MA 02138
www.harvardconsulting.org
info@harvardconsulting.org
the benefits of more efficient patient interactions, lower costs, and as some studies have
found, even higher patient satisfaction.37
However, obstacles include pressure from physician
groups, patient hesitation to accept NPPs in place of doctors, state scope-of-practice laws
limiting the functions that NPPs can provide,38
and logistical limitations presented by too
broad a replacement of physicians with NPPs. The public health emergency has reduced
some of those obstacles in the short run; for example, CMS is using its authority under Section
1135 of the Social Security Act to allow NPPs to enroll as Medicare providers.39
But these
changes are limited even in the short run, and unlikely to endure in the long run. During the
pandemic, patients indicated general ambivalence towards receiving healthcare from NPPs,
and indicated 12% less openness to receiving healthcare from NPPs after the pandemic.
Furthermore, Douglas McCarthy, a research advisor at the Commonwealth Fund, warns that “if
the expansion of NPPs goes overboard, there will be a policy backlash” in the form of stricter
scope-of-practice laws and licensure requirements.40
Rather than expecting the elimination of
obstacles in the long-run, the expansion of NPPs is likely to see the most progress in areas
where collaboration with physicians is maximized and the expectation that NPPs will be forced
to handle complex, adaptable situations is minimized. For instance, NPPs would be better
utilized delivering routine home healthcare to elderly patients with the ability to contact
physicians in extreme circumstances rather than being expected to handle a wide variety of
patients as a primary care provider. Furthermore, this balanced, careful approach reduces the
possibility of policy backlash and an increase in restrictions. COVID-19 will not drastically
accelerate the role of NPPs in healthcare, but the current crisis provides an opportunity for
healthcare delivery to naturally realign the use of NPPs in even more effective ways.
4.7 Equitable Healthcare Guidance
The large majority of causes for racial health and healthcare inequities are beyond the scope
of the provider-patient relationship, but there are still concrete steps that providers can take to
do their part in working towards mitigating healthcare disparities. Foremost among these
steps is in combating implicit racial bias in the medical field which leads to lower quality of
care for minority groups. For example, African Americans are less likely to be tested for
37
Healthcare Finance, “Non-physician Providers: An Unexpected Route to Revenue Increases.”
38
Barton Associates, “Nurse Practitioner Scope of Practice Laws.”
39
Healthcare Business Management Association, “CMS Will Provide Temporary Enrollment Flexibilities.”
40
Interview with Douglas McCarthy, Commonwealth Fund
Providers should continually work towards eliminating bias in quality of care and, in
particular, be aware that medical and public health guidance is harder to comply
with for disadvantaged communities.
KEY TAKEAWAY
15. 15Harvard College Consulting Group
Cambridge, MA 02138
www.harvardconsulting.org
info@harvardconsulting.org
COVID-19 even when presenting the same symptoms as whites.41
In order to truly bridge the
racial healthcare disparity, providers must first combat the latent and implicit biases that are
present with the medical community. Techniques such as including implicit bias reduction
strategies in medical education, or the adoption of strategies where the provider views
interactions from the point of view of minority patients, or the implementation of broader
healthcare reforms to reduce patient loads have all been shown to be successful in reducing
provider implicit bias.42
Secondly, providers and policy makers must be aware of the broader
inequality that many racial minorities face and how those inequities shape their guidance.
Medical and public health guidance is harder to comply with for communities facing long-
term chronic unemployment, food insecurity, housing instability, higher rates of incarceration
and persecution, and subsequently higher rates of preexisting and underlying medical
conditions. Mandatory mask laws and social distancing requirements are harder to comply
with when long-term economic uncertainty is present and housing opportunities are crowded
and poorly maintained by authorities.43
Furthermore, residential racial segregation has forced
many individuals to travel long distances using public transit for work and to reach healthcare
facilities. Therefore, providers and policy makers must acknowledge and work to mitigate the
additional obstacles that many Americans face by shaping their medical and public health
guidance to better suit individual circumstances.
For policy makers, mitigating healthcare disparities goes beyond combating bias and
acknowledging the inequities. Policy makers must create and shape public policy that works
to undo generations of inequality across the spectrum. It is not possible to solve the racial
healthcare disparity in a vacuum. There are many steps involved in combating and changing
structural and institutional racism. In broad strokes, policy makers must acknowledge the need
for sweeping change and a greater level of support for historically marginalized racial groups
and in doing so work to address the long-term challenges facing individuals. Policy makers
should increase the level of investment in the education, housing, healthcare, and opportunity
for disinvested communities in order to combat the generations of structural racism.
41
Rubix Life Sciences, “Health Data in the COVID-19 Crisis”
42
Social Science & Medicine Vol, “A decade of studying implicit racial/ethnic bias in healthcare providers”
43
KFF, “Communities of Color at Higher Risk for Health and Economic Challenges due to COVID-19”
16. 16Harvard College Consulting Group
Cambridge, MA 02138
www.harvardconsulting.org
info@harvardconsulting.org
5. Patients
5.1 Inequalities Exacerbated by COVID-19
COVID-19 has significantly negatively impacted the already present racial inequities in both
health and healthcare. Racial and ethnic minorities have, on average, worse health than whites
before COVID-19 and have persisted and worsened in the COVID-19 era.44
To reiterate, the
health inequities present are not due to race, but to structural, institutional, and individual
racism that has perpetuated a system of worsened health and healthcare for millions of
Americans.45
The minutiae of the topic are beyond the scope of this paper and are a complex
and tangled web of issues, but in broad strokes communities of color, on average, have lower
access to quality healthcare (lack of proper insurance, geographic distance to healthcare
facilities, implicit bias in providers, etc.) resulting in worse health profiles than whites, even
when controlled for socioeconomic status.46
Due to the diminished health of stigmatized groups before COVID-19, the incidence and
severity is higher among these racial groups than whites. This has primarily manifested due to
two reasons, but there are many factors that play into the broader picture: 1) a greater
prevalence of preexisting conditions, such as diabetes, heart disease, and lung disease, has
44
Ibid.
45
David R. Williams, “COVID-19 and Health Equity – A New Kind of ‘Herd Immunity’”
46
David R. Williams, “Understanding how discrimination can affect health”
A greater prevalence of preexisting conditions and lower quality of and access to
healthcare has increased the frequency and severity of COVID-19 infections among
racial and ethnic minorities.
