What Comes After COVID-19’s Initial Peak? 3 Strategic Considerations for Health Systems

Amanda DeMano, Vice President, AVIA

Midstream in their pandemic preparedness efforts, healthcare leaders are already starting to imagine what comes next after COVID-19’s initial surge. Good news came last week in terms of federal relief dollars, but it’s not clear the extent to which these dollars will meet all of the losses. Overrun, extended and undersupplied facilities, backlogs of elective cases and ambulatory visits, major shifts in unemployment, economic recession, state budget deficits, and other conditions that seemed unimaginable to healthcare strategy leaders only a few months ago may become all too real in the post “war” period.

However, good things will also be emerging on the other side. The industry is already making exciting advancements and giant leaps. Providers, payers, and government entities are embracing digital platforms for virtual health, remote monitoring, analytics, collaboration and more to respond to the crisis. These capabilities are currently being procured, implemented, and scaled in days and weeks instead of what has otherwise taken years. How should health systems think about harnessing today’s momentum and leveraging these new assets to face what comes next?

We’re using our insights and ongoing work in the Medicaid Transformation Project to propose three strategic planning opportunities that health systems can consider during the COVID-19 initial surge recovery:

1.  Account for impactful shifts in payer mix, bad debt, and charity care. With recession comes unemployment. With unemployment comes reductions in commercial coverage and overall financial health of patients. With poorer financial health of patients comes increases in uncompensated care and rising Medicaid enrollments. Health systems will need to rapidly implement strategic plans and projects focused on decreasing costs to treat Medicaid and under and uninsured patients to avoid unnecessary utilization of the emergency department and inpatient beds. Pre-COVID-19 strategies that focused on improvements to commercial payer mix are not likely to be successful in the coming headwinds. Health systems will have to find ways to meet or exceed margin on Medicaid rates. They will also have to organize educational and enrollment efforts, because newly unemployed people may not have awareness and experience with public programs like Medicaid. Set goals to optimize Medicaid reimbursement through improved management of Medicaid revenue cycle and supplemental payments (e.g. DSH, 1115 authority). Assign leadership to actively assess federal and state regulatory changes and projected payer mix trends in your market.

2.  Align and target your new digital assets on vulnerable populations. The rapid uptake of technology and the new workforce skills to deploy it have spread almost as rapidly as the virus itself – broad and undiscriminating to target the population en masse. Patients and providers are now regularly engaging in care delivery that extends beyond the four walls of the health system. In the days to come after the initial surge of the pandemic, it will be opportunistic to strategically leverage these new resources and momentum with both providers and patients.

One first step is to make sure that the entire population is hearing your message and knows about your tools. It’s estimated that 20 – 30% of your population may not currently be reached by your general messaging and services due to language barriers, low health literacy, and poverty. Optimize your patient outreach, chatbots, virtual triage, and other newly established tools to reach everyone. These are low/no cost upgrades. Then evaluate the use of your new tools and consider ways to scale them more broadly within the system to achieve strategic goals like reduced length of stay, ambulatory sensitive inpatient encounters, and avoidable ED visits in targeted/vulnerable populations. Leverage remote monitoring and engagement capabilities in new ways, like helping patients with chronic and episodic conditions (e.g. pregnant and postpartum moms, behavioral health patients) manage their care safely at home instead of in your beds and ambulatory care centers.

What the payers do after emergency declarations are lifted will have some implications for how you can implement this care, but for vulnerable populations, the right AI-driven and patient-centric solutions can help you lose less, right now.

3.  Address community needs. Research is clear, Social Determinants of Health (SDoH) have more of an impact on health and wellness than some of the direct clinical care that health systems typically provide. Consequences of an economic recession or depression will almost certainly spike needs in your community related to food, housing, violence prevention, employment, and perhaps even within the employees of your own system. Including community-centered care in your strategy is no longer going to just be a good thing to do for your community benefit goals, but will become a meaningful way to improve the financial health and wellbeing of your health system. Do this not just for your risk-based populations, but for the patients who are hungry and malnourished and therefore develop complications post-surgery, costing the system in readmissions and additional procedures. Do this for the patients who are unable to make their ambulatory appointments due to lack of transportation and cost you a valuable visit slot. Do this for the patients that do not have safe homes and end up with elongated stays in your valuable inpatient beds. Leverage SDoH analytic platforms, SDoH screening tools, and community resource referral platforms to put a laser focus on the interventions that will help you lose less and improve the health of the patients who are impacting the finances of your organization the most.

Implement nutrition support, non-emergency medical transportation and/or housing solutions available now that will produce downstream value to the system bottom line and health outcomes.

Leverage digital assets in targeted ways to address community needs alongside “standard” clinical care. This will help health systems proactively pivot their strategies and remain in a position to serve the rising share of Medicaid volumes and uncompensated care in a post-COVID-19 initial surge recovery.  While systems may not be able to act on every real opportunity, in the face of a crisis, they can take careful stock of the vulnerabilities, prioritize and plan for best ways to address the gaps.

AVIA has strategic advisors and proven resources to help care for vulnerable populations in the wake of, and after, COVID-19’s initial surge. Join us in the Medicaid Transformation Project. Please reach out to us at or access the AVIA COVID-19 Response Hub for more information.

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AVIA has strategic advisors and proven resources to help care for vulnerable populations in the wake of, and after, COVID-19’s initial surge. Join us in the Medicaid Transformation Project. Please reach out to us at or access the AVIA COVID-19 Response Hub for more information.