It is becoming difficult to come up with new ways to describe the tumult and upheaval of 2020, particularly in healthcare. As we look forward, athenahealth sat down with four healthcare experts to hear their thoughts on where 2021 will take us. COVID-19 will still dominate the headlines for the early part of the year. But leaps forward in virtual care and an increased focus on health equity will enhance and enable the industry’s shift to a more holistic, patient-centered model of care.

Vaccine distribution will be top priority

It is no surprise that the first and biggest hurdle faced by the healthcare system in 2021 will be the large-scale vaccination of Americans against COVID-19. Each state and, indeed, each healthcare organization, is being called upon to determine their own distribution process, including who will be eligible when, where vaccines will be distributed, and how patients will be contacted and scheduled for both the initial and the booster shots.

In preparation for the massive logistical effort required to distribute the COVID-19 vaccine according to CDC guidelines, providers are working to set up technology to identify and inform eligible patients, schedule them for shots, and remind them when they are due for their second dose. Aaron Miri, CIO at Dell Medical School in Austin, Texas, shares how Dell is using email, texts, and phone calls to provide patient reminders and informational materials “and that’s going to be key for us with the second shot, reiterating that you’ve got to be here on Day 21.”

Cynthia Burghard, research director, value-based healthcare and IT transformation strategies at International Data Corporation (IDC),  notes that the lack of national guidance means that there will be significant variation in vaccine rollout from state to state, with each organization making its own decision, whether at a corporate or a hospital level.

The good news is that providers have learned a lot over the last year. “Our thought process is that we would take a lot of the lessons learned from the COVID-19 in-the-field testing,” says Miri, “swabbing, processes, administering in parking lots — we plan to use those same methodologies” for the vaccine. Miri notes that Pfizer has been providing an ongoing supply of dry ice to keep the vaccine cold, opening up a number of ways to imagine distribution.

Getting back to business

Although vaccine rollout will dominate much of 2021, a return to routine care will also be top of mind for healthcare organizations.

According to Burghard, the last eight months have led to a backlog of unmet need in terms of colonoscopies, mammograms, and other preventive care. As the vaccine eases patients’ safety concerns, healthcare organizations, especially ambulatory care, will be dealing with a deluge of these kinds of appointments. Paul Brient, senior vice president and chief product officer at athenahealth, agrees that in 2021 the healthcare industry will be dealing with the long-term repercussions of delayed care during the pandemic. “We’re likely to see patients with chronic disease present sicker and under poorer control because they didn’t get regular care during the pandemic.”

“I think 2021 is going to be more of a settling down and balancing year, not so much a hockey stick towards a new model of care,” says Burghard, “I think there's too much to do just getting people vaccinated and getting their preventive services taken care of.”

Virtual care is here to stay

All our experts agree that healthcare can’t put the genie back in bottle when it comes to virtual care — patients and providers now see how much can be managed virtually, and both have appreciated the convenience and relative safety of these interactions.

Although, the team at IDC points out that this all relies on the new White House administration continuing the telehealth waivers and reimbursement parity implemented during the pandemic.

Virtual care will continue to play an important role in controlling the spread of COVID-19 until vaccine distribution is complete. According to Lynne Dunbrack, group vice president at IDC, “one of the top five things that [healthcare] consumers were concerned about doing was getting on public transportation — virtual visits mitigate that concern.” And Burghard points out that the last thing anyone wants right now is to move into a nursing home. “There is motivation to keep people safely at home. Even COVID-positive patients are going home with oximeters and other devices to monitor their health in a home setting.”

The way providers have engaged patients during the pandemic — with phone calls, telehealth, two-way texting, and more — has yielded important efficiencies in care and patient engagement. Dunbrack expects this trend to continue, with providers working throughout 2021 to create clinical workflowsdesigned specifically for virtual care.   

“We expect that there will be significant innovation as these new techniques and tools are adopted and adapted to a post-pandemic world,” says Brient, “At long last, patients will soon be able to engage digitally with the healthcare system in the same way they engage with services they receive in non-healthcare industries.”

Value-based care will progress

“One of the most unexpected observations that providers have had is that those with value-based care (VBC) financial arrangements fared better than practices with just exclusively fee-for-service models,” Brient shares. This financial diversification provided a cushion for practices as visit volumes declined in the spring of 2020. He expects to see practices continue to move into more and new VBC models as a way to differentiate themselves. “Additionally, practices will shift away from problem-focused approaches and move to a more holistic patient-focused strategy, incorporate new ways to engage patients outside of the office, and proactively intervene when necessary.”

Dunbrack sees virtual care as a key part of this shift, with virtual check-ins and remote monitoring allowing providers to keep a close eye on chronically ill patients at home, between visits to identify when proactive intervention is required.

And Burghard believes the pandemic’s lessons will spur a broader way of thinking about value-based care, building off the way organizations used population health technology to manage COVID-positive patients. or provide outreach and education. Those capabilities are now also used to manage risk-stratification to prioritize and reach out to patients around the vaccine.

“The technology and methodology of managing patients more holistically has risen to the surface in the last seven or eight months — a recognition that it’s not just about closing care gaps.”

Racial and socioeconomic equity will be front and center

The effects of COVID-19 have not been evenly distributed across the U.S. population — far more patients of color and poorer patients have contracted the virus, and far more of them have suffered serious illness or death. This undeniable truth is pushing the healthcare industry to consider racial and socioeconomic equity in all decisions affecting care and access, as well as pushing organizations to think more broadly about such upstream drivers of health as food, housing, and technology. A critical necessity given how many more people are unemployed, uninsured, food insecure, or otherwise financially vulnerable as a result of the pandemic.

Even the vaccine distribution efforts bring up issues of health equity. According to Burghard, some states have already taken great pains to ensure vaccine equity, ensuring that food staff and cleaning crews in hospital and long-term care facilities are vaccinated in the first wave, not just clinicians. “Those are some of the signs I see that we're getting more serious about health equity, at least in the context of the pandemic and vaccines.”

Given the new political administration and the current cultural climate, our experts predict that the issues of healthcare equity and health disparities brought to light by the pandemic will continue to be a central focus of healthcare in the coming months.

“There is going to be a lasting impact on how we look at healthcare delivery and outcomes across racial and ethnic lines,” says Brient, “These differences can literally be a matter of life and death, and I hope this will drive continued changes in our society and healthcare system.”