Healthcare fights a two-front war against COVID-19, yet only one of the two fronts has been the beneficiary of widespread media attention. While healthcare workers (doctors, nurses, hospital staff, etc.) nobly work each day to treat patients and the media closely reports their struggles, healthcare’s community partners also scramble to support increasingly at-risk patient populations. As capable allies in our collective fight against the pandemic and capable managers of community well-being (e.g. chronic disease management), they deserve equal attention and assistance.

KEY TAKEAWAYS:

• People need social services in greater numbers due to financial instability caused by widespread layoffs and decreased work hours, and due to lifestyle changes necessitated by the pandemic response.
• Labor and capital available to community partners was limited even before the pandemic. Now, the situation has become dire, with short-term revenue plummeting and federal funding failing to adequately address rising needs.
• Healthcare organizations have put large-scale integrations on hold, including those for SDoH-related needs. Lightweight solutions with simple pathways to adoption and free information hubs will be most helpful right now.
• This pandemic solidifies the value of community partners in providing critical services in support of population health. Once the industry weathers this storm, larger-scale solutions that integrate community resources into providers’ workflows will be in high demand (especially in the context of the march to VBC/capitation of Medicaid).

Demand for services provided by community partners has skyrocketed.

People need the services provided by community resources more than ever, and community partners are scrambling to adapt to the new conditions to meet that demand. Here’s a list describing how some key types of community partners are forced to adjust, and why.

• Food banks/Nutrition Support Programs: Procure and prepare more food for distribution. Adjust food distribution methods to minimize spread of disease, both for workers and recipients of food.
  • Why? Layoffs and limited hours disproportionately impact low-income individuals who already might have been on the cusp of requiring nutritional assistance – more people now need assistance or simply more food (their ability to self-support has declined).
• Housing Assistance: Increase work hours to meet increased demand for assistance, accommodate virtual delivery of services or safely delivery of services in-person.
  • Why? Layoffs and limited work hours also prevent people from paying rent, leading to increased risk of eviction.
• Behavioral Health: Render previously in-person services digitally, offer inexpensive services where possible, find alternatives for helpful practices that are often prescribed/encouraged (ex: group therapy, physical activity, social activities).
  • Why? People are separated from their social networks (social distancing), less able to afford therapy (layoffs/decreases in work hours), and less able to practice healthy behaviors (no gym time, limited time outdoors for many, etc.)
• Transportation: Implement safety measures to ensure protection for those providing and receiving transport, ensure compliance with legislative travel restrictions.
  • Why? Travel provides a vector for transmission of the virus. Extra precautions must be taken to ensure that necessary travel is safe.

Resources available to community partners are limited, in most cases.

Restrictions in labor and capital available to community partners hinders their ability to meet increasing demand for services. Thankfully, most health centers qualify as essential services, yet many of these organizations relied on now-sparse volunteer work to operate at full capacity. Given the increased demand for services, even a slight decrease in a stable supply of labor could be problematic.

Many community partners will also need to increase spending to meet demand and adjust to new conditions, yet cash is scarce right now. Patients are foregoing routine visits in favor of sheltering in place, causing a sharp drop in short-term revenue. Furthermore, even before the advent of COVID, key government funds had not been renewed long-term. This forced many community health centers to consider various means for lowering spending. The Kaiser Family Foundation held a survey to track this response, and their findings are shown in the figure below. Since the study, these numbers have likely drastically increased.

Charitable support for these organizations over the course of COVID-19 has also been mixed, providing large boons for certain organizations while failing to reach others. This discrepancy has allowed certain community organizations to operate at supernormal capacity (despite the subpar conditions) while others are left struggling to continue providing services.

***As of 3/30/20, new federal programs have been implemented to assist community health centers in covering costs associated with the pandemic. However, these are largely oriented towards keeping employees on payroll and paying fixed costs (mortgage, utilities, rent). Variable costs of work (food for food banks, equipment necessary for moving to digital provision of services, funding to expand staff to meet labor demand, etc.) are largely uncovered. So, while these help the workers of health centers to keep their jobs, they do not do enough to help those workers perform their jobs in these trying times.***

 ***As of 4/7/20, Jeff Bezos donated $100 million to address the same issues of food insecurity. This supplements the $12 million raised by the Leonardo DiCaprio-led Feeding America fund, announced 4/2/20.***

So, where can health IT help?

Healthcare organizations involved in provision of services are now faced with a massive uptick in demand for services, so don’t overload inboxes with sales pitches. Yes, many of the care coordination and community network curation solutions that vendors have been selling would now be incredibly useful if they were implemented before the advent of COVID-19. However, the focus of both providers and community partners will now be rendering services to those in need, not improving and iterating on the processes by which those services are rendered. Limited resources and dramatically increasing levels of demand will push most of these services to the breaking point.

However, lightweight solutions with little to no implementation cost may still help. Web-based services that help community organizations more effectively communicate with providers, help patients more readily access community resources that are available to them, or connect interested parties with education resources are all examples of services that could be adopted without much effort. A list of a few services, and why they’re useful to patients, providers, and community partners, is provided below.

• Aunt Bertha: Free to use social service search engine. Helps providers and patients locate services that are available to them.
  • Why? Ultimately helps to connect patients to relevant community resources.
• CORD-19 Dataset: Dataset of all the research conducted to-date on coronaviruses and early data from COVID-19.
  • Why? Keeps community partners, patients, and providers informed with current knowledge.
• NACHC Information and Resource Hub: Information and digital resources for community health centers during COVID-19.
  • Why? Helps community health centers keep up to date with legal developments and helps them to acquire help where possible.
• Xealth: Provides a platform for providers to connect patients with digital resources, enables e-prescription of services and tracks engagement. Requires lightweight integration.
  • Why? Offers healthcare providers a means of connecting patients with valuable digital resources.
• Zoom/Skype/GoToMeeting/Slack: All provide options for free voice/video calling that provide tools for healthcare professionals to abide by privacy regulations. Slack also provides options for multi-channel text communication and file sharing.
  • Why? Offers means of digital communication between providers, patients, and/or community resources with little startup cost in time or money.

What does this mean in the long run?

In the meantime, COVID-19 will slow the adoption of IT solutions that engage community resources to a crawl. After the world weathers the brunt of the disease, though, COVID-19 will have solidified the perceived importance of community-based solutions, prompting more payers and providers to adopt solutions that engage community resources. Social services, stemming from community partners, provide the individual-level interventions necessary to combat population-level problems that are posed by pandemics. Effective solutions that engage these services, especially when circumstances are dire, is of utmost importance.