Healthcare Leadership Council report: Lessons the U.S. should draw from the COVID-19 response to prepare for the next public health emergency

• A new report describes how the private and public sectors should collaborate to shore up the U.S. public health infrastructure in preparation for future pandemics and other widespread emergencies.
• Government regulatory approaches and private-sector actions both are needed to establish optimal approaches to care delivery during a future crisis.
• Innovations in supply chain processes and new approaches to financing likewise should be considered, according to the report.

The U.S. government and the healthcare industry should take specific steps to bolster the public health infrastructure in preparation for future crises, according to a new set of expert recommendations.

Enabling hospitals to meet the needs of all patients during times of surge capacity is among the goals listed in a new report that aims to establish a framework for strengthening public-private collaboration in anticipation of future public health emergencies. The report was issued by the Healthcare Leadership Council, which is a coalition of executives from all disciplines of U.S. healthcare, and the Duke-Margolis Center for Health Policy. Input was provided by an array of other stakeholders, including federal agencies.

During the COVID-19 pandemic, “We have witnessed vulnerabilities that need to be corrected,” said Calvin Schmidt, senior vice president and worldwide leader of government affairs and public policy for Johnson & Johnson, who led the committee that drafted the report.

“We’re trying to lay out a framework in which we will be less reliant on the extraordinary and heroic in times of crisis because we will be better prepared for the unthinkable,” Schmidt added during a media briefing about the report.

Too often during the ongoing pandemic, the public and private sectors missed out on opportunities to coordinate an effective response, said Mark McClellan, MD, PhD, a professor at Duke University and founding director of the Margolis Center for Health Policy.

“There’s a critical need for the private sector and government to complement each other rather than operate on separate tracks that aren’t well-coordinated or reinforcing,” he said.

In addition, McClellan noted, the industry can learn from the successful aspects of the COVID-19 response.

“It’s about the successes, the innovation, the regulatory flexibilities that have also emerged over the past year,” he said. “We want to leverage those as we prepare for future public health challenges. So learn from what didn’t work and build on what did.”

Ensuring optimal care delivery during a large-scale emergency

Some of the report’s recommendations describe ways to identify and apply best practices in care delivery during a pandemic or other crisis.

For example, hospitals and other care delivery organizations should develop:

• Tools and best practices to prevent provider fatigue through creative work schedules, childcare accommodations and necessary system contingencies
• Best practices for improving coordination between care delivery staff and public health organizations

Government regulations should be streamlined to allow for implementation of standardized delivery-system best practices, the report states. Those should cover capacity, virtual care, licensure and certification, and scope of practice.

“Congress should establish and enact a national emergency licensure policy for emergencies,” the report states.

For example, in prolonged emergencies, cross-state licensure should be permitted to allow hospitals to address workforce needs more efficiently by using out-of-state clinicians. In addition, professional associations should work with state health departments to identify best practices for workforce mobility given the varying licensure and scope-of-practice laws.

“We’ve learned a great deal over the past several months about how conflicting federal, state and local regulations, rules and laws can impair emergency response even under the best of intentions,” McClellan said. “A high priority is to harmonize all these regulations, create uniform waivers that can be immediately plugged into place.”

Promoting needed innovation in the supply chain

As described in HFMA’s November 2020 cover story, hospitals are seeking ways to transform various aspects of the supply chain. But as detailed in the newly issued report, coordination with government agencies also is crucial.

“We should never again have a situation where states and healthcare providers are feverishly competing against each other for the critical supplies that they need,” Schmidt said.

“Whether it’s in manufacturing of particular key ingredients and medical products or equipment that’s needed in a public health emergency, we’re seeing some private-sector responses in that already,” McClellan said. “And a public-private partnership would really help make it more robust and leverage any public health emergency spending to increase the stockpile.”

To prevent supply disruptions of the sort that hampered hospitals during the pandemic, especially in the early stages, innovations should be widely implemented, the report states. Among those cited are:

• Using virtual stockpiles based on “time to inventory” for selected products
• Diversifying product sourcing geographically, including via domestic manufacturing for high-priority products
• Creating standards for what should be stored in stockpiles, including quantity and duration of storage
• Updating those standards regularly based on the most recent science and with active engagement from providers and other stakeholders

Supply chain processes involving data sharing and capacity expansion have improved during the course of the pandemic, McClellan said, and those practices need to be standardized.

“Some of that [improvement] has required federal expenditures,” he said. “So in areas like critical supplies of drugs and other medical-response projects, this public-private collaboration can not only lead to more stable supply chains now in the pandemic, as we start to build up capacity, but organizations [also] are investing in sustaining this capacity for the longer term.”

Establishing adequate financing for future emergency responses

Policymakers should identify “specific financing vehicles to support capacity building for preparedness, public health, and emergency response efforts,” the report states. One such tool could be “healthcare payment models with upfront payments and more flexible payment structures.”

Specifically, alternative payment models should be promoted to “allow for greater financial flexibility in emergencies, aligning model components to reduce administrative burden when possible.” Such models should “include built-in contingency policies for emergency periods, such as upfront payments to help organizations manage through crisis periods and transition to alternative payment models over longer terms.”

That approach would help healthcare organizations respond to emergencies by pivoting to offer modes of care delivery such as telehealth.

“That’s an area where there’s some need for public investments, improving the infrastructure as well as supporting the waivers,” McClellan said. In general, he added, “The private sector is taking steps and with federal collaboration could take more [steps] to support new kinds of care models.”