Healthcare in the U.S. has been on a long journey as it transitions from fee-for-service to value-based care. Improving access to care and prevention, resolving disparities, and increasing collaboration between competitive hospital systems makes sense and improves outcomes under any circumstances — but these changes are even more urgent in the face of the coronavirus pandemic. The problem statements outlined below offer an opportunity to rethink healthcare to address our current and future health:

  • How might we scale equitable access to nationwide testing?
  • How might we enable hospitals across the country to work as one?
  • How might we increase adoption of telehealth?

Are you working on problems related to clinical care teams, mental health, interoperability and data sharing, equitable distribution of care, telemedicine, and preventative health? We’re interested in connecting with those framing the problems or offering solutions: Reach us at

How might we scale equitable access to nationwide testing?


Diagnostic testing helps public health officials develop a baseline understanding of how disease spreads, and it’s the first step in the COVID-19 containment approach: test, trace, and isolate. In the first months of the coronavirus pandemic in the United States, issues with testing — from faulty tests to supply shortages — resulted in a “tragic data gap” that undermined America’s pandemic response efforts. The virus isn’t going away anytime soon, but we can’t stay shut down indefinitely; testing is the key to reopening safely. 

As of June 2020, the U.S. is conducting about 500,000 tests each day — a vast improvement — but access to testing is uneven. In some states, such as New York, free tests are readily available; in other states, such as Texas, testing is far below target levels and some people wait in line for hours to be tested. 

The Families First Coronavirus Response Act (FFCRA), passed on March 18, requires public and private health care programs to cover diagnostic testing at no cost to patients. But some patients have to pay out of pocket and wait for reimbursement, and since pricing is unregulated, the cost per test varies widely. (Most major diagnostic labs charge around $100 per test, Medicare’s reimbursement limit.) Ongoing, frequent testing is needed to fully restart the economy, but individuals can’t bear this cost. Who will pay for it? 

Beyond eliminating financial barriers, testing must be safe, fast, and easy to access. Some people fear testing sites because they don’t want to be near others who may be infected; some don’t know how to find a testing site or don’t have a facility nearby. Even in places where it’s easy to pop into a neighborhood testing site, the turnaround time for test results is still 48 hours — a long time to wait if you don’t feel well and are trying to avoid contact with other people. 

While Covid Exit Strategy tracks state-level progress against a testing target of 500,000 U.S. tests per day, a Harvard report suggests 5 million per day would “help ensure a safe social opening” and we would need “20 million tests per day by mid-summer to fully remobilize the economy.” Nobel Prize-winning economist Paul Romer has recommended testing Americans every two weeks — 25 million daily tests — until a vaccine is available. At minimum, regular testing for essential workers in healthcare, emergency response, manufacturing, and food production could go a long way toward building security and confidence; testing those in contact with major transmission sites, such as prisons and nursing homes, can also help curb outbreaks. 

We must continue to sustain and scale equitable access to nationwide testing; without it, the U.S. will struggle to respond, reopen, and recover.


  • How might we better understand needs and set effective testing capacity targets? 
  • How might we improve forecasting and strengthen domestic production to ensure adequate supply of testing materials? 
  • How might we eliminate barriers to testing and provide incentives for frequent, ongoing testing? 
  • How might we foster innovation to improve the accuracy, speed, and convenience of testing? How might we support the development of fast, affordable, at-home tests? 
  • How might the private sector engage in supporting testing as an essential part of safe reopening plans? 
  • How might we ensure consistent pricing and affordable delivery of testing? 
  • How might we build the political and financial will — beyond the “first wave” — to conduct large-scale, ongoing testing?

How might we enable hospitals across the country to work as one?


To effectively prevent, treat, and monitor public health, different types of data — from individual health records and infection rates to hospital capacity and strategic supplies reserves — must be easily shared. This data currently lives across multiple settings — from physician offices and hospitals to laboratories and pharmacies — and even within some hospital systems, there’s no common infrastructure to pull disparate streams of information together in a meaningful way. 

Despite advances in electronic health information exchange over the past decade, progress has been inconsistent across regions and states. Several issues persist: a lack of standardized data and interface technologies, limited interoperability across care teams, and uncertainty about privacy- and security-related requirements under the Health Insurance Portability and Accountability Act (HIPAA). And furthermore, in a healthcare system that includes both private and nonprofit hospitals, data-sharing may be perceived as a competitive risk. 

