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Across the United States, community by community, businesses are making plans to re-open their doors to their customers. 

The past several months wrought a dramatic financial and social toll on our communities, with few sectors suffering the unique dichotomy that healthcare providers have experienced. The precipitous drop in routine face-to-face encounters, the temporary suspension of elective procedures, along with a rapid shift to telemedicine have been juxtaposed with the urgent requirement to scale up emergency and intensive care to meet the needs of patients with COVID-19. The reality is, a mix of sentiments are being expressed by ambulatory practices as the country begins to reopen; eagerness to return to normalcy and the desire to provide care and stave off further revenue losses are combined with genuine anxiety and trepidation about the safety and pace of reopening efforts. 

Federal and state guidelines outline gating criteria which should be satisfied prior to proceeding with a phased comeback. At a minimum, these include a downward trajectory of influenza-like illness and COVID-like syndromic cases over a 14-day period, a downward trajectory of documented cases or of positive tests as a percent of total tests within a 14-day period; hospitals being positioned to treat all patients without crisis care and a robust testing program in place for at-risk healthcare workers, including emerging antibody testing1. Several states have introduced more specific or stringent criteria requiring a similar two-week trend of declines in the number of deaths, increases in testing, available hospital capacity and contact tracing 2, sufficient isolation facilities and personal protective equipment3

The U.S. consumer confidence index is an economic indicator published by The Conference Board to measure consumer confidence, which is defined as the degree of optimism on the state of the U.S. economy that consumers are expressing through their activities of savings and spending4. The April Consumer Confidence Survey®, based on a probability-design random sample, indicates consumers’ appraisal of current conditions declined considerably in April. Those claiming business conditions are “good” decreased from 39.2 percent to 20.8 percent, while those claiming business conditions are “bad” increased from 11.7 percent to 45.2 percent4. Further, in assessing the usage intent after COVID-19 for wellness activities and telemedicine, McKinsey and Company found 48% of respondents intend to continue to use telemedicine for physical health services and 55% intend to use telemedicine for mental health care5.  Given these consumer confidence statistics, ambulatory care providers may find value in surveying their own patient population.

Practice leaders we have spoken with indicate they are starting to bring back preventive care services, conducting a virtual visit first with the patient, then progressing to a face-to-face visit if it’s determined that is safe for both the patient and provider. Additionally, some providers are considering a remote services clinic infrastructure with synchronous and asynchronous services, recognizing they need to provide an option that allows patients to receive care away from the bricks and mortar setting.

It is important for patients to be reassured that their safety in going to the clinic environment is paramount and that effective precautions are in place to maintain distance among patients, that protective equipment will be available and that a system of testing is in place to ensure clinic staff are healthy. Most organizations have been proactive in their communications, posting information on their websites, doing outreach via email, text messages, letters and through patient portals. These parallel processes, along with posted signage and preparatory telephone or virtual visits, allow for clear expectations to be set between the practice and the patients it serves.

Throughout the pandemic, practices have largely continued to serve patients with emergent conditions by implementing procedures to triage patients to virtual or face-to-face visits by having patients wait in their vehicles until the provider team is ready and then proceeding directly to an examination room.  For administrative and back-office staff who have been able to work from home, practice leaders will want to consider extending this accommodation and, in some cases make it permanent. 

Many of these techniques and methods will likely need to continue in the months ahead as the risk of community spread of the coronavirus lingers. Combined, the guidance of states, the precautionary measures taken by ambulatory practices and the conscientious loosening of restrictions reflecting data-driven achievements will create the safe environment patients require before returning to their doctor’s office.


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Graham Brown

Graham Brown

Senior Vice President, NextGen Advisors

Graham Brown is a principal and senior vice president with NextGen® Advisors focused on transforming care with provider organizations. His practice centers on accountable and value-based care strategy, population health management programs, and technology solutions for providers enabling new models of care delivery across the United States.

Mr. Brown is a former senior vice president and national practice leader for population health and clinical integration with GE Healthcare Partners (previously The Camden Group) where he led multidisciplinary client teams in strategy creation, program development, implementation, operations, and performance optimization engagements. He is an experienced leader in organizational development, managed care contracting, and change management initiatives.

Mr. Brown has over 25 years’ experience supporting provider groups, health and hospital systems, integrated delivery networks, and managed care payers to assess, design, contract, and implement systems and structures for population health management. He has worked nationally across the United States and Canada.

Graham completed his undergraduate studies at the University of Victoria, the Emily Carr University of Art and Design, and the Instituto Europeo di Design in Florence, Italy. He is certified in conflict resolution and negotiation by the Justice Institute of B.C. and received his Master of Public Health from the University of Rochester Medical Center.