COVID-19 Health Care Response and Resilience Program

Duke Margolis Center for Health Policy, Families USA, and United States of Care are urging Congress to Enact the COVID-19 Health Care Response and Resilience Program, and other key health care reforms in the next COVID-19 legislative package.

Health care providers and health care organizations are reorienting their workforces, modifying facilities, and prioritizing critical services to provide effective and safe care for individuals with COVID-19 – all while facing significant continuing revenue shortfalls. The revenue shortfalls are the result of the large drop in utilization seen across the health care system. Some recovery in utilization has occurred since the spring, but the continued presence of the virus is leading to stretched hospital capacity and an ongoing need to modify health care practices.

The way providers are paid has led to these financial crises. Fee-for-service (FFS) payment has been criticized for encouraging volume over value; now organizations are also finding that FFS offers no backstop when utilization drops in a public health emergency. Conversely, providers and health systems who participate in value-based payment (VBP) have been more financially stable, particularly those in advanced alternative payment models who receive upfront, ongoing payments not tied to FFS. VBP providers have been able to quickly implement an effective pandemic response, while FFS providers have had to rely on regulatory and payment changes to meet the needs of their patients.

To help address the financial impact of COVID-19, providers are receiving $175 billion in emergency financial support from the Provider Relief Fund and the Paycheck Protection Program (PPP). As the pandemic continues, providers will likely need additional funding assistance. It should help them implement better approaches to contain the virus and meet the needs of their patients through improved care delivery, not simply address financial shortfalls.

Our proposal recommends that the additional funding be used to support feasible steps to help contain the pandemic, including:

• Data sharing and coordination with public health, to provide assistance with point-of-care testing, contact tracing, and other local containment efforts.
• Participating in joint planning and response across health systems and with public health authorities to manage surges in seriously ill COVID-19 patients.
• Managing COVID-19 patients outside the hospital including in the home and other community-based settings.
• Implementing care teams focused on chronic disease management using telehealth, remote monitoring, and assistance with social needs like food insecurity.
• Shifting services like drug infusion and care management for complications in cancer patients to less costly home or ambulatory settings, when such shifts are clinically appropriate.
• Adopting new models of care for patients with specialized health problems, such as: home dialysis for patients with end-stage renal disease rather than visits to dialysis centers; and home- and community-based care models for complex patients, like “hospital at home” care or advanced home rehabilitation services.