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Forecasting in the New Normal of COVID-19: ‘Our Crystal Ball is Very Murky’

Hospital planners thrive on data and historical markers, but how does one forecast for the future when grappling with a public health event unlike any other in modern times?

It’s a question that Jefferson Health has grappled with for months, but thankfully strategy leaders at the Philadelphia-based institution had a little bit of foresight early in the pandemic. Chief Strategy Officer Monica Doyle and colleagues looked to split their team up, with some focusing on the nitty-gritty of surge planning while others had the freedom to “scour the universe” for information to guide strategy during the next year and a half.

They’ve started tracking what Jefferson calls “normalization volume” trends, comparing their rebound in visits to prior baseline data and then devising forecasts that predict patient bed utilization based on whether COVID-19 cools or flares back up again.

“The next 12 to 18 months are really a new frontier. There is no historical reference to go to for this,” Doyle said. “Much of what we as planners have relied upon in the past is premised on past utilization and consumer behavior, and all of that is up in the air. Our crystal ball is very murky right now.”

To sharpen that picture, Doyle and colleagues have focused more on big-picture economic indicators to guide strategy. Those include unemployment and uninsured rates, consumer confidence in returning to restaurants or museums, and even mobility data to gauge how frequently community members venture outside of their homes.

Jefferson is now evaluating a number of different commercial forecasting tools while harnessing a new demand model it developed over the last 18 months. Doyle said they’re exploring whether they can adapt that model to incorporate new inputs and allow the hospital system to forecast demand on a more real-time basis. If successful, it would grant a better sense of consumer needs over the next 12-18 months, Doyle said, rather than three- and five-year calculations.

“This is a transformational event for every industry, not just health care,” she noted. “We think that the recovery will move in tandem with national and regional economic recoveries, so we’re being much more creative in looking at leading indicators.”

Telemedicine Is King 

One does not need a forecasting model, however, to see that virtual visits will remain a huge piece of the puzzle whenever the pandemic abates, Doyle said. “The genie is out of the bottle on telemedicine, and there is no going back.”

Doyle believes they’ll likely rely on virtual solutions for scheduled primary care and specialist visits, on-demand urgent visits, pre-admission testing, tele-triage and remote patient monitoring in the home to avoid unnecessary hospitalizations in observation-status scenarios.

“Based on our provider's experience with telehealth, we were able to quickly convert many in-person visits to virtual during the pandemic,” Doyle said. “While our proportion of in-person visits is increasing, patients appreciate the convenience of virtual care.”

Forecasting Will Be Key

Jefferson Health leaders are confident they will be ready for what happens next by utilizing a demand model developed internally as their health system became a 14-hospital enterprise through a series of mergers in Pennsylvania and New Jersey. Whether forecasting for a “reopening” phase or a second wave of COVID-19 admissions, Doyle said the model will enable them to predict the resources that will be required for the organization to meet the clinical and operational needs of patients under either scenario. This would include addressing such factors as inpatient bed capacity, ambulatory care volumes and usage of telehealth services.

Looking ahead, Doyle emphasized that the pandemic has created an “opportunistic moment” to begin testing out new ways of doing business, and she encouraged strategy leaders to seize this moment.

“My best advice would be to challenge assumptions and traditional paradigms,” she said. “Don’t assume that we are going to return to the old normal. I think this is really an opportunity for planners to move your organizations where you likely knew they needed to go anyway.”

This article features an interview with:

Monica Doyle
Senior Vice President and Chief Strategy Officer
Jefferson Health
Philadelphia, Pennsylvania

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