Health Care in 2021: Partial Recovery Amid Ongoing Pandemic Underscores New Realities

The light at the end of the tunnel has proved farther away than had been hoped at the start of 2021. Widespread availability of COVID-19 vaccines has led to a semblance of normalcy, with a lifting of many 2020 restrictions, such as indoor capacity limits, return to in-person schooling and the opening of most countries’ borders by the fall. Yet more people have died of COVID-19 in 2021 than the year before, coronavirus variants are triggering surges in infections and deaths, quarantining is a regular occurrence and the likelihood of achieving herd immunity has faded.

Health care continues to bear much of the brunt of this persistent public health crisis and its many ripple effects. Snapping back to pre-pandemic approaches is not going to work. What’s increasingly clear is the pandemic has exacerbated some long-term, structural challenges in health care while highlighting the wisdom of seizing opportunities for innovation and reinvention.

Here are the hot-button issues from 2021.


1. Health care workforce shortages and issues have only gotten worse.

With little relief from the stress and strain of COVID-19 cases, plus resignations and firings due to non-compliance with vaccine mandates, and staffing from physicians to medical assistants is in turmoil.

Traditional recruitment and retention programs, coupled with typical short-term stopgaps such as relying on temporary staffing agencies, is simply not enough anymore. How does health care sustain its workforce through continuous crises? And strike the right employment balance for various settings, from hospitals and outpatient locations to home health, telemedicine and more?

Solving these problems takes a two-pronged approach: 1) Take good care of your existing workforce by addressing burnout, investing in career development and putting in place programs that make employees want to stay.


And 2) think beyond traditional roles and licenses. A cornerstone of a more expansive approach to the healthcare workforce is recruiting and training non-clinical people to handle clinical support roles such as medical assistants, nursing aides and students. Another key change is to Rather than rely on third party educators to fill their pipelines and staffs, some health systems including Adventist Health and MultiCare  are taking control by building their own schools and programs tailored to their staffing needs.


2. Health care equality is a growing priority.

The COVID-19 crisis has added urgency to increasing health care access and equity. Disadvantaged communities have been hit significantly harder by the virus, with more infections and deaths and greater economic hardship.

The Biden Administration established the COVID-19 Health Equity Task Force on the first day of Biden’s presidency. The U.S. Department of Health and Human Services recently created the Office of Climate Change and Health Equity while the Centers for Medicare & Medicaid Innovation has made advancing health equity a strategic objective in all programmatic decisions.


3. Achieving equality depends on addressing SDOH and expanding mental health services.

Think of all those TV news reports showing miles of cars lined up for a box or two of food. Add skyrocketing rates of depression, anxiety and other mental issues among the disadvantaged in particular, but throughout the broader U.S. population as well.

Moving from episodic care to long-term population health management for all will require that payers build resources and financial incentives into contracts with providers so they can collaborate with social service agencies and community organizations to handle SDOH. Providers also will need to develop and execute long-range strategies to extend care and services to the poor and disadvantaged, such as forming federally qualified health centers (FQHCs) and FQHC Look-Alikes.


4. COVID-19 showcased the advantages of capitated payments.

Fee-for-service providers are still digging out from 2020 when volume and revenues dropped precipitously even as expenses rose. Primary care physicians, for example, lost an average of $67,774 in gross revenue per full-time physician in 2020, according to a Health Affairs report.

Yet providers operating with risk-based contracting continued receiving monthly member payments independent of volume.


5. It’s critical to learn lessons from this pandemic to cope with future crises.

COVID-19 has shown that the U.S. health system can become overwhelmed. Building in more resiliency and flexibility, not simply building expensive new facilities, is key to managing the next crisis.

As patient volumes slowly rebound, however, some providers are deemphasizing telehealth and other digital innovations embraced early in the pandemic. Yet investing in, promoting and normalizing use of alternative workforce, technology and care models including telehealth is vital for preparing for  the next pandemic.


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