Healing Healthcare: Part 4: 2020: The COVID Impact

Tim Duer

Healthcare, COVID-19, Healthcare Industry

November 23, 2021

Healing Healthcare: Part 4 2020: The COVID Impact

Prior content for the Healing Healthcare series focused on the emerging history and progress of the operational aspects of the US healthcare system, including the development of pay structure, utilization management, and the overall advancement of modern healthcare establishments. For better or worse, whenever possible, there was a division between the worlds of finance & managed care and the clinical operations of health systems. These two worlds faced an almost instantaneous collision in March 2020, as the impacts of COVID-19 for the country and the world began to appear. While COVID-19 took center stage in 2020 for all sectors of industry, the associated challenges that were faced by the healthcare industry were multi-faceted and unique. While many were forced to grapple with some previously unconsidered proceedings, it was the pace of these changes that those in healthcare had to handle more so than other industries. As Dr. Shantanu Nundy, a primary care physician practicing just outside Washington, D.C., and the chief medical officer at Accolade, told NPR in a May 2021 interview, “Health care has changed more in the past year than during any similar period in modern U.S. history. And it changed for the better”(1).

Clinical Challenges

While researchers were coordinating their efforts to accelerate vaccine development and other measures to reduce COVID-19 spread, clinicians were presented with the harsh realities of treating very ill patients in unparalleled circumstances. The workforce had to balance challenges associated with caring for these patients while still facing the chaotic alterations to daily life that everyone faced such as home-schooling, grocery shortages, and quarantine in general. These progressive stressors gradually contributed to workforce shortages in many areas of clinical care, as the burnout of staff led to the “great recession” impacting the healthcare sector more than any other, and 3.6% more health care employees quit their jobs in 2020 than in prior years.(2)

While clinicians were facing the challenges of caring for patients with COVID-19, others had to consider the options available to continue with the delivery of care for patients that were required to be quarantined. In the areas of outpatient or ambulatory care, many patients were either uncomfortable entering healthcare facilities or were required to remain at home due to quarantine orders. As a result, clinical teams had to make difficult decisions in how to triage and/or determine alternative ways to provide care. While telemedicine had been present well before COVID-19, the need for alternative care delivery models provided the opportunity for telehealth to shine. In less than a year, “COVID-19 … pushed the inevitable telemedicine revolution forward by a decade.”(3) In an incredibly rapid rate of change, both providers and patients gravitated to the platform and saw the benefits of what had previously been seen as an undesirable concept, “instantly reshaping services ranging from routine checkups to addiction treatment."(1) A November 2021 Causeway Solutions national survey of 600 respondents showed that a majority 58% of respondents reported having used a telehealth platform and would use it again (another 9% used telehealth but would prefer not to try it again); this is up from 41% and 9% in November 2020. While this year-to-year growth appears significant, it pales in comparison to the growth from November 2019 to November 2020; where the number of healthcare claims via telehealth increased by 2,900%!(4)

Financial Implications

While hospital systems faced these confounding challenges to their status quo, the financial bottom line was also under attack. Although non-profit organizations far outnumber for-profit systems in the US, numerous factors have applied increasing pressure for all health systems to become financially sound in operations. Although this topic alone could justify another installment of this series, at the core, financial performance has become essential to justify the personnel and capital tech expenditures that are required for health systems to remain at the forefront of the industry. With so many factors playing into healthcare revenue (for more information, see Part 3 of Healing Healthcare: Changing Healthcare Payments, there has been increased attention placed on more reliable revenue streams. This attention led many systems to turn to outpatient surgical procedures as revenue generators. While this turn had become an excellent option for many systems, COVID-19 had other plans in mind.

Many states required the halt of “elective” surgeries during the COVID-19 quarantine peek, both to avoid unnecessary use of equipment/services and to avoid any additional exposure for patients and staff. This hold meant that ambulatory surgeries and the associated surgical centers had their schedules frozen, and the previously reliable revenue streams were no longer present. What was the financial impact? A May 2021, multi-center study (5), estimated the national loss in revenue to be a massive $22.3 billion! With an impact this substantial, it’s obvious that 2021 (and beyond) requires both a shift towards recapture and a shift in financial operations.

Getting More Value from the Numbers: The Role of Research, Data, and Analytics

Clinical Care and Diagnoses

The above-described challenges in staffing, financial management, and care delivery have all provided an opportunity for data analytics to expand in the healthcare space and have also made data-driven decision-making an essential part of operations. Health systems have recognized that the information that had typically been relegated as being helpful for scholarly work, now holds the keys to improving quality and efficiency in care. As hospitals were able to combine their internal data with public health data, real-time COVID-19 tracking became possible, benefiting both patients and hospitals alike. Hospitals were able to be more predictive in their anticipated needs for providers, equipment, and hospital capacity, and public health officials could identify areas of rapid spread and look to increase messaging regarding preventative measures. As the pandemic spread, the most important decisions inside and out of hospitals were made using data.

