Post-COVID, What Is the Future of Healthcare?

Bryan Cote

Telehealth services and an increased focus on mental wellness and value-based care will be among the pandemic’s lasting legacies on healthcare.

With millions of people around the world now getting vaccinated each day, the worst of the coronavirus pandemic appears to be behind us. But as we emerge from the worst public health crisis in a century, COVID-19 is prompting one question from experts and laymen alike: “What is the future of healthcare?” Bryan Cote offers key insights.

During BRG’s Healthcare Leadership Conference (HLC) in December, a panelist from a managed care organization said anti-anxiety medication use among her health plan’s members had tripled since the pandemic began. Is that on track with what you’re hearing? What other trends are you seeing?

BC: It is definitely on track with what we’re hearing about increased stress—and even with pandemic news improving, that will likely continue for a while. I expect more of the healthcare community to balance the short-term need for medication with the broader goal of non-pharmacological options, particularly for children, teens and young adults, like programs that promote exercise to mitigate the effects of anxiety and depression. Orange Theory in my area has partnered with doctors and insurers to offer programs for employers that mitigate stress. 241 Sports focuses on play programs for kids who would otherwise be given a pill—now it’s a frisbee. These programs have had to adjust to COVID, but they also have real staying power as a result of the pandemic. Not being able to visit a therapist’s office for counseling has of course been part of the challenge, but telehealth’s expansion has filled a gap when people really needed help. 

COVID-19 only exacerbated what has been going on. The Affordable Care Act and parity laws have changed the landscape as far as what insurers have to cover. Other factors, like the rise of social media, the aging of America (which highlighted cognitive issues) and even the opioid epidemic, have brought an increased awareness when it comes to how mental health affects overall health. For better or worse, that awareness and focus on behavioral health’s importance has only grown as a result of the pandemic.

How will these lessons translate into healthcare changes for the everyday lives of Americans?

BC: What we’ve learned from COVID-19 is that everyone can use some form of mental-health services. My 17-year-old heads off to college soon, and I’ve heard therapists suggest it’s not a bad idea for incoming students to start a relationship with someone now. 

Part of the problem is our system isn’t set up with enough access to therapists and programs for those really struggling. The wait times alone are staggering. Reimbursement is improving for mental health, but there’s still a big gap, and access for those with severe issues is particularly limited. We probably need more efficient methods and technologies to triage the population to prioritize who most needs mental health services. I expect more app-based solutions will emerge.

I think we’ll also see the healthcare market figure out opportunities to fill a gap. We’ll likely see a rise in urgent care facilities for mental health services that look more like living rooms than emergency rooms. These facilities already exist in some places, and they likely will be in most cities by the middle of the decade. Basically, crisis support for high-risk situations. In a few years, we’ll likely point to COVID-19 as a major driver of that change.

Do you envision that we’ll point to COVID-19 as the impetus for adoption of value-based care models for behavioral health?

BC: Definitely. What we’ve learned is that it’s very difficult for smaller physician practices to do value-based care. Many of them are joining or will join larger groups so they don’t have to worry so much about what they’ll be paid for or how to get approval for every single patient visit. They’ll need mental health providers or telehealth services to help them manage the patient’s overall health, and the insurers are onboard. 

I think you’re going to see mental health practitioners as not just a nice-to-have but an essential part of what primary care physicians and pediatricians are offering, partly because they are being incented to address depression and anxiety right away rather than refer out. We’re already seeing alternative payment models for those helping address drug and alcohol addiction and the severely mentally ill. COVID-19 will accelerate all of it, especially in certain cities where the insurer and the practitioners agree.

Value-based care also is easier to do well if, say, a practice that focuses on surgery joins forces with a larger group that has offerings like behavioral health. Insurers also are focusing more on this type of holistic care. Say a patient is getting treated for Crohn’s disease. The insurer increasingly is likely to be onboard with covering behavioral health services, because it knows that a patient doing better mentally is more likely to adhere to treatment regiments, get better faster and ultimately save money on costs. COVID-19 should accelerate interest and reimbursement for the right models.