KEY TAKEAWAY
17. 17Harvard College Consulting Group
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increased the vulnerability of individuals, and 2) lower quality of and access to healthcare has
prevented timely and accurate testing and treatment of individuals with COVID-19.47 48
This healthcare disparity has resulted in many racial inequities such as an age-adjusted
hospitalization rate that is 5 times higher for non-Hispanic American Indian, Alaska Native, and
black individuals and 4 times higher for Hispanic individuals than non-Hispanic white
individuals.49
5.2 Telehealth’s Impact on Accessibility
A diminished access to quality healthcare is one of many barriers causing racial inequities in
health, but this obstacle can be overcome, at least partially, through the expanded use of
telehealth. Many American communities face racial residential segregation and lower access
to preventative care facilities which leaves room for an expanded role of telehealth in their
preventative care system.50
However, an expanded telehealth presence must be done in
concert to address the structural racism that individuals face. For example, underinsurance
and subsequently the cost of care is one aspect of the barrier to care that individuals may face,
therefore increased telehealth access must follow policies to reduce the overall cost of care in
order to be most effective. Furthermore, other structural barriers such as access to mobile
devices and high-speed internet, educational materials, and social awareness must all be
addressed in order for telehealth to have a greater impact in increasing the accessibility and
decreasing healthcare inequities.51
47
Clyde W. Yancy, “COVID-19 and African Americans”
48
Dorn, A. V., Cooney, R. E., & Sabin, M. L. “COVID-19 exacerbating inequalities in the US”
49
CDC, “COVID-19 in Racial and Ethnic Minority Groups”
50
KFF, “Communities of Color at Higher Risk for Health and Economic Challenges due to COVID-19”
51
David R. Williams, “Racism and Health: Evidence and Needed Research”
Telehealth has the potential to increase accessibility for disadvantaged
communities, but other structural barriers will still persist.
KEY TAKEAWAY
18. 18Harvard College Consulting Group
Cambridge, MA 02138
www.harvardconsulting.org
info@harvardconsulting.org
5.3 Willingness to Accept Home-Based Model
The pandemic has highlighted that nursing home stays oftentimes result in patient neglect,
isolation, depression, and medical deterioration. Many people prefer a stay-at-home option
over nursing homes; however, over 62% of Medicaid funding for long term care is distributed
to nursing homes.52
With the pandemic exposing systemic problems in the nursing home
system, patients can expect to see a re-evaluation of Medicaid funding and Medicare
coverage. Medicaid may become more focused on home- and community-based care, and
Medicare may increase coverage of home health care. Melissa Buckley, director of the CHCF
Health Innovation Fund, cites increased utilization of Ready Responders, an on-demand at-
home healthcare service in New York, as evidence of patient willingness to accept home-
based care.53
5.4 Telehealth Adoption and Experience
For patients, telehealth services offer a number of benefits by allowing them to interface with
their healthcare provider in a virtual setting. Remote medical services provide patients
convenient access to care from the privacy and comfort of their own homes. Telehealth can
also reduce geographic or financial barriers to care by reducing secondary expenses like
transportation costs or childcare. During the COVID-19 pandemic, telehealth has allowed
patients to access treatment without fear of contracting the virus while in the doctor’s office;
this is especially important for elderly or immunocompromised patients. Additionally,
52
Raymond Castro, “The 'American Health Care Act' Would Cause Nearly Half a Million New Jerseyans to Lose Health
Coverage”
53
Interview with Melissa Buckley, California Health Care Foundation
Patients are especially eager to receive community- and home-based care over
nursing home stays.
KEY TAKEAWAY
For patients, telehealth services allow accessible and convenient care while
reducing secondary expenses and transmission of COVID-19. However, common
forms of telehealth, including virtual visits, remote patient monitoring, and home
diagnostics, are currently limited by technological capabilities, most notably internet
speed and access.
KEY TAKEAWAY
19. 19Harvard College Consulting Group
Cambridge, MA 02138
www.harvardconsulting.org
info@harvardconsulting.org
coronavirus patients that are not in critical condition can be treated and self-monitored
at home, reducing the risk of transmission to healthcare providers and other patients.54
There are a wide variety of telehealth products and services available to patients. The most
common form of telehealth is the virtual visit, which allows patients to interface with a doctor
over a designated telemedicine platform, another telecommunication software like Zoom or
Facetime, or a phone call. During the visit, the physician can evaluate the patient’s symptoms,
diagnose their conditions, and provide guidance and treatments like prescriptions or lab
orders. Often, virtual visits are equally as effective as in-person visits. Virtual visits can be used
to address a wide variety of non-emergency conditions, including post-surgery care,
prescription refill, or therapy and counseling.55
Dr. Joe Kvedar, president of the American
Telemedicine Association and Vice President of Connected Health at Mass General Brigham,
emphasizes mental health and chronic care as key areas for telehealth usage: “Mental health is
number one and will continue to be in there as the physical exam is talking to that patient and
watching them, so video is perfect for that. Second: follow up care for chronic illness[es]”.56
Another well-known form of telehealth is remote patient monitoring (RPM). RPM involves the
use of devices and software to enable patients and physicians to track disease and symptom
progression. RPM devices are often wearable or non-invasive and transmit data to the
physician for review. With RPM sensors, physicians can monitor temperature, blood pressure,
oxygen levels, and other metrics and can use data analytics to assess change in condition over
time. Physicians are also notified when there are significant changes in a patient’s condition.57
Based on the data, physicians can modify patients’ treatment plans or educate patients on self-
care. “Doctor’s offices are now moving towards remote patient monitoring, and that allows
better management for chronic conditions in particular. So, if you have diabetes management
or chronic heart failure, those kinds of disease states really benefit from the ongoing sort of
information collection and review by a practitioner to intervene,” says Thomas (TJ) Ferrante,
senior counsel and member of the Telemedicine and Digital Health Industry Team at Foley &
Lardner LLP.58
Although RPM is most commonly used in chronic situations, it is increasingly
being used for acute conditions so that those patients do not need to stay in the hospital.59
54
MedicalNewsToday, “Telemedicine benefits: For patients and professionals.”
55
Smithsonian Magazine, “Is COVID-19 the Tipping Point for Telemedicine?”
56
Interview with Dr. Joe Kvedar, American Telemedicine Association
57
Healthcare Information and Management Systems Society, “Remote Patient Monitoring: COVID:19 Applications
and Policy Challenges.”
58
Interview with Thomas (TJ) Ferrante, Foley & Lardner LLP
59
Ibid.