Just like the telehealth opportunities presented by Covid-19, the insights and opportunities that data can provide for both planning and diagnostics will remain. In response to the urgencies presented by the pandemic, providers and administrators have now “realized the value of data, so data tracking will be extended to other prevailing diseases like HIV, cancer, and diabetes to unearth new healthcare solutions.”(6) This advancement will serve patients, providers, and administrators well as the post-covid rebound continues.

Patient Acquisition and Marketing

Beyond predictive diagnostic analytics, providers have also been forced to utilize data to drive more efficient patient acquisition and scheduling strategies. In response to the financial implications that resulted in 2020, health systems reported a reduction in the marketing budget from 9.9% of revenue allocated in 2020 to 7.2% in 2021(7). This reduction has provided marketing teams with the unenviable task of regaining volume with less budget. As a result, the progressive shift in healthcare from mass marketing to a more personalized approach to patient outreach has accelerated. This change has been well established in other sectors, but healthcare marketing has always been an outlier compared to other fields.

Top health care marketing teams are now focusing on key service lines that are prepared for growth and identifying consumers that are most likely to benefit from those services. While internal CRM tools can help track messaging to current patients, the expansive availability of consumer data provides the key to shifting these precision marketing messages to new consumers and optimizing a new patient acquisition campaign. Causeway Solutions works with healthcare clients to utilize predictive and prescriptive modeling to minimize marketing waste and ensure that individuals who are most in need of the care being offered are targeted. This use of “big data” is allowing healthcare systems to identify potential patients, deliver to them content that they desire, and maximize the marketing budget. This is a change that will not be temporary and will continue to lead the way as the future of healthcare marketing.


Like so many other aspects of our society, the pressures applied by and the responses associated with the Covid-19 pandemic will have long-term implications. While there are so many obvious negative impacts, one positive outcome is that “the pandemic has opened up new ways of thinking, forcing [healthcare] leaders to meet an unprecedented need for expanded care.”(8) These unprecedented needs require new ideas for care delivery models, new ways to view patient and consumer data, and an inclusive vision for healthcare operations. Fortunately, the early response shows that the healthcare industry and its members seem up for the challenge.


[1] Henning, J. (2021, May 13). How healthcare in the U.S. may change after COVID: An optimist's outlook. NPR.org. https://www.npr.org/sections/health-shots/2021/05/13/996233365/how-health-care-in-the-u-s-may-change-after-covid-an-optimists-outlook

[2] k, I. (2021, September 15). Who is driving the Great Resignation? Harvard Business Review. https://hbr.org/2021/09/who-is-driving-the-great-resignation

[3] Facher, L. (2020, May 20). 9 ways Covid-19 may forever upend the U.S. health care industry. STAT. https://www.statnews.com/2020/05/19/9-ways-covid-19-forever-upend-health-care/

[4] FAIRHealth. (2020). Monthly telehealth regional tracker, Nov 2020. American Medical Association.

[5] Bose, S. K., et al. (2021). The cost of quarantine: projecting the financial impact of canceled elective surgery on the nation's hospitals. Annals of Surgery, 273(5), 844-849. https://journals.lww.com/annalsofsurgery/fulltext/2021/05000/the_cost_of_quarantine__projecting_the_financial.5.aspx?casa_token=qUBp3BsyCjUAAAAA:rbOnr9jOdCGiwpWXEZVSsE7lZ2NdildJDr-G-GKmu_03GyQunxGBmUYKiYhJV5U3ZZPdnmocifyJELeQdSPh8Q

[6] Jones, D. (2021, November 5). Five COVID-19 induced changes for healthcare workers that will stick around. HCP Live https://www.hcplive.com/view/five-covid-19-induced-changes-healthcare-workers

[7] Mitchell, H. (2021, July 27). Marketing budgets fall sharply in 2021. Becker’s Hospital Review. https://www.beckershospitalreview.com/digital-marketing/marketing-budgets-fall-sharply-in-2021-5-takeaways.html

[8] Levine, D. (2021, February 22). How will healthcare delivery change post-pandemic? U.S. News & World Report. WR 2/22/21: https://www.usnews.com/news/health-news/articles/2021-02-22/how-will-health-care-delivery-change-post-pandemic

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