"Hope for the Best, but Plan for the Worst": Health System Advice on Natural Disasters

After natural disasters like wildfires in California and hurricanes in Puerto Rico, leaders from an integrated healthcare system and a health plan spoke at the AHIP Institute & Expo to share their first-hand lessons on how businesses can continue their operations when disaster strikes.

Richard Shinto, MD, MBA, president and CEO of InnovaCare Health and MMM Holdings, which offers health plans in Puerto Rico, explained that emergency preparedness is an important consideration for insurers, not just care providers, because “payers support the providers, and if we’re not structurally sound, there could be some real consequences.”

Preparing for disaster makes good business sense, Shinto explained, not just because of the moral obligation for first responders to provide healthcare, but also due to a business’s responsibility to protect its investments and the power of social media to broadcast to communities which companies took an active role in helping after a disaster.

After Hurricane Maria battered the island of Puerto Rico with 155 MPH winds last fall, InnovaCare’s disaster planning ensured that there was an emergency management team in place to provide oversight from both the disaster area and an unaffected location in New Jersey. A disaster recovery team was activated to get essential functions running in the community, and the business recovery team was responsible for maintaining key business operations.

In particular, the business team was especially crucial because it helped ensure that the plan’s supply chain of providers, like medical equipment and home health services, also had continuity plans in place and were operational after the storm. The plan had already made capitation payments in advance to primary care providers and specialists so the provider network could stay intact. It also had cash on hand for when the storm had passed so the company’s employees could be paid.

“If you don’t have your employees, you can’t get your company up on its feet,” Shinto said, as he explained how InnovaCare provided assistance to staff who lost their homes and also built its own laundromats and barbershop to try to restore some normalcy to life in the wake of a hurricane.

One of his main takeaways was to “hope for the best, but plan for the worst.” Overall, the experience before, during, and after Maria showed Shinto that time is of the essence when responding to a disaster, but a quick response is only possible if there is sufficient planning beforehand.

“By showing that aggressive response, it shows commitment to the employees, to the providers, and to the community,” he concluded. “The return on that is really worth the investment, instead of always thinking about the dollars.”

Skip Skivington, MBA, vice president of healthcare continuity and support services, Kaiser Permanente, agreed that his experience with the California wildfires had also taught him the importance of planning—especially because having a plan in place allows health systems to pivot off the plan when things go wrong, as they are bound to do during a disaster.

When the fires tore through California, one of Kaiser Permanente’s medical centers had to be completely evacuated, the first time in its 75-year history that had happened. Skivington and his team, particularly the incident commander, had to make that split-second decision because one of the fires was spreading at 800 yards per minute.

In a “disaster mode,” Skivington explained, the healthcare system became a sort of quasigovernmental agency, because the local patients recognized it as an institution that could be relied upon. This pressure, and how Kaiser responded to it, made him realize that there is “an obligation to bring our best and rise to the occasion as a community.”

He spoke of the importance of robust 2-way communication teams to enable downstream planning, like when the regional command system was called upon to ensure beds in safe hospitals were available for evacuees. The health system is still feeling reverberating effects from the fires, as 200 of its 1200 physicians in Santa Rosa lost their homes and some moved away from the area.

Overall, his takeaway from the experience was that health systems have to relentlessly execute drills for disaster situations in as realistic a way as possible. The evacuation checklists and kits that were in place proved crucial when the medical center had to be evacuated in a quick but orderly fashion without “adding chaos to an already chaotic situation.”

Skivington summed up his thoughts on emergency preparedness with a quote: “The more we sweat in peacetime, the less we bleed in wartime.”