Dr Samyukta Mullangi: COVID-19 Has Spurred Us to Ask How We Can Innovate Care Delivery

During The American Journal of Managed Care®’s Institute for Value-Based Medicine® event held in conjunction with Memorial Sloan Kettering Cancer Center in New York City, “The Future of Cancer Care Delivery Information,” Samyukta Mullangi, MD, MBA, fellow in medical oncology at Memorial Sloan Kettering Cancer Center. Her research interests lie in health policy, informatics, and alternative payment models, and here she discusses what we can learn about health care delivery from the COVID-19 pandemic.

Transcript

What lessons from COVID-19 inform us as we move into the next phase of delivery system reform?

COVID-19 was such a shock to our health care system. It was a shock to our economy, but certainly to our health care system, and I think it exposed a lot of deficiencies in our health care delivery sector: how fragmented our organizations are, how underfunded our public health infrastructure is, and also, obviously, the limitations of our fee-for-service delivery system. And I'd like to expand a little bit more about that.

I think health care in America really has its underpinnings on a very stable fee-for-service payment system, which in the best of times, is not, I think, the greatest way to pay doctors or pay for medical care. But certainly when you have a once-in-a-generation shock, like COVID-19, I think it really exposes those limitations even further.

When the pandemic first broke out and there was that threat of contagion, clinics shuttered. As much as they tried to ramp up their telemedicine offering, even at its peak, clinic volumes were still not where they had been. And there were other trends, too. As patients lost their jobs and maybe rolled away from commercial insurance and to Medicaid, all of these things collectively had this impact of significant financial duress on physician practices.

And so I think one thing that comes out of the COVID pandemic is this idea that our payment reforms have to not only target cost savings and quality improvements, which they've been targeting historically, but also potentially this new concept, which is sustainability of physician practices. Financial sustainability is what I meant, the idea that fee for service, for all of its pros and cons, is really dependent on patient volume to keep it going. And as such, it's actually a pretty vulnerable form of financing when you have these sorts of shocks that hit the system.

In contrast to that, if you had a prospective payment system, like habitation, or bundled payments, that's actually a bit more of an assured form of payment, and it can keep practices going when things like this happen. Not only that, it can also actually give practices the flexibility to change the way they practice, without waiting for reimbursement policy to catch up.

In the beginning of the pandemic, there was all this confusion around, “Well, if we go to telemedicine, will that be reimbursed for?” Because historically, there hadn't been widespread acceptance or use of telemedicine. In a model in which you get paid up front or paid on a monthly basis, regardless of patient volume, the physicians can more flexibly turn over into virtual care or offer things like home-based care or proactive symptom monitoring in a way in which they don't have to bill for each and every encounter.

I'm hopeful that COVID-19, for all of its disruptions to our economy in our lives, maybe affords us this opportunity to think about, how is it that we've structured our payment systems and health care? And is there an opportunity to do things differently?