The COVID-19 window: ‘High ground’ health policy during times of crisis

Policy wonks know that real change happens only under extraordinary conditions. They often talk of policy “windows” that tend to remain open only for a brief period. Even during a crisis, one must act fast before the window closes.

As co-directors of the Osteopathic Health Policy Fellowship, a national training program for mid-career osteopathic health professionals, we focus on moving participants away from their “stakeholder” positions focused mainly on their and their colleagues’ needs, and toward what is needed for overall population health.

System transformations

During the SARS-CoV-2 (COVID-19) pandemic, clinicians have a distinct perspective to contribute to policy development, especially at a time when the world is tuned in to their heroic work on the frontlines of the pandemic.

Clinicians are in a unique position to redirect that focus back to systemic issues, such as those that impede access, quality and care in population health and health care. Doing so could promote system transformations that may improve population health outcomes now and when we return to a “normal” state.

Proactive, not reactive

Difficult times foster an unfortunate tendency to react to circumstances instead of taking a more proactive, principled stand. But “high ground” perspectives should not be regarded as luxuries made possible by “normal” times of health and prosperity.

Instead, we should take a cue from the ancient Greeks, who knew that the word “crisis,” rooted in the same word family as “critical,” is a time for thinking and resisting the same path that created the crisis in the first place. It is hard to stay at the high ground during a crisis, but it is also a test of our commitments. A crisis should not be a springboard for returning to normal, but a moment of reflection to help us get to where we need to go.

Policy development feels different during a crisis. COVID-19 prompted relaxing of HIPAA restrictions and changes in Medicare telemedicine reimbursement. Both were previously resisted but appeared suddenly prudent. What will become of these policies when the crisis is over? Will they be undone as the perceived “need” wanes or tweaked as part of policy reflection and remain in force?

We are well-positioned to gather information and data upon which to make evidence-informed recommendations and policy. This is just one issue among many that COVID-19 raises.

The COVID-19 pandemic also highlights the structural flaws with American health care, including lack of investment in both public health and health care and the continuity of supply lines. As unemployment skyrockets, the dangers of linking health care access to employment become more evident.

Both health insurance and employment opportunities must be framed around the greater good and must not be reduced to opportunistic stakeholding. So too should political partisans, Democrat or Republican, resist the temptation to use this moment to merely push through longstanding pet issues.

The big picture

COVID-19 further challenges us in the midst of a presidential election where “big picture” health policy discussions should be front and center.

New policies (e.g., testing availability; understanding outcomes; and the process and limitations of public health mandates) should be responsive to immediate needs that are well-defined, evidence-based and equitable. This perspective is fair game in the time leading up to the election as the nation grapples with high COVID-19 infection and death rates.

In the coming months, policymakers, policy developers and advocates will focus on assuring that we are prepared for the next crisis. But there remains a question of the nature and focus of this work, particularly as to whether the suffering and lives lost—as well as the heroic efforts of health workers, who do the grinding, often-dangerous work of care—will be in vain.

This work must begin now in the midst of this crisis if a more responsive, population health-focused system is to be one positive outcome of the current moment.

Examples of high-ground approaches include:

• Pre-emptively advocate from a patient care and outcome perspective. For example, while personal protective equipment is critical to the health of the team, framing the issue as one of assuring the ability to meet unexpected demand both serves the population and promotes the safety and health of the health workforce.
• Identify, develop, and implement policies and strategy for the next pandemic, which must be seen as just around the corner. Make ongoing notes of what works and what doesn’t to keep memories and ideas fresh for later use.
• Assure that the next generation of health professionals has opportunities to train during the pandemic as its members will be on the front lines during future events.
• Take an evidence-informed approach to health care. With a novel agent, such as COVID-19, the evidence is in flux, often beginning with conservative approaches based on our understanding of “similar” agents. As experience builds, prevention and treatment approaches must change. It falls to the health professionals to convey this information to patients and colleagues, while also dispelling misinformation.
• Become a meaningful advocate with institutions and policymakers to set policies in place that will improve the health care response during future pandemics and crises. Changes that improve the lives of the population will also serve health professionals.

Related reading:

What we know about COVID-19 immunity

5 things every DO can do to better understand the business of medicine