Weill Cornell Medicine orchestrated a scenario planning exercise in 2019 to improve its operations and performance as preparations for potential crises ahead of time like the COVID-19 pandemic.

How scenario planning yields advantages for providers in unprecedented times

July 24, 2020
by John R. Fischer, Senior Reporter
While no provider or practice could have predicted the pandemic, those who planned for the possibility are in a better position than those who did not. Such planning is known as scenario planning, in which companies, without certainty, prepare for different situations that could take place at any point in the future.

One provider that engaged this tactic in 2019 was Weill Cornell Medicine, and pandemics were among the possible scenarios it planned for. HCB News spoke with radiologist Dr. Geraldine McGinty, president of the American College of Radiology and chief strategy and contracting officer at Weill Cornell Medicine, about the lessons learned from the exercise and how it has helped her and her colleagues’ operations and performance since the pandemic hit.

The inspiration for the tactic, she says, came from Shell Oil, which began using similar practices in the 1970s to prepare for drops in oil prices. “They had thought about the things that might happen in their future and then looked at their current operations and said, ‘What do we need to do now to be prepared whatever happens?’ We tried to be quite broad about what might happen in our future so we could prepare ourselves. I’m not saying we predicted the pandemic. But definitely having gone through that process of thinking about an uncertain future helped us prepare and be more adaptable and nimble.”

Preparations involved a number of impact factors to consider, including:

Reimbursement: One prediction was the need to recover lost revenue, which was due, in part, to social distancing measures and equipment cleaning tactics that prevent resumption of prior workflows and volumes. Addressing this has involved salary cuts, layoffs, and reductions in health insurance benefits. McGinty and her colleagues say practices that sought financial expertise in advance and had established reserves, solid banking relations and strong relationships with referring providers and hospitals are better able to leverage relief programs.

Regulations: A degree of deregulation was predicted and has been seen regarding governed payments to physicians and hospital services. Broader coverage of telehealth and relaxation of state licensure requirements are expected to continue, along with downward pressure on fee-for-service rates and less overall health insurance coverage by employers. Practices must work with policymakers and payers on insurance plans and reimbursement, and should invest in professional society membership to build relationships with local lawmakers.

Replacement: AI is not expected to replace radiologists during the pandemic, due to the fact that imaging, while valuable, was excluded early on as a viable screening method for COVID-19. Instead, it is predicted to augment the productivity of radiologists in the future. The radiology community, however, should be wary that lack of support for APP radiology assistants (RAs) practicing independently may lead to the demise of RAs or cause APPs to seek out other medical APP groups.

Research and educational changes: Radiologists will be limited in their ability to attend in-person meetings, instead having to rely on virtual formats. While this loss will have an impact, it may give way to more structured processes for inclusion on committees and projects, which may benefit a more diverse group, according to McGinty. Her department is setting up a “virtual visiting professor” exchange program for trainees to learn from external speakers.

Cyber and terrorist attacks, epidemics and pandemics: Protests, such as those over the murder by police of George Floyd and conditions like climate change, are expected to enhance the disruptions during the pandemic, along with a second wave of COVID-19 cases predicted in the fall. Weill Cornell Medicine has deployed home-working capabilities quickly, based on its scenario planning, which showed that future departmental planning would need to account for the potential continuation of home-working and double down on redundancy and data security.

McGinty and her colleagues agree that honesty and transparency are needed to keep teams engaged and prepare for situations like this. Decisions may be made with some uncertainty about the outcomes, but leaders who take responsibility for decisions and actively seek out different opinions will inform their decision-making and improve organizational performance for the long term as well as in crisis situations. This, in effect, will help keep optimism strong.

“Think about what’s going well for you, what you think you need to improve on, think about the competitive environment and threats to your business,” said McGinty regarding scenario planning. “Then think about where you see your opportunities to be more successful. You start with that, and then you have to think about when you see opportunities, how you’re going to execute or operationalize those, and if you see threats, how you’re going to mitigate them.”