How The Pandemic Flipped The Default In Healthcare.

The coronavirus pandemic has upended our lives in so many ways. And while it’s not easy to find a bright side, one silver lining of the pandemic has to be the prevailing switch to a “digital first” mentality in healthcare. 

While health systems used to approach digital care with risk aversion and resistance to change, remote models are increasingly becoming the standard of care. (In all kinds of work, the switch to remote doesn’t appear to be going anywhere.)


If you wanted to schedule a telemedicine appointment in 2019 to save time and money, you would have had a hard time getting your provider to accommodate you. (It’s hard enough scheduling an appointment in the first place!) But with the swift and critical changes ushered in by the 2020 pandemic, your options now look very different. As a pregnant patient myself, I have had only 6 in-person visits over the past nine months, a number that would have been at least double in the past. I have saved time and gained tremendous convenience with the same quality of care and zero adverse consequences. With the necessity of reducing in-person healthcare visits in order to lighten the strain on systems fighting coronavirus, digital care options are now a standard part of the mix. According to Rasu Shrestha, Executive Vice President & Chief Strategy and Transformation Officer for Atrium Health, “what was the norm in 2019 is now archaic.”

But remote care options are not only added as new alternatives to in-person care. They are what behavioral scientists consider “defaulted,” or selected as the primary path for all patients unless overridden by necessity. The response of health systems to the coronavirus pandemic has entirely flipped the default for providing care, moving from in-person care as the default to remote care taking its place. While the pre-pandemic model was characterized by friction (e.g., allowable technologies restricted to a few) and misaligned incentives (such as the lack of reimbursement for telemedicine), the pandemic served as the catalyst for a new paradigm where remote models of care have become the norm. In an article just published in BMJ Leader with Janet Schwartz, we argue that healthcare leaders can leverage strategies from behavioral science, such as defaults, to gain better short- and long-term outcomes. 

By flipping the default from in-person to remote care, healthcare systems accomplish two things: they decrease friction toward the preselected option, and imply that the defaulted option is recommended. Decreased friction makes it easier for patients to comply with the default, and the implicit recommendation signals that remote care is sufficient for their case. 

The switch to remote care as the default has brought several benefits already. In addition to the time and cost savings to patients, remote care can provide more healthcare access to rural populations that typically have greater difficulty making it to the clinic. And there is even some evidence that it has led to fewer unnecessary procedures and improved health outcomes, such as fewer preterm births. Importantly, in-person care is still always an option for cases where it is necessary, but is not the first line of defense. For more complicated cases, or those involving bloodwork or physical operations, in-person visits can and should be scheduled. 

Remote care is not the only default that can be flipped in healthcare. Indeed, there is promising evidence that by defaulting processes such as vaccination or mail-order prescriptions, vaccine uptake increases and more prescriptions are filled and taken. Using defaults in such a way can lead to herd immunity more quickly in the case of vaccines, and to better health outcomes with increased medication adherence. 

Some organizations are working to make vaccination and mail-order prescriptions the default, just as care has so dramatically flipped from in-person to remote. Securing a high enough rate of coronavirus vaccination adoption will be a formidable challenge, but behavioral science can help. And whereas remote care has been granted staying power from the Centers for Medicare and Medicaid Services (CMS), which have now permanently expanded coverage of more than 60 telehealth services, it remains to be seen whether greater systemic change will take place through the optimization of defaults in other areas. 

What is clear, however, is that healthcare leaders who strive for the best outcomes should look to insights from behavioral science to design their systems so they can achieve better outcomes during the pandemic and beyond. Flipping the default is one tool that can be applied to enact exactly this sort of paradigm-shifting change.

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