Health Evolution - Health Evolution’s curated hub of actionable advice being posted around the web to help our community separate signal from noise.

Amid the COVID-19 pandemic, health care provider, payer and life sciences CEOs’ time is more constrained than ever.  With so much noise it can be hard to find the more insightful and actionable articles that tend to get lost in the fray.

As a service to readers, Health Evolution will hand-pick and curate the most-appropriate articles from around the web to share here — and we’ll update this page as frequently as is appropriate.

Updated April 22, 2020 at 10:12 am ET

The National Institutes of Health published COVID-19 treatment guidelines that were created by a panel consisting of physicians, statisticians and other experts.

• Takeaway: “The guidelines consider two broad categories of therapies currently in use by healthcare providers for COVID-19: antivirals, which may target the coronavirus directly, and host modifiers and immune-based therapies, which may influence the immune response to the virus or target the virus,” NIH explained in the announcement.
• What else to know: NIH’s guidelines also include information about evaluating and stratifying patients based on risk, best practices for managing patients at different stages, guidance on treating critically ill patients, and more. The agency said it will update the guidelines as new data enters the literature.

CMS relaxes interoperability rule for six months.

• What happened: “Recognizing that hospitals, including psychiatric hospitals, and critical access hospitals, are on the front lines of the COVID-19 public health emergency, CMS is extending the implementation timeline for the admission, discharge, and transfer (ADT) notification Conditions of Participation (CoPs) by an additional six months,” CMS wrote.
• CMS Administrator Seema Verma explains: “Now more than ever, patients need secure access to their healthcare data. Hospitals should be doing everything in their power to ensure that patients get appropriate follow-up care. Nevertheless, in a pandemic of this magnitude, flexibility is paramount for a health care system under siege by COVID-19. Our action today will provide hospitals an additional 6 months to implement the new requirements.” 

Updated April 20 at 12:16 pm

COVID-19 population data shows race disparity. New data released by the CDC shows that 33% of people who’ve been hospitalized with COVID-19 are African American. Research from Johns Hopkins found similar statistics. Considering only 13% of the U.S. population is African American, why is there such a disproportionate number? NPR reported on this disparity and why it exists.

• Takeaway: One reason, experts tell NPR, is there’s a higher prevalence of obesity, high blood pressure and diabetes among African Americans. People with these chronic conditions are more likely to get hospitalized and sicker from COVID-19, according to various studies. There are other societal reasons, experts believe, for this race disparity.
• Insightul Quote: “Every major crisis or catastrophe hits the most vulnerable communities the hardest,” Marc Morial, president and CEO of the National Urban League, told NPR. “Black workers are more likely to hold the kinds of jobs that cannot be done from home. There also is bias among health care workers, institutions and systems that results in black patients … receiving fewer medical procedures and poorer-quality medical care than white individuals.”

AHA issues roadmap for return to elective surgeries. The AHA, American College of Surgeons (ACS), American Society of Anesthesiologists (ASA) and Association of periOperative Registered Nurses (AORN) developed a roadmap to guide readiness, prioritization and scheduling for the return of elective surgeries. The groups say facilities should not resume elective procedures until there has been a sustained reduction in the rate of new COVID-19 cases in the area for at least 14 days.

• Takeaway: AHA says there are multiple principles hospitals should follow when developing a timeline on resuming elective surgeries. Those are Timing, testing, adequate equipment, prioritization and scheduling, data collection and management, COVID-19- related safety and risk mitigation surrounding a second wave, and other issues, including the mental health of health care workers, patient communications, environmental cleaning and regulatory issues.

Here’s the complete roadmap.

The financial situation for hospitals is dire.  Industry groups are calling on the government to provide for funds in the “Provider Relief Fund.” The initial $100 billion won’t be enough to keep many hospitals afloat, says the Federation of American Hospitals in a policy brief.  The government has begun the second round of distributing funds from the CARES Act this week. 

• Takeaway:  “A recent analysis by JPMorgan found that the $100 billion in stimulus funds for providers included in the CARES Act would only be sufficient to cover hospitals’ losses for two months – not including additional costs associated with increasing capacity and purchasing supplies to fight the outbreak.”
• Author’s advice: “The infusion of funds for providers from the CARES Act is a start, but unfortunately nowhere near enough. Swift action is necessary to ensure that our nation’s caregivers can continue to serve all the patients who depend on them every day. Congress must act quickly to protect hospitals before these dire warnings become a grim reality.”

Social distancing works. It really works. A new study from researchers at Columbia University Mailman School of Public Health finds that almost 185,000 deaths in the Northeast and 33,000 deaths in the Midwest could be averted by reducing person-to-person contact through actions such as travel restrictions, social distancing, and self-isolation for sick individuals.

