Three lessons learned as the COVID-19 pandemic emergency ends

The COVID-19 public health emergency (PHE) ended in the United States on May 11, 2023. The pandemic (a disease that rapidly spreads over a wide area) has been declared endemic (the consistent presence of a disease in a population). The end of the PHE does not mean our work is done. While COVID-19-related deaths are at the lowest level since the pandemic began in March 2020, 1,000 people are still dying every week in the U.S. from COVID-19. What lessons have we learned?

1. Be prepared for the next pandemic
   
   Every health system needs to be prepared for “when” and not “if” the next pandemic occurs. As human exposure to pathogens increases with population density, deforestation and the existence of concentrated or confined animal feeding operations (CAFOs) where most American livestock are raised, there is a greater chance that human immune systems will not be able to keep them in check.
   
   We need to ensure that our health care system has the capacity to respond to the next public health emergency. This should start with a bipartisan plan that focuses on primary prevention. Mitigating or preventing the next pandemic will alleviate the burden and cost of maintaining trained staff, enhanced infrastructure and vaccine production.
   
   
2.  Make health care more accessible and affordable
   
   The U.S. Congress allowed states to receive enhanced federal funding in exchange for keeping Medicaid recipients continuously enrolled through the end of the PHE. As a result, enrollment in Medicaid and the Children’s Health Insurance Program (CHIP) increased by 23.3 million to 95 million from February 2020 to March 2023. Now that the emergency has ended, the Department of Health and Human Services (HHS) estimates that up to 15 million people could be disenrolled from Medicaid.
   
   Medicaid disenrollment and loss of adequate health insurance are not the only challenges to accessible and affordable health care. Between 9 and 40 percent of American adults owe medical debt, which includes individuals and families with insurance coverage. Additionally, while enhanced federal subsidies have tempered premiums and out-of-pocket price increases of Affordable Care Act policies, both employer-sponsored coverage and ACA premiums increased in 2023. Affordable and accessible health care is still out of reach for many Americans.
    
3.  Pay physicians and hospitals differently
   
   The pandemic had a serious impact on primary care and physician-owned practices, as well as hospitals’ ability to prioritize lucrative elective procedures over treating emergency COVID-19 cases. Additionally, physicians that relied exclusively or primarily on fee-for-service payment struggled to maintain their practices as office visits and revenue declined. Over-reliance on elective surgeries, which accounts for as much as two-thirds of hospital revenue, resulted in an estimated $200 billion loss from March through June of 2020.
   
   Health care providers that relied on fee-for-service payments are now seeing the benefits of a risk-adjusted capitated payment system. Not only does this ensure a predicable income stream for the physician but it also reduces the amount of medically unnecessary care delivered. When capitation is combined with achieving quality measure benchmarks and addressing potentially preventable events, physicians are incented to keep their patients healthy rather than getting them into the office.
   

As Winston Churchill said during the bleakest days of World War II, “Never let a good crisis go to waste.” If we don’t apply the lessons learned from the COVID-19 pandemic, then Churchill’s admonition in a 1948 speech to the British House of Commons will be fulfilled, “Those that fail to learn from history are doomed to repeat it.”

Steve Delaronde is senior manager of product, population and payment solutions at 3M Health Information Systems.