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BLOG: Segmenting Health Systems

The COVID-19 pandemic has separated health systems based on the impact of the pandemic on their staff, operations and finances. While many health systems have struggled in these areas, some have truly succeeded.

This means that stakeholders developing relationships with health systems to improve outcomes must do so through the use of their specific pharmaceutical treatments. Demonstrating a clear appreciation of the priorities, abilities and focus of a treatment is essential and is not a one-size-fits-all situation.

Even prior to COVID, a health system’s priorities could be assessed through their County Health Ranking and Community Health Needs Assessment (CHNA). The CHNA is required for all nonprofit health systems every three years. It is used to demonstrate that profits that would typically be taxed are instead spent on efforts to improve the health of the population served. As such, the CHNA highlights the priorities for each health system. Knowing the areas that each health system is focused on provides a foundation for pharmaceutical manufacturers to build relationships with them.

Perhaps the elements most impacted by COVID are health systems’ staff, finances and processes. There is clear separation in health systems that are stressed to the point of breaking when the introduction of non-COVID projects would likely be met with open hostility. Low vaccination rates, high hospital occupancy and low staffing levels are currently putting strain on many health systems. By better understanding these stressors, pharmaceutical manufactures can mitigate this hostile reception rather than further straining health system staff.

Most recently, the number of workers such as nursing aides and support staff has become limited in health systems as those workers find employment in settings that not only pay more but are less stressful, offer the ability to work from home and often do not require vaccination. With a better understanding of a health system’s staffing stressors, manufacturers can better identify health systems that are less burdened by staffing shortages and more open to taking on non-COVID-related projects.

Health system finances is another area that has been stressed by COVID. This is especially true for health systems that were firmly planted in fee for service. As their volume of outpatient procedures, such as elective surgeries, diagnostic studies and physician visits, declined, so did their revenue. Contrast that to health systems with their own health plans. For these systems, the decrease in utilization represented a significant savings. So here, as with staffing strain, identification of health systems that are financially strong offers a target to other systems that are in a position to invest in further population health improvement efforts.

Finally, there are also systems in place to guide uniformity in care. Throughout COVID, there were health systems able to have EHR embedded guidelines in place that were quickly adjustable based on the changes in the CDC COVID treatment recommendations. These systems are able to use this same process in managing other disease conditions. This is in contrast to those systems with a high level of treatment variation because of a lack of process.

By better understanding these three elements — staff burden, financial focus on managing risk, and embedded care management processes — pharmaceutical manufacturers can better identify health systems that are in the strongest positions to be the ones leading in value-based partnerships in a post-COVID world.

Chief Medical Director

Richard has focused his career on improving health outcomes, especially for some of the most vulnerable populations. This has been achieved through several avenues, beginning with his continued active role as a treating internist/geriatrician.…