Doctor’s offices are now moving towards remote patient monitoring, and that allows better
management for chronic conditions in particular. So, if you have diabetes management or
chronic heart failure, those kinds of disease states really benefit from the ongoing sort of
information collection and review by a practitioner to intervene.
20. 20Harvard College Consulting Group
Cambridge, MA 02138
www.harvardconsulting.org
info@harvardconsulting.org
Finally, an emerging area of telehealth is in-home diagnostics. In-home diagnostic tests allow
patients to test themselves for specific conditions and transmit their results to their healthcare
provider wirelessly, saving both doctors and patients time and money. Dr. Kvedar expects to
see major growth in home diagnostics in the coming years: “I think home testing is a really
interesting growing area. Digital biomarkers is another one where software is coming out, for
instance, that by the sound of your cough, can diagnose pneumonia.”60
Many home
diagnostics technologies are still in development and are not yet in widespread use. However,
the pandemic has generated incentives for the use of these tests, and a number of companies
are working on developing at-home diagnostic tests for coronavirus.61
In order to take advantage of telehealth services, patients need to have access to and
familiarity with technology. For a virtual visit, patients must have a desktop, laptop, or phone
enabled with a camera or microphone. Additionally, for all forms of telehealth, patients must
have a data plan or wifi connection to connect to the software and transmit information to
their physician. Finally, most patients will need to be English speaking for virtual visits or will
need a patient liaison or family member to facilitate communication.62
Ferrante credits the
combination of technological innovation and the isolation of the pandemic for the recent
boost of telehealth adoption: “As technological advancements happen, and broadband gets
more accessible and faster, you're seeing the results in the actual products themselves. That is
helping users become more likely to use it and feel comfortable with it, and the same with
physicians. So, for the COVID-19 pandemic, one of the silver linings has been that it's really
pushed telehealth in front of the whole world and put it under the spotlight for everyone to
see.”63
60
Interview with Dr. Joe Kvedar, American Telemedicine Association
61
TechnologyNetworks, “Home Testing is the Future and One Day It Might Even Replace Your Doctor.”
62
Gorverning: The Future of States and Localities, “Telemedicine Works Great When Patients Have Access.
63
Ferrante
21. 21Harvard College Consulting Group
Cambridge, MA 02138
www.harvardconsulting.org
info@harvardconsulting.org
6. Policy Makers
6.1 Public Healthcare with respect to Telehealth
COVID-19 has significantly accelerated the timeline for the adoption of telehealth by
providers and physicians; the same is largely true for the policy landscape around telehealth,
with a few caveats. Before the pandemic, Medicare policy strictly limited the use of telehealth
to specific instances (for instance, rural hospitals).64
Medicaid, with its “fifty states, fifty
approaches” model, included much more flexibility for telehealth before COVID-19; all 50
states provided reimbursement for some variety of live video services. During the public
health emergency, Medicare restrictions in particular have been significantly relaxed. This
includes waiving limitations on the type of care providers eligible for Medicare
reimbursement; new rules that Medicare can now be billed as originating site for telehealth
services; the ability for audio-only phone services to be reimbursable through Medicare;
federally qualified health clinics and rural health clinics can be reimbursed for telehealth;
waiving video requirements for evaluation/management services; and Medicare Advantage
discounts for telehealth services.65
The rapid adoption of telehealth has brought the benefits
of telehealth to the forefront of the policymaking process - namely, patient choice, enhanced
connections with particularly vulnerable populations, an expanded care continuum, and
reduced cost for public programs already operating on thin margins.
These benefits were present before the crisis, but COVID-19 has provided the opportunity for
them to be fully realized. For Medicare, these expansions will stay in place during the
indefinite length of the public health emergency. Beyond this, Seema Verma, the head of
CMS, has said she “can’t imagine going back” from the current looser regulatory
environment,66
and bipartisan legislation has been introduced in Congress to make the new
regulations permanent.67
Similar progress is being made for state-level programs and
Medicaid - for example, a recent bill passed in Colorado bars health plans from imposing
limitations on telehealth use.68
64
HealthcareDive, “Telehealth Seeks to Move Beyond Flu, but Stymied by Regulations.”
65
Centers for Medicare and Medicaid Services, “Declared Public Health Emergencies – Health Standards and Quality
Issues.”
66
STAT, “Medicare Leader Calls for Expanded Telehealth Access After COVID-19.”
67
House Resolution 7187, 116th
Congress.
68
Bloomberg Law, “Telehealth Barriers Smoothed Under New Colorado Law.”
Rapid changes were made to previously divergent Medicare and Medicaid
telehealth policy due to the pandemic. As these changes move towards
permanency, issues of patient data access and optimizing regulations bear
consideration.
KEY TAKEAWAY
22. 22Harvard College Consulting Group
Cambridge, MA 02138
www.harvardconsulting.org
info@harvardconsulting.org
However, there are two distinct and important considerations for policymakers to bear in mind
with regard to telehealth as the COVID-19 crisis evolves: patient data and sustainable
regulation. For one, the rapid, forced adoption of telehealth presents an opportunity to
empower patients through improved data access and interoperability, but if not implemented
well, data and accessibility policies could hinder patient access. Patients are willing to adopt
these measures; of those that indicated a preference, a majority of survey respondents to
HCCG’s July healthcare survey said they were “likely” or “extremely likely” to use data services
afforded by telehealth to take control of doctor choice and to feel more confident in their
health outcomes (86.5% and 75.4%, respectively).69
Efforts like the MyEHealthData system
from CMS (which allows patients to access and track usage of their healthcare data) can
capitalize on this opportunity and ensure patient data engagement remains at the center of
healthcare in the long-term.70
In order to ensure that programs are actually desirable and effective, policymakers should
build them from the patient experience outward. Eleanor Perfetto, a senior researcher at the
National Health Council, says that “the lack of patient engagement would be crippling” to
future development of data-focused solutions.71
The other major consideration is that a
blanket repeal of all regulations could lead to adverse effects (for instance, billing telephone-
only calls as a service equal in quality to advanced telehealth systems is not sustainable).
Perfetto says that the landscape for telehealth “is and will remain different,” and that the crisis
provides an opportunity to study which regulations work and which ought to remain scaled
back. As the crisis continues, robust measurement of what applications of telehealth are most
effective for particular populations and diseases (as a bill introduced in Congress in early June
would do)72
can ensure an optimal effort towards building policy in the long term.
