For years, we have written about the need to decentralize the healthcare system to improve access, cost, and quality. The general hospital’s model of providing all healthcare needs under one roof overcomplicates care delivery, resulting in worsened care outcomes for patients and exorbitant hospitalization costs. This model spilled over to primary care, as well, where care is typically centered in the family physician’s office.

Now, as healthcare technology improves, the decentralization of the hospital may finally be coming into play. 

Telehealth’s transformation of care delivery

2020 was the year of telehealth. Its use skyrocketed as COVID-19 kept people in their homes, and telehealth became a primary option for patients to interact with providers. A July 2020 survey found that patient satisfaction with virtual care is so high, many hope that it remains available post-COVID.   

Telehealth enables the expansion of care away from a centralized location and into the home, with primary care provider groups like One Medical integrating virtual care directly into their practice. Telehealth has even transformed emergency care, with groups like Ready Responder able to provide emergency treatment in-house while video conferencing with doctors. All in all, the boom in telehealth services has drastically transformed how health professionals view care delivery.

The evolution of care from in-person to virtual could allow for an even more fundamental shift in how care is conceptualized. Primary care providers are already leveraging new technologies for a wide range of care needs, from monitoring blood pressure to tracking prescription compliance. Integrating healthcare tech into everyday life via wearable health technologies (think Fitbits and Apple Watches), remote patient monitoring, and provider-based apps and technologies can make care more preventative in nature, while also taking into account social conditions for each patient. 

Furthermore, decentralizing care by bringing it into a digital space allows for timeliness in treatment. From the expediency in which a patient can access medical care to the consistent monitoring of chronic conditions, new technologies are allowing for interventions to be taken before a patient’s health worsens. They’re also giving providers a glimpse into the patient’s everyday life, through which a provider can give recommendations on lifestyle changes to improve long-term health.

The hospital without walls

Amid this technological transformation, hospitals are floundering under the stress of COVID. They are filled to capacity with pandemic patients, while simultaneously skipping out on elective procedures that traditionally earn the highest revenue. COVID has revealed a fundamental flaw in the general hospital business model: by trying to be everything to everyone, hospitals cannot run efficiently in or outside of a pandemic. 

And yet there are promising signs that decentralization is possible. In response to the pandemic CMS established COVID protocols allowing hospital care to be provided in alternative locations. A March rule gave hospitals permissions to use hotels, dorms, and inpatient rehabilitation clinics as hospital sites. In November, CMS updated the rule to allow eligible hospitals to treat eligible patients in the comfort of their own home. CMS’ program shows that some care does not need to be provided in the general hospital. 

The next step for hospitals is to embrace technologies that enable care outside of their walls. A recent article in The Guardian proposed what such a model might look like, where brick and mortar hospitals are transformed into a connected network of healthcare providers and information that brings care into a digital community, rather than keeping it centered in a building. In practice, this wouldn’t eliminate the need for in-unit specialist care entirely. It would just mean that each of the services provided by hospitals—from elective surgeries to emergency care—would be housed separately, embracing technologies that enable care closer to home (as providers like Ready Responder are already doing). 

Digitization allows for healthcare to be “embedded in our lives”. With the evolution of telehealth and other technologies, healthcare can become more integrated in society. The logic behind the “hospital without walls” is as follows:

  1. Primary care providers, aided by decision-making technology, can take on greater care responsibilities
  2. Healthcare specialists are able to do more work in the community, as an extension of social care, since all healthcare becomes more precise and preventative 
  3. Secondary care can be set up more like ambulatory care, with specific clinics for specific issues 
  4. Care becomes more flexible, therefore better facilitating the handling of medical emergencies such as another pandemic 

Moving the needle on hospital centralization 

Continued evolution of CMS’ decentralized models will require a systemic approach—not just in regards to how specialists integrate into the community, but how hospitals approach sudden medical emergencies (such as a pandemic). Temporary field hospitals popped up across the world in response to COVID, but many went unused, mainly due to staffing and supply shortages. But as the model of hospital delivery changes to a decentralized, technology-backed model, there will be broader room to reinvent how the medical field responds to medical crises.  

While the world is still impacted by the pandemic, technologies like telehealth are a promising development coming out of an uncertain time. The US is experiencing a drastic shift in how medical care is practiced; it will be interesting to see how hospital system design adjusts to this paradigm shift.


  • Jessica Plante
    Jessica Plante