The researchers created an online tool identifying U.S. counties that are at risk of exceeding their critical care surge capacity limits within six weeks and estimated the lives that could be saved with enhanced social distancing and ramped up medical care.

• Takeaway: “A 40% contact reduction could decrease the number of counties exceeding their critical care bed limits between 81.5% – 87.3%, and a high intensity patient surge response could decrease the number of counties exceeding their critical care bed limits between 24.6% – 48.0%.”
• Author’s advice: “Courageous medical providers are saving lives in dire circumstances and they could better do their jobs and minimize their own risks of COVID-19 if counties across the nation adopt and maintain stringent social distancing policies,” Charles Branas, PhD, professor and chair of epidemiology said in a statement.

Rural Hospitals feel the squeeze. Before COVID-19 ever entered the picture, rural hospitals were already in trouble. In 2019, a record-setting 19 rural hospitals closed. It’s not accelerating at an even faster pace and it won’t get any easier thanks to COVID-19, NPR reports. Decatur County General Hospital in Tennessee will shut down indefinitely by April 15, it will be the ninth small-town hospital to close in 2020 alone.

• Takeaway: “The loss of revenue over the last few weeks due to the inability to provide non-emergency care is destabilizing core health services in rural America,” the National Rural Health Association said in a statement.
• What’s next: “Health policy experts say a rural hospital’s ability to stay open through the coronavirus pandemic may depend in part on whether the state it’s in has expanded Medicaid. Idaho has, but Tennessee, where Decatur County General is slated to close, has not.”

New York is merging all its hospitals to battle the coronavirus. Vox reports on the bold plan that essentially “socializing the entire system,” to fight against the pandemic.

• Takeaway: “From Buffalo to NYC, hospitals will be sharing staff, patients, and supplies for the foreseeable future, with Albany overseeing the distribution of resources,” according to Vox.
• Reasons the plan is remarkable: “There are about 200 hospitals in New York state, totaling 53,000 beds before Cuomo told them to double their capacity. About 20,000 of those beds are in New York City,” Vox reported. “It is a matter of necessity, as New York has already seen more than 100,000 COVID-19 cases and 1,500 deaths — with the peak still projected to be a week away, according to the Institute for Health Metrics and Evaluation’s estimates, requiring as many as 100,000 beds.”

Helping public health officials combat COVID-19, by Google SVP Jen Fitzpatrick and Chief Health Officer Karen DeSalvo, MD.

• Takeaway: “We’re publishing an early release of our COVID-19 Community Mobility Reports to provide insights into what has changed in response to work from home, shelter in place, and other policies aimed at flattening the curve of this pandemic,” according to Fitzpatrick and DeSalvo.
• What’s next: “Given the urgent need for this information, where possible we will also provide insights at the regional level,” they explain. “In the coming weeks, we will work to add additional countries and regions to ensure these reports remain helpful to public health officials across the globe looking to protect people from the spread of COVID-19.”

The Federation of American Hospitals is collecting COVID-19 resources relative to issues and advocacy.

Updated Tuesday, March 31 at 12:28 am EST

The top 3 Coronavirus priorities for the next month, as outlined by former CMS Acting Administrator Andy Slavitt.

• Takeaway: Slavitt outlines three jobs to be done:

1. 1. 1.          Support the front-line workers
      2.          Continue or improve social isolation to bend the curve
      3.          Give scientists enough time to work on therapies, cures and a vaccine

• Author’s advice: “We’ve reached 2,000 deaths in the US and in a couple days will be passing 9/11 totals. And 10s of thousands [are] unheard of. “What happens beyond that point is history not yet written.”

COVID-19 Priorities Checklist for State Leaders. Slavitt is currently Board Chair at United of States of CARE, which issued the 10-page document and described it as a dynamic list of best practices.

• Takeaway: “Our goal is to continue to elevate best practices and push forward new approaches to the unprecedented medical and public health challenges that more American cities and states will have to confront.”
• Author’s advice: Immediately prioritize these five areas:

1. 1. 1.                   Take action to slow the spread of the virus
      2.                   Build and sustain the supplies, health system capacity and workforce needed to cover the immediate medical challenge
      3.                   Ensure access to health care for those with COVID-19 and those losing their coverage as a result of the economic downturn
      4.                   Protect individuals most at risk for COVID-19
      5.                   Lay groundwork for the long-term approach to the epidemic and economic recovery

National Coronavirus Response: A Road Map to Recovering, published by the American Enterprise Institute and written by former FDA Commissioner Scott Gottlieb, MD, and former CMS Administrator Mark McClellan, MD, former FDA medical device center Deputy Director Lauren Silvis, Johns Hopkins epidemiologist Caitlin Rivers and Johns Hopkins professor and health security expert Crystal Watson.