6.2 Telehealth Policy
69
Results from HCCG July 2020 Healthcare Survey
70
Centers for Medicare and Medicaid Services, “Administration Announces MyHealthEData Initiative.”
71
Interview with Dr. Eleanor Perfetto, National Health Council
72
Healthcare IT News, “New Bill Would Mandate Research on Telehealth Regulations.”
Telehealth policy changes adopted during the pandemic include increased
reimbursement, removal of state licensure barriers, and waiving of requirements for
patient locations. Supporters of telehealth have been lobbying for permanent policy
changes in the areas of reimbursement, HIPAA and platform, and state licensure, all
adjustments that could transform the future of healthcare.
KEY TAKEAWAY
23. 23Harvard College Consulting Group
Cambridge, MA 02138
www.harvardconsulting.org
info@harvardconsulting.org
Prior to the pandemic, there were a number of policy restrictions that limited provider
and patient adoption of telehealth services. “For example, if you want to get paid by Medicare
for delivering telehealth services, the patient has to be in a qualifying rural area. The patient
has to be in an originating facility, which is typically is a hospital or a skilled nursing facility or
doctor's office, the patient's home
wouldn’t count and you couldn’t
get paid for that. And then there
has to be a certain set of providers
and certain CPT (current
procedural terminology) codes,”
says Thomas (TJ) Ferrante, senior
counsel and member of the
Telemedicine and Digital Health
Industry Team at Foley & Lardner
LLP. “So, we put all that together
and it really hasn’t resulted in great
use in this country for telehealth,
particularly the Medicare
beneficiaries.” 73
As a result of the
COVID-19 public health emergency and national disaster, government entities such as
Centers for Medicare & Medicaid Services (CMS) and the Department of Health and Human
Services (HHS), eliminated many of the restrictions that had been in contention, including the
originating site and rural area requirements.74
A number of crucial steps have been taken to adjust existing policies during the pandemic,
resulting in the rapid adoption of telehealth. First, CMS has implemented a temporary
expansion of telehealth coverage. The following changes fall under this expansion: telehealth
is reimbursed for all Medicare beneficiaries; physicians can provide telehealth services across
state lines; therapists are no longer restricted from providing telehealth services; payments
are increased for telephone only visits; and there is no pre-existing relationship needed
between the patient and the provider.75
CMS has also released a telehealth toolkit designed
to accelerate the adoption of state telehealth coverage policies. This toolkit includes
73
Interview with Thomas (TJ) Ferrante, Foley & Lardner LLP
74
Department of Health and Human Services, “Telehealth: Delivering Care Safely During COVID-19.”
75
Center for Medicare and Medicaid Services, “Coronavirus Press Releases.”
One of the things that we’d like to see continue is reimbursement by health plans for audio-only
interactions; we can do a lot that way…Ideal reimbursement is something that’s value-based,
where we get paid for quality and outcomes. We can use any care delivery model we want within
that context; telehealth flourishes in those kinds of settings.
TELEHEALTH
POLICY
CHANGES
Removal of state
licensure barriers
Wider range of
practitioners can
deliver telehealth
Reimbursement
for all Medicare
beneficiaries
No pre-existing
relationship
requirement
Waiving of the originating site
requirement
Increased payment for
telephone only visits
24. 24Harvard College Consulting Group
Cambridge, MA 02138
www.harvardconsulting.org
info@harvardconsulting.org
information on eligible patient populations, coverage and reimbursement policies, eligible
healthcare providers, technology requirements, and pediatric considerations.76
Policymakers will play a significant role in maintaining the momentum of telehealth and
incentivizing providers to adopt telehealth technologies. Many doctors are eager to see the
telehealth waivers enacted during the pandemic made permanent, particularly those waiving
guidelines that limit telehealth to rural areas, restrict coverage in the patient’s home, and
prevent all Medicare beneficiaries from continuing to use telehealth services.77
Dr. Joe
Kvedar, president of the American Telemedicine Association and Vice President of Connected
Health at Mass General Brigham: “There’s something called the originating site rule and it’s
been waived through the public health emergency, but what it used to be with Medicare was
that the patient has to be in the health professional shortage area, which has a very specific
definition.”78
Dr. Kvedar highlights three areas where doctors hope to see permanent policy
change: reimbursement, HIPAA and platform security, and state licensure. “One of the things
that we’d like to see continue is reimbursement by health plans for audio-only interactions; we
can do a lot that way,” he says. “Ideal reimbursement is something that’s value-based, where
we get paid for quality and outcomes. We can use any care delivery model we want within that
context; telehealth flourishes in those kinds of settings.” Additionally, current licensure policies
vary across state lines, and the process to obtain cross-border licensure can be lengthy and
expensive. As a policy solution, Kvedar envisions regional licensing that would permit
providers licensed in one state to treat patients across state lines without additional licenses.79
In the future, Ferrante foresees the removal of originating site requirements and the
expansion of telehealth coverage and payment parity under commercial health plans.
However, he notes that CMS does not have the legal authority to change these policies
permanently on its own. “It has to be an act of Congress, actual legislation. So, there's been a
lot of lobbying effort, a lot of pressure happening in the last few weeks to try to push Congress
to pass laws that would make some of these relaxed rules become more permanent,” he
states.80
In order to help generate policy change, stakeholders in healthcare can write to their
congressional leadership, provide feedback on the CMS Physician Fee schedule, or join
telemedicine associations. These policy changes are likely to define the future of telehealth
technologies for patients and providers.
76
Center for Medicare and Medicaid Services, “State Medicaid & CHIP Telehealth Toolkit: Policy Considerations for
States Expanding Use of Telehealth (COVID-19 Version).”
77
mHealth Intelligence, “Experts Weigh in on Post-COVID-19 Telehealth Rules and Policies.”
78
Interview with Dr. Joe Kvedar, American Telemedicine Association
79
Ibid.
