HRI spoke with Sundar Subramanian, a principal with PwC’s Strategy&, about the importance of modeling at the local level to understand the capacity needs for health systems during a pandemic such as the COVID-19 crisis in the US.
There are different modeling tools out there. What does this one show that is most helpful for health industry planning?
If you see how decisions need to be made to solve this problem, it really comes down to a ZIP code level. The heat maps available apply the same transmission across the country, and they’re not adjusting to the local population mix. The first thing that we’re doing is applying the different, distinct local characteristics from the ZIP code.
For instance, there are some areas that are very rural, with elderly populations that are at a much higher risk and don’t have any hospitals around. Alternatively, there are other places based on their ZIP codes where diseases may be transmitted more quickly because they’re urban centers, but they may not have the severity or high-risk population. In these situations, we need to be able to make decisions at a local market level.
Second, our model is severity adjusted. Though getting COVID-19 is often painful, most people who get it will suffer minor symptoms and recover. It’s those folks among us who are at risk of developing serious or critical issues that we really need to be worried about and aiming preventive measures to make sure that they are protected and, if they do get sick, that there’s enough resources in the system to have ventilator capacity. This model gets at that.
HRI: When you understand the gaps between the severity of the pandemic and health system capacity, what types of interventions are available?
Sundar Subramanian: For health systems, the goal is to get resources to the place they’re needed at the moment they’re needed. There are ZIP codes that may have excess capacity and others nearby that are at capacity, but you could balance between these areas. Every county may get affected and “peak” in a number of cases, but it may not be at the same time. Having the perspective at the ZIP code level can enable more dynamic resource sharing.
There are other things one can do, too. How can you engage the local businesses like pharmacies to reach out to the members of the community who may be at risk of severity to keep them from getting infected? Can the community come together to make sure that things like their groceries are taken care of so that they don’t need to go out?
It’s not just about sharing of resources, but how you can come together to reduce the transmission for those who are at risk. That will reduce the need for ICU beds or ventilators, because if people don’t get infected, they won’t show up.
Other interventions could be to proactively solve for shortages in equipment, beds and key personnel such as nurses and doctors. Can you have mobile units to transport equipment between hospitals in a dynamic way? Maybe there’s an immediate need in a ZIP code that’s “peaking” that’s just a few hours away from a ZIP code that may not get hit right away. You could shift the resources to the one that will get hit first.
For health systems, the goal is to get resources to the place they’re needed at the moment they’re needed. There are ZIP codes that may have excess capacity and others nearby that are at capacity, but you could balance between these areas. Every county may get affected and “peak” in a number of cases, but it may not be at the same time. Having the perspective at the ZIP code level can enable more dynamic resource sharing.
HRI: What’s the difference between immediate operational resource planning and scenario planning?
Sundar Subramanian: The operational resource planning is everything we’ve talked about—what is needed at what point in time. If you can plan for that well, you can use your resources more effectively than having excess in any one location and a shortfall in another.
Scenario planning comes in two factors for health systems right now. The first one is about the spread and impact of the COVID cases. There are a lot of variables that are changing, including speed of transmission and decisions that states or cities are making around social distancing, which can change the timing of the peak or the number of cases or decisions around converting other units into hospitals, which changes the available capacity. When all of these are at play, you can run a few scenarios to see the resilience your system has, which points are breaking, and plan around that.
The other side of scenario planning is financial stability. Many health systems and local and community hospitals are running out of cash because elective procedures have been reduced while they’re waiting for COVID-19 to hit. This low volume affects their financial position and their ability to respond when it does come. So there is a linkage between scenario planning and operational resource planning to figure out what you could do now to make the right trade-offs.
PwC has developed this model to help healthcare stakeholders—payers, hospitals, etc.— to better direct decisions.
HIA Strategy Consulting & Growth Platforms Leader, PwC US