• Takeaways: The report lays out a phased approach that begins with slowing the spread, then transitions into state-by-state reopening, establishing immune protection and reducing physical distancing and ultimately includes preparing for the next pandemic.
• Author’s advice: “In each phase, we outline the steps that the federal government, working with the states and public-health and health care partners, should take to inform the response. This will take time but planning for each phase should begin now so the infrastructure is in place when it is time to transition.”

Read more about it in our brief summary. Or access the full report.

Updated Monday March 30 at 10:00 am EST

Given the ongoing pandemic— and because the in-person Health Evolution Summit has been postponed — we are hosting a virtual gathering, Pandemic Response: A Public-Private Call to Action. During the webcast, CEOs and other C-level leaders will learn from each other and from federal and state government officials about insights and best practices for preparedness, mitigation, education and communication. Leaders will also discuss lessons learned on the front lines of the battle and share information about the available diagnostics, treatments, cures and forthcoming vaccines.

When: April 2, 2020 beginning at 8 am ET.

View the agenda and register. (Here’s the FAQ about postponement.) 

CEO Reading List

COVID Community Vulnerability Map. Jvion, a health care analytics company, has released a COVID Community Vulnerability Map. The interactive map identifies populations down to the census block level that are at risk for severe outcomes upon contracting a virus like COVID. It also is overlaid with points of interest, such as hospitals, food sources and transportation, in relation to the at-risk communities.

• Takeaway. This map can help “inform providers, public health organizations and community support agencies as they look to deploy interventions, outreach and other services to keep individuals from contracting the virus and, once infected, manage their care towards a positive outcome.”

Check out the map here.

Perceptions of COVID-19 among the general public. The Annals of Internal Medicine assessed knowledge and perceptions about COVID-19 among a convenience sample of the general public in the United States and United Kingdom.

• Takeaway: While the nearly 6,000 residents in the U.S. and UK had good knowledge of the main mode of disease transmission and common symptoms, the results showed several important misconceptions on how to prevent acquisition of COVID-19, including falsehoods that have been repeated on social media.
• Author’s advice: “In conclusion, the general public in the United States and United Kingdom appears to have important misconceptions about COVID-19. Correcting these misconceptions should be targeted in information campaigns organized by government agencies, information provision by clinicians to their patients, and media coverage.”

Singapore modelling study estimates impact of physical distancing on reducing spread of COVID-19. A new study in The Lancet looked at the impact of physical distancing on reducing spread of COVID-19.

• Takeaway: Researchers looked at the effective measures from the country of Singapore in stopping COVID-19. They found that quarantining of people infected with the new coronavirus and their family members, school closures plus quarantine, and workplace distancing plus quarantine, in that order, work the best with a combination of all three being most effective in reducing cases.
• Author’s advice: “If the preventive effect of these interventions reduces considerably due to higher asymptomatic proportions, more pressure will be placed on the quarantining and treatment of infected individuals, which could become unfeasible when the number of infected individuals exceeds the capacity of health-care facilities. At higher asymptomatic rates, public education and case management become increasingly important, with a need to develop vaccines and existing drug therapies,” Alex R Cook, PhD National University of Singapore

The COVID Tracking Project. This is an independent, volunteer-run accounting of every coronavirus test conducted in America. “We attempt to include positive and negative results, pending tests, and total people tested for each state or district currently reporting that data,” the website states.

TAKE ME TO THE DATA

COVID-19 response reveals why public-private partnership is vital to health care. The newest Leadership Matters column from Health Evolution Founder and Executive Chairman David Brailer, MD,

• Takeaway: “I believe that a future investigation into early coronavirus testing will not show that federal agencies failed to follow rules, but rather that the rules themselves were obsolete and not adequate for today’s challenges.  It is a systematic institutional failing that demonstrates the huge downside of having the government too much in control of health care.”
• Author’s advice: “Over the next few weeks, we will face a once-in-a-century fight for the health and wellbeing of our citizens and our nation.  When it is done – and we will put it behind us – we will then ask what we learned and what we should do differently next time.  I hope this includes an exploration of how much we benefit from our America’s unique public-private collaboration and how we can make it stronger and deeper in the future.”

COVID-19 is sparking a lot more questions than answers right now. Here’s one from Paul Keckley: Coronavirus: A gray rhino that will the re-shape the U.S. health system?

•  Takeaway: “Is this coronavirus pandemic a Black Swan that caught most by surprise or is it a gray rhino that lurked obviously but was ignored? It’s a legitimate question. In my view, it’s a gray rhino.”
• Author’s advice: “What’s clear from prior pandemics is that quick action is necessary to contain the spread and mitigate longer-term adverse outcomes. The fast and dramatic actions taken in China, Taiwan were successful: mass quarantines and lockdowns, significant limits on gatherings and mass testing proved effective.”