80
Interview with Thomas (TJ) Ferrante, Foley & Lardner LLP
25. 25Harvard College Consulting Group
Cambridge, MA 02138
www.harvardconsulting.org
info@harvardconsulting.org
6.3 Public Healthcare in General
COVID-19 will change the landscape for public healthcare in the United States in specific,
rather than broad-based, ways. As the pandemic has laid bare inequities and inefficiencies in
the privatized healthcare system, the economic and health crisis in the US has been
compounded by the unique extent to which healthcare is tied to employment.81
With mass
unemployment induced by the coronavirus and associated public health measures, one
option is to decouple employment from health insurance status. The most extreme solution
would be a fully public healthcare plan. Politicians have made the case that a single-payer,
public system (most commonly conceived as Medicare for All) is needed more than ever.82
However, public opinion on Medicare for all does not appear to have shifted drastically over
the course of the pandemic; according to monthly aggregate polling data from the Kaiser
Family Foundation, 56% of voters supported a national single-payer health plan in January,
before the pandemic; in May, that number remained at 56%.83
Another way to address the
coupling of employment and healthcare would be through stimulus measures that include
wage subsidies; under this plan, the government pays workers’ wages in order to maintain
their relationship with their employer during an economic crisis. Wage subsidies have been
pursued by other developed nations with high degrees of success; while the US
unemployment rate has neared 20%, Germany has no change in employment due to its wage
subsidy policy.84
However, wage subsidies would be a significant investment and reorientation
of the US’ patchwork approach of loans and unemployment and are not likely to be pursued
as a future measure in the short term — although they were proposed by a bipartisan group of
lawmakers in the early stages of the COVID recession response.85
Without significant movement in public opinion on nationalized healthcare, and with an
extremely low probability of any legislation creating a Medicare-for-all system or other
extreme policies like wage subsidies passing Congress, expansions of public healthcare in
response to COVID-19 are most likely to succeed within existing policy infrastructure. For
example, 14 states have not expanded Medicaid under the Affordable Care Act (ACA). The
81
Niskanen Center, “What’s Wrong with Employer-Sponsored Health Insurance?”
82
For an example, see the following op-ed: Chicago Sun Times, “Coronavirus Makes it More Clear Than Ever:
Healthcare is a Human Right.”
83
Kaiser Family Foundation, “Public Opinion on Single-Payer, National Health Plans.”
84
Brookings Institution, “The Effect of COVID-19 on Labor Markets.”
85
House Resolution 6918, 116th
Congress.
While their appeal might seem greater, radical healthcare policy overhauls like
Medicare for All are unlikely to rapidly emerge as a result of COVID-19. However,
the crisis does provide an opportunity for many innovations and optimizations
within the existing policy infrastructure to be realized.
KEY TAKEAWAY
26. 26Harvard College Consulting Group
Cambridge, MA 02138
www.harvardconsulting.org
info@harvardconsulting.org
ACA allows states to expand Medicaid access to uninsured adults who earn up to 138% of the
federal poverty level, with the federal government covering 90% of the costs. In June, the first
Medicaid expansion during the coronavirus went to a ballot initiative in Oklahoma, where it
narrowly passed.86
With mass unemployment creating more uninsured adults, a positive
feedback loop is established between worsening health outcomes and the economy;
expanding Medicaid significantly halts this tailspin. However, Carolyn Yocom, a researcher at
the Government Accountability Office specializing in Medicaid, warns that states that have not
yet expanded Medicaid still have a significant amount of inertia of adoption, even with the
pandemic; Yocom calls Medicaid expansions “a practical matter of what states can afford, and
a tricky thing for states to balance as they tighten their belts” with declining revenues.87
To alleviate this, the federal government could incentive Medicaid expansion and alleviate
cost concerns by returning to covering 100% of the costs- not 90%, as is currently the case
(originally, the federal government covered 100% of costs, but the federal share declined to
90%, where it will stay indefinitely unless action is taken otherwise).88
Other ways to use public
insurance to lessen the negative impacts from COVID-19 include designing a sustainable
policy on telehealth (as previously described), similarly shifting Medicaid regulations to
encourage more home-based and community care (which is supported by 87% of survey
respondents who indicated preference);89
loosening regulations for federally qualified health
centers to allow them to provide emergency services, receive payment at hospital rates, and
expand primary care capacity;90
earmarking funds specifically for rural healthcare facilities as a
86
NPR, “Oklahoma Votes for Medicaid Expansion Over Objections of Republican State Leaders.”
87
Interview with Carolyn Yocom, U.S. Government Accountability Office
88
Center on Budget and Policy Priorities, “Medicaid Expansion Continues to Benefit State Budgets.”
89
Results from HCCG July 2020 Healthcare Survey
90
Rural Health Information Hub, “Federally Qualified Health Centers.”
27. 27Harvard College Consulting Group
Cambridge, MA 02138
www.harvardconsulting.org
info@harvardconsulting.org
part of future federal relief packages (rural providers are disproportionately affected by the
pandemic)91
, and using emergency waivers to promote budget blending92
and state-level
policy experimentation (for example, a series of initiatives funded by emergency Section 1115
waivers in North Carolina includes addressing homelessness as a public health matter,
expanding the provision of behavioral therapy, and more).93
While COVID-19 might not
radically change the landscape for a Medicare for all-style national plan becoming
institutionalized in the United States, beneficial policy options within existing structures
present a unique opportunity to maximize the potential of public healthcare.
6.4 Vaccines
In the short run, the development and distribution of a COVID-19 vaccine presents a number
of policy challenges with far-ranging implications. The precise timeline of vaccine
development remains unclear, as does the possibility of multiple viable vaccines coming in
waves.94
After the scientific development of a vaccine, the rapid distribution of a vaccine at the
national and global scale is another matter entirely. For both of these phases, policymakers
will see considerably more success from pursuing a proactive path. In the development phase,
this takes the form of balancing safety concerns and oversight with support for as rapid a
process as possible. The push to expand nationwide coronavirus testing provides a cautionary
example; during the critical phase before tests were needed at scale, the FDA failed to widely
grant Emergency Use Authorization (EUA), a policy through which the approval process for
drugs or products is shortened. The agency eventually modified the EUA process in February,
but by then, critical weeks had passed and testing efforts had been hamstrung.95
When it
comes to EUA for a COVID vaccine, the stakes are even higher. In order to reduce the
regulatory burden on vaccine development in the safest way possible, policymakers ought to
establish a consistent standard well before a vaccine enters the distribution phase for how
EUA’s will be granted based on science and evidence, not political pressure.96
91
Health Affairs, “The COVID-19 Pandemic and Rural Hospitals.”
92
Brookings Institution, “Budgeting to Promote Social Objectives.”
93
North Carolina Department of Health and Human Services, March 27 Letter to Centers for Medicare and Medicaid
Services
94
USC News, “Coronavirus Vaccines are Coming, but When Will They Arrive?”
95
The Atlantic, “The 4 Key Reasons Why the US is So Behind on Coronavirus Testing.”
