Philadelphia After Covid-19: Taking The Optimistic Path

Imagine it’s 2030. The Rolling Stones are launching their new tour, “The Rolling Stones Zombie Edition.” In an interesting twist, both Ivanka Trump and Chelsea Clinton have announced their intentions to run for president in 2032, while President Andrew Cuomo is saying “Bring it on.” And the biggest myFlix movie hit is the 10th sequel of “Nightmare on COVID Street: Edition X.” It appears that even ten years later, people are spending money to be frightened by COVID again.

And what about health care? After the shocks of 2020, the heroics, the lingering trauma to families and caregivers — how did healthcare delivery change by 2030? Is it still fragmented, confusing, occasionally unsafe and deeply inequitable?

I’m the head of a major health system and university in Philadelphia. Sadly, it’s a city bedeviled by deep poverty, despite the resources of several leading academic health centers. Our challenge is to harness imagination, good will, and partnerships among many people to create solutions. More than anything, it’s a challenge that requires vision, and it requires optimism.

Looking ahead ten years is a helpful mind-shift. It’s a technique called writing a “history of the future.” Using this re-imagination helps overcome the instant reaction to innovative ideas: “That’ll never happen. We can’t afford it. The government won’t allow it …” All these objections are really excuses, and they block the imaginative impulse.

But instead of excuses, imagine your white-board covered with the ideal — the ideal healthcare system of 2030 in Philadelphia. We find that everyone can fill in the ideal, everyone has good ideas when they look that far ahead. And then, let’s ask each person, what did we do in 2021, 2022, etc, to get to that ideal in 2030?

Without a vision of an ideal, the alternative is to limp into 2030 still battling the barriers of the moment, still blaming each other, still failing to ensure good health for all Americans.

Here’s a success story: We used the history of future technique in 2013, as we envisioned using telehealth at Jefferson Health. I began thinking about “healthcare with no address” in 2009, when I chaired an Apple-inspired initiative to re-envision education in the health sciences. Getting to know the Steve Jobs vision triggered this thought: If the iPhone signaled a shift to a mobile and digital lifestyle, what would trigger that exact shift to a personal, mobile healthcare platform based on digital technology?

In 2014 at Jefferson Health, we began investing in telehealth, building the nation’s most comprehensive faculty-driven, all-specialty telehealth program. As a result, when the COVID-19 pandemic hit, Jefferson was ready for that first wave. In fact, our telehealth physicians started calling themselves “The Night’s Watch,” after the Game of Thrones border patrol. The preparation we began years earlier paid off. Our daily telehealth calls went from 50 a day to 3,500 a day. Our virtual visits went from 100,000 in six years to 100,000 just in the first quarter of 2020. We ramped up quickly with minimal disruption because we had a plan.

The role of telehealth in COVID-19 may become the “iPhone moment” for healthcare — the recognition that we can bring care home, that we can build healthcare with no address. But there’s a twist — we have to ensure that the shift to mobile, digital healthcare is ethical, equitable, and sustainable.

As we look ahead, we know that the COVID-19 crisis accelerated the shift to digital technology for every workplace, for every piece of the supply chain, and even for service industries. This is known as the “Fourth Industrial Revolution,” when online meets offline and machine learning takes over many jobs people do today.

Which raises the question: What’s next? How do we take our success with telehealth and release the secret weapon of imagination to ask: What will healthcare delivery look like in 2030? How can we use the acceleration of digital technology to address equity in our city? How can we build responsible innovation?

One way to answer the 2030 question is predictably depressing. You can argue that in 2030 we will continue to split as a country between astonishing medical science available to the wealthy, versus continued disparities in mortality and access to care for people living in poverty.

That’s why I argue that coming out of the COVID-19 pandemic, the healthcare system must commit itself to re-imagining the future. We can, in fact, make healthcare delivery equitable, cost effective, and customized to individuals.

The COVID-19 pandemic has shown us how:

· We must make bring health into homes and neighborhoods — the home should be the locus of care delivery, not a remote large building attached to a hospital. It’s time to strip from hospitals everything that can be done in an outpatient setting, leaving hospitals the location for the very sick and for very complicated therapy. At the same time, we need to strip from outpatient settings anything that can be done at home. We have the ability to deliver sophisticated medicine at home, and more effectively than in a big building next to a hospital — from pregnancy monitoring, to managing diabetes, to helping older people remain in their homes longer. Remember, the vast majority of COVID-19 healthcare has been delivered at home — where most patients have endured the virus.

· We must use technology and augmented intelligence to make this revolution possible. AI cannot simply make the wealthy healthier. Ethics and trust must be built into every AI product, from the beginning, not as a marketing afterthought. We need clear, intuitive, and trustworthy design.

· High-speed access to the internet must be seen as a utility — as critical to public health as electricity and clean water. Telehealth made its biggest inroads during the COVID-19 pandemic. But even on the phone, health disparities persisted. Social workers were counseling patients about how to get data plans. Bottom line: Broadband is now oxygen. Everyone needs to have access, just as in the early 20th century, municipalities across the country made electric and then telephone lines completely integrated into American life.

In Philadelphia, we’ve been working to overcome exactly these disparities. Even before the COVID-19 crisis, our social workers were counseling cancer patients to find a data plan. While almost everyone has a phone, not everyone can afford expensive internet access to download treatment plans, health monitoring, and even appointment reminder apps.

Under our Philadelphia Collaborative for Health Equity, we’ve created partnerships between Silicon Valley firms and community organizations seeking to help people suffering from Type 2 Diabetes. Even as normal medical care became difficult, community groups stepped up. The volunteer work was amazing. Our job was to provide guidance based on what behaviors make the most difference.

There is a lot to do. But if we do this right, by 2030, we will have achieved the goal of health assurance — allowing people to lead happy, productive lives without the hassles of health care getting in the way.

Now imagine this: It’s January 2, 2030. A mutant strain of an RNA encapsulated virus has been afflicting people in Philadelphia. Of course, people old enough to remember the dark days of early 2020 and the COVID 19 crisis, especially healthcare workers, immediately panicked … for a second … and then they smiled. Because they knew healthcare had evolved from a broken, fragmented, expensive, inequitable “sick care” system to a “health assurance” system where most of their care happens at home.

AI bots instantly identified the new illness. Wearables picked up immediate physiological changes and signaled individuals to self-isolate. Home 3-D printers cranked out the appropriate filtration masks for the new virus. Anyone panicking in memory of 2020 could trigger an immediate connection with their bot psychiatrist to start monitoring depression. Medications were delivered by drone. With 10G broadband connectivity a given, schools and workplaces were now gathering spaces, not human warehouses, and easily converted to all-virtual activity.

A far cry from what we witnessed in Philadelphia and throughout the country during the COVID crisis of 2020.

A decade later: Health assurance was clearly the difference between life and death.

This story is part of the FORESIGHT publication “We can design the future of health” which explores how communities across the U.S. are using future trends to re-envision health and well-being for everyone. See full series here.