Updated Monday, March 16, 11:00 AM ET.

Virtually Perfect? Telemedicine for Covid-19. Judd Hollander, MD, Associate Dean for Strategic Health Initiatives at Sidney Kimmel Medical College at Thomas Jefferson University andBrendan G. Carr, MD, Associate Dean of Healthcare Delivery Innovation at Thomas Jefferson University write in The New England Journal of Medicine about why telemedicine and AI are ideal for Covid-19 screening. 

• Takeaway:  While there are barriers to telemedicine, specifically coordination of testing, credentialing, program implementation and payment parity, it’s well suited to help combat the pandemic.  It will reduce the number of patients that will get exposed to the virus and will address concerns about workforce capacity. 
• Author’s advice: “A central strategy for health care surge control is “forward triage” — the sorting of patients before they arrive in the emergency department (ED). Direct-to-consumer (or on-demand) telemedicine, a 21st-century approach to forward triage that allows patients to be efficiently screened, is both patient-centered and conducive to self-quarantine, and it protects patients, clinicians, and the community from exposure.”

Coronavirus: Health care accelerates innovation in pandemic response.  Health Evolution contacted executives from Providence at the U.S. epicenter of the outbreak in Seattle, as well as Spectrum Health, Ginger and Blue Cross Blue Shield Association to report on how they are handling the outbreak. Amid so much bad coronavirus news, we found innovative spirits pushing ahead even harder than usual.

Combating Coronavirus starts with keeping workers well. By Michelle Williams, Dean of Faculty at Harvard T.H. Chan School of Public Health and Arianna Huffington, founder and CEO of Thrive Global in Fortune.

• Takeaway: “We’re already seeing the tremendous toll — physical, mental, and emotional —that the coronavirus is taking on the world’s public health workforce.”
• Authors’ advice: “It’s imperative that we prioritize well-being in our own lives — building healthy habits around sleep, movement, nutrition, and hydration that help us mitigate stress, avoid burnout, and truly recharge. Ultimately, these are the most important disease prevention steps all of us can take.”

 Why it’s not impossible that COVID-19 kills a million Americans,  by former CDC Director Tom Frieden, MD, in an article on Think Global Health.

• Takeaway: “During the three major emergency responses I oversaw at CDC in the past decade — H1N1, Ebola, and Zika — CDC and state and local health departments were able to learn quickly and act quickly to protect people. The COVID-19 pandemic is an unprecedented threat — never before has a new respiratory pathogen been identified then spread around the world.”
• Author’s advice: Frieden offers 10 action items: protect the vulnerable, stop non-essential visits to nursing homes and long-term care facilities, accelerate work on treatments and vaccines, cancel large gatherings, protect health care workers, stop handshake, stay inside if ill, telework while virus is in your area, assess school closure and learn more as fast as we can.

Taiwan’s impressive efforts to thwart coronavirus.  
Based on data in the Journal of the American Medical Association, we created this infographic demonstrating why Taiwan is something of a success story amid the chaos.

• Takeaway: Despite being close to mainland China, Taiwan had only 44 cases as of the first week in March because “the government activated its Central Epidemic Command Center for severe special infectious pneumonia,” to significantly reduce spread.
• Advice: “Proactive testing, big data analytics, and new tech innovation [can] keep coronavirus rates down, according to the research in JAMA. This includes leveraging its national health insurance (NHI) database and integrating it with its immigration and customs database for analytics, usage of clinical real-time alerts, QR scanning and online reporting of travel history and health symptoms to classify travelers’ infectious risks based on flight origin and travel history in the past 14 days. They also sought out patients with severe respiratory symptoms based on the NHI database.”  

How should hospitals develop a strategy for coronavirus?

Vineet Chopra MD, Associate Professor of Medicine and Chief of the Division of Hospital Medicine at Michigan Medicine, and a team of researchers write in Annals of Internal Medicine about the steps U.S. hospitals should take to prepared for COVID-19.

• Takeaway: The “best-case scenario estimates suggest that COVID-19 will stress bed capacity, equipment, and health care personnel in U.S. hospitals in ways not previously experienced.” The authors’ say providers should be developing a strategy for patient volume and complexity, protecting and supporting health care core workers on the front lines, figuring out how to allocate resources, and creating a robust open communication policy.
• Authors’ advice: On patient volume and complexity, the authors suggest hospitals attempt to geographically cohort patients with COVID-19 to limit the number of health care personnel exposed and conserve supplies. When it comes to communication, the authors say, “crisis communications should ideally occur via several media, such as a telephone hotline, the hospital Web page, social media platforms, or text-based messages.”

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