96
Clinical Trials Arena, “FDA May Be Risk-Averse to Grant Emergency Use for a COVID-19 Vaccine.”
Short term policy on vaccines should make every effort to avoid being an obstacle to
development and deployment. To ensure equitable and rapid vaccine distribution,
policymakers should establish proactive guidelines and pursue and aggressively
multilateral vaccine foreign policy.
KEY TAKEAWAY
28. 28Harvard College Consulting Group
Cambridge, MA 02138
www.harvardconsulting.org
info@harvardconsulting.org
After a vaccine is developed, policymakers can play a proactive role to ensure equitable and
broad distribution. One form this takes is vaccine prioritization, i.e., who should have access
first. In Texas, after the H1N1 vaccine became available, the first available vaccinations went to
healthcare workers. After that, providers were left with ambiguous directions from the CDC
that conflicted with the state government’s recommendation, and confusion over the order of
prioritization delayed distribution.97
The ethical issues of which populations receive access first
are difficult, but a concrete proactive plan that makes a difficult choice will serve policymakers
better than a reactive, patchwork response. It is more efficient for a difficult choice to be made
once at the federal level rather than those difficult choices being debated over and over again
at the state and local level. Next, the possibility that vaccine access will become another
reflection of inequality in the healthcare system can be overcome by considering vaccination
to be a public good and providing free access to at least the most vulnerable populations, if
not free access for all. Proactive statements like the current administration’s announcement98
in mid-June that vaccines will be free for those that cannot afford them are a step in the right
direction, but concrete policies (e.g. price controls) about vaccine access should be weighed
and put in place well before there is a vaccine to distribute. Beyond domestic distribution, if
the global distribution of the COVID vaccine distribution follows the pattern of past
pandemics, there will be significant inequities across countries. This type of “vaccine
nationalism” where countries develop and distribute vaccines with a solely inward focus is
incredibly dangerous; it will all but certainly lead to worse outcomes for countries without a
developed vaccine (which could even be the United States if another country acquires a
vaccine first) and prolong the pandemic worldwide.99
97
Texas Department of Health and Human Services, 2010 Final After-Action Report to H1N1 Pandemic.
98
CNBC, “Coronavirus Vaccine Will Be Made Free For Americans Who Can’t Afford It.”
99
Foreign Policy, “America First vs. The People’s Vaccine.”
29. 29Harvard College Consulting Group
Cambridge, MA 02138
www.harvardconsulting.org
info@harvardconsulting.org
To avoid this outcome, policymakers should pursue a multilateral vaccine foreign policy;
coordinating research across countries will promote a more rapid development phase, and
coordinating distribution approaches through partnerships with NGOs like GAVI, vaccine
bond structures, and establishing reliable global supply chains to understand supranational
stock and flow.100
Multilateral vaccine agreements between countries will be more effective if
established preemptively; the Coalition for Epidemic Preparedness Innovations, an
agreement founded by Norway and India, provides a framework for this.101
In addition to
these agreements, it is essential that nations participate in global institutions like the WHO
that act as centralized sources of information and standards. And although the current
administration has criticized the WHO for failing to apply proper scrutiny to early Chinese
communications about the virus, the policy of US withdrawal from the institution does not
adequately address that criticism (changes to the voting and governing structure of the
organization would be far more effective); furthermore, the move decreases global
coordination in vaccine distribution, which the US would undoubtedly benefit from.102
A
proactive vaccine development and distribution policy framework will allow the most effective
response to the current crisis by stopping regulation from being a burden to innovation,
ensuring rapid distribution through clearly communicated prioritization, protecting already
vulnerable populations from being punitively impacted by costs, and laying the groundwork
for global coordination. In the long term, this proactive approach can serve as a model for
response to future global pandemics and crises in contrast to the initially reactive responses to
the current crisis.
6.5 Supply Chains
100
Harvard Business Review, “A COVID-19 Will Need Equitable, Global Distribution.”
101
Global Research Collaboration for Infectious Disease Preparedness, “Coalition for Epidemic Preparedness
Innovations.”
102
JAMA Network, “COVID-19 Reveals Urgent Need to Strengthen the World Health Organization.”
While increasing tracking and reporting of medical equipment production is
beneficial in the short term, policymakers should consider collaborating with like-
minded countries to diversify suppliers and manufacturing plant locations.
KEY TAKEAWAY
30. 30Harvard College Consulting Group
Cambridge, MA 02138
www.harvardconsulting.org
info@harvardconsulting.org
The shock to the medical equipment supply
chain was one of the most widely-spoken
impacts of the COVID-19 pandemic. As
countries began establishing export
restrictions, huge vulnerabilities were
revealed in the supply chain. First and
foremost, the public health crisis exposed
the massive dependency on China for
medical supplies. In 2019, China exported a
total of $9.8 billion in medical equipment to
the United States. Furthermore, China
accounts for up to 75% of U.S. imports on
specific products, such as personal
protective equipment or sanitary bed articles .103
Through manufacturing reports, it also
became clear that the source of raw materials used in medical supplies is not well recorded.
Finally, over recent years, relaxation over what qualifies as a U.S. product has occurred,
masking true dependencies on other countries. Taken together, these vulnerabilities not only
led to shortages of medical equipment, but also to swift policy considerations.
Overall, we can expect to see increased tracking of raw materials and more accurate reporting
on production processes in the near future as well as diversification and onshoring of U.S.
medical supplies in the more distant future. The Medical Supply Chain Security Act has
already increased security and reporting of medical equipment, while increased usage of
corporate surveys can obtain specific supply chain information about the status of medical
supply production, distribution, and export policy.104
An example at the local level: Ohio State
Wexner Medical Center has set the foundations for better tracking and storing of medical
equipment by creating a centralized warehouse to increase visibility and accountability of
necessary inventory.105
There have also been financial incentives for U.S. companies to
increase onshore production of medical supplies. Although these temporary incentives have
had desired effects, it is predicted that more permanent onshore production will take at least
two years considering the time required to install controls, upgrade facilities, and complete
audits.106
Similarly, there is potential for collaboration with like-minded countries to diversify
and create multiple U.S. medical equipment suppliers. The shock caused by the public health
emergency, although unpleasant, can lead to a necessary revamp of the medical equipment
supply chain.
103
Congressional Research Service, “COVID-19: China Medical Supply Chains and Broader Trade Issues”
104
Ibid.
