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Preparing for the Next Pandemic: Building a More Resilient U.S. Healthcare System

The COVID-19 crisis taught us that we rely too heavily on foreign countries for medical supplies and pharmaceutical components.

For the past two years, we have given our all to beat the COVID-19 pandemic. While infection rates are continuing to decline nationwide, the virus is inevitably here to stay, and our nation’s healthcare system is in crisis. Consequently, we must collectively refocus and strive to be as prepared as possible to meet demands of the ongoing pandemic response and recovery efforts, as well as future infectious disease outbreaks.

Recently, the Senate Health, Education, Labor and Pensions (HELP) Committee released draft legislation, Prepare for and Respond to Existing Viruses, Emerging New Threats, and Pandemics Act (PREVENT Pandemics Act). This legislation is a tremendous step forward to improve the nation’s overall preparedness and lays the groundwork for enhanced public health emergency readiness. As our nation endeavors this change, our leaders and policymakers must keep several important factors in mind.

Restoring public trust

Public anxiety, fear, and uncertainty continue mounting, particularly surrounding our nation’s ever-changing pandemic mitigation measures. Therefore, we must restore public trust through clear, consistent communications from our nation’s health officials and government leaders. Recognizing politics often makes consistency difficult to achieve, a scientific-based approach should be considered to help set public expectations by linking realistic metrics (case numbers, hospitalizations, and deaths) with tangible community-based mitigation measures (masking, testing, and limiting public engagements).

The recently released CDC Community Levels guidance is a great step forward. It moves the nation in the direction of linking metrics to public health actions that both individuals and communities collectively can take. The metrics are driven by community-specific case counts, COVID-19-related hospital admissions and Intensive Care Unit (ICU) capacity. This alleviates uncertainty and provides standards for individuals and communities that allows for no mask wearing when metrics are low and the ability to ratchet up public health actions such as mask wearing when COVID-19 activity is high. The CDC Community Levels will provide clarity to the pandemic-fatigued public.

Maintaining readiness

Today, we have 40% fewer hospital beds in the U.S. than we did 40 years ago. Absent a public health emergency, hospitals usually operate at a 66% occupancy rate, and only get paid if there is a patient in a bed. Accordingly, to create value and optimize costs, hospitals closed, consolidated, or created new models to deliver care to minimize financial exposure. The pandemic has highlighted that the healthcare and insurance industries business model must shift to one that incentivizes and rewards maintaining open surge capacity. This starts by adequately funding healthcare preparedness.

Currently, hospitals rely on U.S. Department of Health and Human Services (HHS) Hospital Preparedness Program (HPP) funding to provide preparedness and mitigation related activities. This program started in the aftermath of September 11, 2001, and provides $276 million per year to more than 6,000 hospitals across the country. Over the past 20 years, funding for this program has slowly been reduced by over 46% from its initial $515 million per year allocation in 2001. Present allocation of HPP funding equates to an average of $46,000 per hospital, which is often spent offsetting emergency preparedness salaries and equipment. This funding must be drastically increased so hospitals can create critical care capacity, stockpile supplies, plan, prepare and build resiliency for the future.

Improving healthcare delivery and resolving supply chain challenges

Over the past two years our healthcare heroes saved countless lives through skill, innovation, and passion, as well as pure grit and perseverance. At the same time, our hospitals found ways to create capacity by repurposing space, converting community centers, and building field hospitals to care for the tidal waves of patients. Amidst this crisis, many healthcare providers have faced widespread staffing shortages as caregivers vacated positions due to burnout, retirement and/or becoming sick with COVID-19 themselves.

Going forward we must bolster our U.S. Public Health Service Commissioned Corps (USPHS). This team of approximately 6,000 caregivers is playing an instrumental role in our nation’s current response to COVID-19 by staffing field hospitals and treatment centers. To truly be effective this team must be sized based on the worst-case scenario that all 330 million Americans need care during a public health emergency. Moreover, state and local governments should consider pre-establishing contracts with vendors that can ramp up staffing at the first sign of a potential public health emergency – during a declared disaster, this support is often eligible for reimbursement by federal grant funding.

Additionally, the COVID-19 crisis taught us that we rely too heavily on foreign countries for medical supplies and pharmaceutical components. A 2020 Council on Foreign Relations study found that 97% of the U.S. antibiotic supply came from China; moreover, 80% of active ingredients used to create our medicines are imported from China or India. As a result, during the height of the COVID-19 response, Americans faced critical shortages of personal protective equipment (PPE), ventilators, and other medical equipment. To address this, Congress should provide American businesses with tax incentives or readiness funds that will enable them to quickly ramp up production or build a real-time capability to meet supply and demand of PPE, equipment, pharmaceuticals, and other critical medical supplies, as needed. This will help our nation’s healthcare industry strike the right balance – relying on imports, where necessary, with the ability to easily ramp up our own production capabilities, if needed.

Lastly, to coordinate this broader entire effort, a federal Public Health Emergency Response & Recovery Office should be established to serve as a “one-stop shop” that is dedicated to directly assisting their state, tribal, local, and territorial government counterparts as they prepare for current and future health hazards they may face.

Conclusion

Building a more resilient healthcare system as we learn to live with COVID-19 is no longer an option – it is a critical necessity as we strive to preserve our future health and well-being while functioning as a society. As rates of COVID-19 transmission decline over the coming months, we must act with urgency to rebuild our workforce of caregivers for future emergency staffing, restore trust in our healthcare system through improved crisis communications, and reform insurance reimbursement models to incentivize healthcare readiness, as well as transform domestic manufacturing capacity to establish a more resilient medical supply chain. Now, let us begin this difficult work together, in a bipartisan fashion, to ensure we can be as prepared as possible for future public health emergencies.

Brock Long and Jeff Bokser
Brock Long is the former Administrator of the Federal Emergency Management Agency (FEMA) (2017-2019), and Hagerty Consulting’s Executive Chairman. He has more than 20 years of experience assisting and supporting public and private organizations nationwide as they work to build robust emergency management and public health preparedness programs. Jeff Bokser is Hagerty Consulting’s Vice President of Healthcare Programs with strategic expertise in all aspects of healthcare operations, finance, crisis management, and recovery. Jeff has over 20 years of experience as a senior leader at NewYork-Presbyterian and Yale New Haven Health and served as Incident Commander guiding 40,000+ employees through numerous internal and external emergency response and recovery operations.

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