Each day brings new details and a new definition of the challenges facing the healthcare providers on the front lines of the Covid-19 pandemic. In the face of these upheavals, we examine the near-term implications of this public health crisis and offer an action plan to help leadership teams support their employees and communities while minimizing the disruption to their medical services and underlying businesses.

Implications of Covid-19 for providers

The exponential rise in Covid-19 patients has required new protocols and workflows, including testing, monitoring and anti-infection practices, as well as supportive care for those testing positive for the coronavirus. Emergency medicine and infectious disease staff are at high risk of infection, but also of overwork and exhaustion as they grapple with an ever-growing number of Covid-19 patients.

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Traditional communication methods are being upended as patients reach out to clinicians via e-mail and messaging apps with Covid-19 concerns and other requests. The demand for urgent care and telemedicine is growing, and the rise in new users is likely to increase public and payer acceptance of telemedicine and digital health engagement tools. To avoid hospitals, patients may also turn to alternative sites of care such as pharmacy in-store clinics, including those operated by CVS, Walgreens and Walmart in the US and “one-minute-clinic” kiosks operated by Ping An Good Doctor in China. That shift in behavior could increase the popularity of these outpatient healthcare destinations after the crisis.

Patient volumes will decline in the near term, particularly in elective departments and primary care, as hospitals focus on Covid-19 patients while other patients observe shelter-in-place directives or isolate themselves at home. In countries with universal healthcare or single-payer coverage, the public health crisis may lead to even longer waits for surgeries and risk depriving patients of needed care. Shifting priorities also will reduce short-term cash flow for hospitals, ambulatory surgery centers, physician groups and labs. These financial pressures will add to the emotional burdens of provider management and physicians as they strive to preserve job security for their staff. 

Providers are contending with a disrupted supply chain for essential drugs, medical devices and equipment. The most acute shortages include personal protective equipment, ventilators and antiviral therapies.

Act now: Near-term priorities

Clinical

• Put patient safety first by implementing infection-control measures for all stakeholders. These protocols will require constant adjustment.
• Ensure you are making the best use of clinicians, equipment and facilities. Preserve clinicians’ ability to safely treat patients by training and educating staff on the use of protective gear, especially in environments where gear is in short supply. Do regular screening for Covid-19 symptoms and testing as needed.
• Increase the use of telehealth and digital health engagement tools.
• Find ways to support physicians and staff and provide them respite from their heavy workloads, including additional rooms where they can rest. 

Financial

• Revisit financial and cash flow forecasts, setting up a 13-week rolling forecast. Update the organization’s base-case analytics on Covid-19, including scenario planning for financials and labor pools, duration of the pandemic, population impacted, and changes to patient flow, treatment mix and capacity.
• Manage cash tightly and draw on all sources, including taking on additional debt, delaying payables, and discussing early payments with payers and governments.  
• Identify immediate operational actions to reduce costs, such as non-personnel-related G&A expenses, and make a list of later actions. Set up clear triggers for initiating deferred actions.
• Prepare for clinical and nursing labor shortages. Some markets will experience an estimated 20% to 30% decrease in labor as schools close, forcing parents to stay home, and illness among medical staff increases. In others, clinicians may be required to work longer hours, practice outside of their normal specialties or shift from elective work to Covid-19 care. Build a locum nursing and physician pool, efficient rostering practices and rapid training for clinicians required to take on new responsibilities.

Operational

• Establish a crisis governance model for decision making across sites. Determine which decisions site staff can make themselves and those central staff will make. Ensure clear communications systemwide.
• Make supply-chain readiness a top priority. Communicate with vendors regularly to keep informed of risks and, if needed, identify alternate suppliers.
• Build dynamic forecasting capabilities to prepare for peak demand of ICU beds and treatment of Covid-19 patients, as well as critical elective surgeries. Prepare for the possibility that government health departments may need to commandeer staff, beds and supplies to balance disrupted supply chains.

Communication

• Communicate frequently with all stakeholders, including employees, patient communities, customers (payers, third-party administrators, corporates), the media and government bodies. 
• Keep messages practical and concise, from trusted sources.
• Be attentive to staff morale. Leadership has never been more important.
• Act as a trusted adviser to patients during this time of uncertainty.

Government and policy

• Coordinate with other stakeholders, including providers, pharma companies and nonprofit organizations, to provide advice and support to local government officials on containment, testing and treatment.
• Alert government officials to shortages and provide input on how they can ensure adequate supply of drugs, personal protective equipment, ventilators and other vital supplies. 

Plan now: Prepare for a post-Covid-19 world

• Accelerate adoption of telemedicine and invest in digital health engagement tools. This crisis could result in a permanent behavior change if providers use technology to offer quality care and an intuitive experience. Maintain contact with patients via telemedicine to prevent new medical complications.
• Reassess facilities and staffing capacity postcrisis to manage pent-up demand for deferred elective procedures or rebalance as procedures shift to ambulatory sites of care.
• Position outpatient and retail health centers as trusted healthcare destinations, and build a relationship with newly acquired customers.
• Review M&A and partnership opportunities in your markets.
• Set up distributed supply chains for critical medical supplies, to be better prepared for future pandemics and more agile in responding.
• Explore opportunities to transform the organization’s cost structure, increase flexibility and accelerate operational improvements such as shared services and automation.

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Coronavirus

The global Covid-19 pandemic has extracted a terrible human toll and spurred sweeping changes in the world economy. Across industries, executives have begun reassessing their strategies and repositioning their companies to thrive now and in the world beyond coronavirus.

Vikram Kapur is the leader of Bain & Company’s Healthcare practice in Asia-Pacific and is based in the firm’s Singapore office. Lucy d’Arville, Satyam Mehra and Michael Brookshire are partners with Bain’s Healthcare practice and are based in Sydney, New Delhi and Dallas, respectively. 

The authors wish to thank Tim van Biesen, leader of Bain’s Global Healthcare practice, Joshua Weisbrod, leader of Bain’s Healthcare practice in the Americas, and Loïc Plantevin, leader of the firm’s Healthcare practice in Europe, the Middle East and Africa, for their contributions to this article.