105
Hal Mueller, ”What COVID-19 has changed for hospital supply chains”
106
Deborah Kaplan, “How tariffs ravaged the COVID-19 medical supply chain”
31. 31Harvard College Consulting Group
Cambridge, MA 02138
www.harvardconsulting.org
info@harvardconsulting.org
6.6 Drug Development Regulation
Much like other medical equipment, China and India combined account for 31 percent of the
world’s active pharmaceutical ingredient manufacturing plants worldwide. More specifically, in
2018, according to the FDA, China accounted for 13.4 percent of drug and biologic imports in
the U.S., ranking second among all import countries. Similarly, India supplies 40 percent of
U.S. generic pharmaceuticals, with China serving as the major active ingredient supplier for
these pharmaceuticals.107
COVID-19 has highlighted risks associated with concentrating
pharmaceutical supplies and raw materials in a select few countries, fueling efforts to establish
more local and better monitored supply chains. Export controls imposed in over 25
economies, which led to the delay and denial of medical supplies to the U.S., have further
exacerbated the need to reconsider the pharmaceutical supply chain.108
Although it is unlikely that significant pharmaceutical manufacturing will move to the U.S. in
the short-term given costs, taxes, and regulatory considerations, subtle changes in the supply
chain are expected. For instance, according to James Bruno, owner of Chemical and
Pharmaceutical Solutions, Inc., start-up pharmaceutical companies are leaning towards use of
Western active pharmaceutical ingredient suppliers. Compared to larger pharmaceutical
companies placing a large emphasis on economies of scale, smaller companies are less
worried about profits down to the cents; therefore, these companies prefer to use more local
raw materials in production processes.109
In addition, the Securing America’s Medicine
Cabinet Act of 2020 is designed to enhance advanced pharmaceutical manufacturing
programs in the U.S., strengthening U.S. competitiveness in pharmaceutical development.110
Another expected change is increased tracking of supplies and raw materials necessary for
drug development. Pharmaceuticals are only required to report production processes and
supplies during shortfalls. However, noticing a problem when there is already a lack of
supplies does not allow for enough time to initiate a response. Thus, we should expect
improved oversight over the supply chain in order to increase accountability and security of
manufacturing processes.
However, taking into account a more forward-looking perspective we can expect to see U.S.
pharmaceutical companies moving their manufacturing onshore. Given the regulatory and
capacity hurdles that must be passed, James Bruno estimates that it would take at least two
107
Rick Mullin, “COVID-19 is reshaping the pharmaceutical supply chain”
108
Deborah Kaplan, “How tariffs ravaged the COVID-19 medical supply chain”
109
Interview with James Bruno, Chemical and Pharmaceutical Solutions, Inc.
110
Mullin
In the long term, policymakers should establish regulations that promote and favor
re-shoring of pharmaceutical manufacturing processes.
KEY TAKEAWAY
32. 32Harvard College Consulting Group
Cambridge, MA 02138
www.harvardconsulting.org
info@harvardconsulting.org
years for a company before they are able to re-shore.111
Many pharmaceutical companies are
in the process of consolidation, resulting in less competition and potential increased revenues
that can be used to make the transition to onshore production. Furthermore, according to
James Bruno, the current pharmaceutical production processes are less labor-intensive and
more automated, eliminating the India’s and China’s previous upper hand in less labor.112
Combined with a government more conducive to pharmaceutical business, these collective
drivers are likely to push pharmaceutical manufacturing back to the U.S.
6.7 Shift to Home-Based Care
The COVID-19 pandemic has placed significant strains on the nursing home industry, both
from a financial and a safety perspective. Financially, nursing homes have experienced rising
costs and shrinking revenues. The values of publicly traded nursing homes have plummeted,
exemplified by Genesis Healthcare share prices falling from $1.77 in February to $0.82 in
May.113
The safety of nursing homes has also come under scrutiny as more than a third of
COVID-19 related deaths in early months are attributed to residents or workers at nursing
homes.114
These strains as a result of pandemic serve as catalysts of permanent change for the
nursing home industry.
More immediately, changes should be made to create a safer experience for nursing home
residents and employees. There is currently low enforcement of safety controls with little to no
penalty for non-compliant nursing homes, according to AARP.115
Infection and general safety
control should be increased via higher safety standards, more severe financial penalties, and
more frequent enforcement. Along similar lines, nursing home residents often live in close
quarters, which increases the likelihood of disease contagion. The layout of nursing homes
should be altered to ensure that both residents and workers are not in such close proximity.
Furthermore, nursing home workers typically face low pay, averaging at $13 per hour, and
understaffed, poor working conditions.116
In combination with the unfortunate reality that
111
Bruno
112
Ibid.
113
Howard Gleckman, “The Grim Post-COVID-19 Future For Nursing Homes”
114
Joe Eaton, “Reimagining the Nursing Home Industry After the Coronavirus”
115
Ibid.
116
Joe Eaton, “Reimagining the Nursing Home Industry After the Coronavirus”
Policymakers should not only mandate increased safety controls and precautions in
nursing homes, but also redistribute Medicaid funding to allow for home care.
KEY TAKEAWAY
33. 33Harvard College Consulting Group
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staffers typically have criminal backgrounds — revealed through investigations by the
Department of Health and Human Services — poor working conditions lead to rampant abuse
and neglect of patients. Improved staff conditions, better training, and more accurate
background checks should be implemented alongside increased safety checks to improve the
safety and experience of nursing home residents.
More drastic, systemic policy changes also need to be made in Medicaid funding of elderly
healthcare. The current nursing home industry exists largely out of necessity, housing over 1.3
million Americans who have no other option for care.117
Medicaid pays the bills of more than
60 percent of nursing home residents, amounting to $41 billion a year. Although according to
survey responses 57% of patients believe that Medicaid spending rules should be changed to
focus on home and community-based care rather than nursing homes, Medicaid funds almost
exclusively go to nursing homes.118
If Medicaid spending rules were altered to support home
care, patients would not only experience greater freedom of choice for care, but also overall
improved care given the subpar conditions of nursing homes. Furthermore, changes to the
federal law should be made to allow for a functioning long-term care insurance market,
enabling patients to better afford the type of care they want.
117
Ibid.
118
Result from HCCG’s July 2020 Healthcare Survey
34. 34Harvard College Consulting Group
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7. Survey Data and Analysis
In order to assess patient perception of telehealth and the likelihood to continue use after the
pandemic, HCCG conducted a survey of 312 participants. This survey gave insight into
variance in opinion on telemedicine across demographics such as age, race, and income.
Across all age groups, sexes, races, and income groups, the most common concern regarding
telehealth services was the quality of care or misdiagnosis. Across all age groups, sexes, races,
and income groups, the most common incentive for using telehealth services was reduced risk
of COVID-19, and convenience was second to reduced exposure.
The survey suggests that there is variation in willingness to adopt telemedicine in the long-
term across age groups. Respondents aged 60+ were least likely to believe that the pandemic
increased willingness to use telemedicine in the absence of a pandemic, while respondents
aged 30-44 were most likely. Providers interested in implementing telemedicine after the
pandemic should focus on marketing their services to elderly patients and educating them
about the benefits of virtual care. Patients older than 60 are more likely to have chronic
conditions and therefore are a target group for telemedicine.
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Our findings also reveal variation in willingness to adopt telemedicine across household
income brackets. Respondents with household income under $15k were the only income
group to be more likely to say that the pandemic has not increased willingness to use
telemedicine. Generally, as income increased, respondents were more likely to say that the
pandemic has increased their willingness to use telemedicine services. These results indicate
that providers and policymakers should investigate disparities across socioeconomic status
and consider targeting low income patients for telemedicine, which could help make care
more accessible and less expensive.
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Finally, our survey results indicated differing perceptions of telehealth by region of residence.
Respondents in the mountain region were the only regional group more likely to say that the
pandemic has not increased their willingness to use telemedicine in the absence of the
pandemic. Mountain states are more rural than coastal regions and patients living in these
areas often have reduced access to healthcare. In turn, promoting telemedicine services to
patients in these areas though education and policy change would likely benefit both patients
and providers.
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8. Conclusion
Beyond the impact on and responses of patients, providers, and policy makers, two main
themes emerged. Firstly, no matter what policies are implemented, and (for example) no
matter how telehealth is rolled out, the effects in the United States are going to vary widely
across many metrics, including region, income, race, current access to healthcare, political
affiliation, and many, many others. Nearly every analysis that separated on a particular metric
displayed vastly different opinions among patients, responses from governments and
institutions, and practices among healthcare providers (in this paper we discuss race and
access, and income, but this trend was more general; this is easiest to see in survey data
where opinion-based responses are broken down by a variety of demographics). This
profound heterogeneity, while perhaps not surprising, has a strong impact on policy decisions
in particular. To be most effective, at a high level, policy changes must allow for local
interpretation and implementation, without sacrificing the actual intent of the policy itself. This
is a very fine line to walk (as we explore in §6.4). However, the guaranteed heterogeneity of
impact means that policy makers need not worry about thinking of all edge cases, and they
need not attempt to please everyone; instead, they may provide stronger higher-level
guidance and support, and leave enough room to maneuver such that the effects of region- or
other group-based externalities are minimized. An example of such a policy is earmarking
funds specifically for rural healthcare facilities as a part of future federal relief packages; ideas
like this don’t necessarily prescribe how rural facilities should run, and they allow for a
universal positive (i.e., extra funding) to make an impact where it’s most needed on a local
level. Secondly, for the most part, patients are ambivalent about their healthcare choices,
which leaves room for better designed systems to gain a foothold. The clearest example of
this is discussed at length in this paper: telemedicine during the pandemic. Results from
HCCG’s survey, as well as the opinions from experts interviewed, aligned on the idea that the
end of the pandemic doesn’t necessarily immediately mean the end of telemedicine; rather,
there are parts of the new system that are simply more convenient, cheaper, and provide
equivalent care, and if policy makers and providers work together to continue development of
telemedicine, patients are willing to accept (some parts of) the new model. The necessary
ingredient throughout any beneficial change is collaboration between all three groups
discussed in this paper; policy makers should give providers room to innovate and remove
barriers that patients may face when adapting to a changing healthcare system.
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Isaac Struhl (Lead)
Isaac is a senior studying Physics and Computer Science. With HCCG, he has led a case team
for a large sports and entertainment company, signed clients and directly managed 3 case
teams, and most recently served as the Vice-Director of Operations for the group. Outside of
HCCG, Isaac has worked in various roles and fields, including computational biology research,
teaching CS at Harvard, and an industry position at Google.
David Paffenholz (Editor)
Originally from Germany, David now lives in Eliot House and studies Economics.
Throughout his time with HCCG, David has largely been focused on consumer tech - he’s
led a case team for Snapchat and worked with Global Fortune 500 tech firms. Outside of
HCCG, David has interned at Fifth Wall, an LA-based real estate focused venture capital
firm, and a startup in the healthcare tech space. Whenever he gets the chance, he loves
to go windsurfing.
Abhishek Malani (Editor)
Originally from Glastonbury, Connecticut, Abhishek is a junior studying Economics with a
secondary in Computer Science. With HCCG, he has led teams for an international non-profit
and a large video game company. Outside of HCCG, Abhishek has conducted equity research
at Fred Alger Management, New York based investment fund. He loves going hiking and is set
on climbing Half Dome in the future.
Fredericka Lucas
Originally from Richmond, Virginia, Fredericka is a junior living in Leverett House and studying
Neurobiology and Economics. As a member of HCCG, she has worked with leading medical
device companies on market and data analysis cases. Outside of HCCG, she is a member of the
varsity track and field team and is involved in biomedical research at Harvard. This summer, she
is interning as a business analytics consultant for a biotech startup in the rare cancer space.
Harrison von Dwingelo
Originally from Redding, Connecticut, Harrison is a sophomore in Quincy House studying
economics. Previously, Harrison was a Sergeant in the United States Army where he
worked as a forward observer controlling the indirect fire assets for frontline maneuver
elements. Outside of HCCG, he enjoys reading fantasy.
Will Schrepferman
Originally from a small town in Indiana, Will is a sophomore in Eliot House studying
Government on the Data Science track. During his time with HCCG, Will has worked on cases
focusing on consumer analysis and franchise financial modeling. Outside of HCCG, Will has
interned for software startups and policy research groups; on campus, he enjoys engaging
with international relations through Model United Nations.
Nicky Wojtania
Nicky is a senior in Quincy House studying Bioengineering and Economics. Throughout
her time at HCCG, she has worked on a number of cases focused on healthcare, such as
with a leading medical device manufacturer and a nonprofit health organization. Outside
of HCCG, Nicky has conducted bioengineering research, worked at Huron Life Sciences
Consulting, and leads business development at a healthtech startup.