The government is already working on solutions. The Centers for Medicare & Medicaid Services (CMS) Interoperability and Patient Access final rule, published in May, is a big step forward. This implements certain provisions of the 21st Century Cures Act, giving patients better access to their health information and improving interoperability by requiring all hospitals to send admission, discharge, and transfer notifications to primary care and other downstream providers. 

But public health requires more than just individual patient records; other types of data — such as hospital capacity, infection rate, and equipment inventory — are needed for a coordinated response effort. In an unprecedented move, New York State set up a central command center to coordinate the movement of staff and medical resources across all of its 200 public and private hospitals — prioritizing cooperation over competition. New York State also established an online portal to connect hospitals and healthcare facilities with volunteer healthcare workers. 

The United States also has a national tracking system to identify and remedy specific problems: The CDC’s National Healthcare Safety Network (NHSN) was initially established to track healthcare-associated infections among a few hundred hospitals; 25,000 medical facilities participate, and it has expanded to track data such as blood safety errors and healthcare personnel influenza vaccine status. Most recently, the NHSN added the COVID-19 Module, enabling hospitals and long-term care facilities to report daily counts related to case numbers, hospital capacity, healthcare worker staffing, and healthcare supplies.

Challenges with information exchange and interoperability are not new, but the current crisis provides an impetus to reconsider what data is collected and how it is shared. State-level coordination and expansion of existing national networks will help us address the coronavirus pandemic in the short term and serve as the foundation for better health outcomes beyond the pandemic. 

We invite the public to comment on the following opportunities.


  • How might we make use of existing efforts, such as health information exchanges or national tracking systems? Which systems have the greatest potential? How might we modernize or adapt for both pandemic and “peacetime” use?
  • How might new tracking and surveillance systems complement or improve on existing efforts?
  • To ensure interoperability, what standards must providers, software developers, payers, hospitals, and other healthcare organizations agree to adopt?
  • How do we incentivize adoption of data sharing while protecting both individual privacy and organizational needs?
  • How can we engage public and private stakeholders to collaboratively improve reporting on national progress toward interoperability and information sharing?

Submit your comments.

How might we increase adoption of telehealth?


Some experts predict that home will be the new center of healthcare delivery. A rise in remote healthcare technologies — from text and apps to virtual reality and voice assistants — and the expansion of telehealth services to nursing facilities and remote locations are evidence of this shift. Telehealth is growing — partly because it’s convenient, prevents hospital-acquired infections, and meets the needs of an aging population. And beyond delivery of care, virtual clinical trials create opportunities to increase engagement and improve the quality of data.   

However, adoption of telehealth has been a challenge for a number of reasons, including issues regarding quality of care, privacy and HIPAA compliance, physician training, inconsistent user experiences, individual state policies, reimbursement, and regulations. In addition, some are concerned about the impact remote healthcare technologies will have on existing health disparities: People of color and those with low socioeconomic status already have less access to digital health information. Patients using telehealth technology need high-speed internet access, hardware, and familiarity with digital tools. It is critical to ensure that the increase in telehealth does not increase health disparities. 

But telehealth may have finally found its use case during the coronavirus pandemic. Remote healthcare options, including telehealth, have alleviated burdens on hospitals and reduced exposure during the coronavirus pandemic. To meet the demand, Medicare and private payers have expanded coverage for telehealth, and physician organizations are providing guidance for how doctors could transition to virtual care. The U.S. government has invested $200 million in telemedicine solutions and thanks to eased regulations, more than 1 million Medicare members received telehealth services in the week ending April 18, compared with only 11,000 the month before. Now is the time to invest in digital infrastructure, the creation of non-digital remote options, and updated regulations and industry practices so the United States can ensure safe and equitable access to remote health services.


Provide clear guidance and services for physicians 

  • Designate an authority — a government agency or a network/association — to define remote healthcare best practices and guidelines.
  • Increase non-digital remote care options, such as using non-emergency medical transportation programs, to either transport patients or allow for in-home, in-person patient visits.
  • Support physician telehealth licensing with improved public communication: Publicize licensing requirement changes and renewal dates; provide clear guidance regarding the types of remote healthcare models that require licenses.
  • Encourage states to join the interstate medical licensure compact, which offers physicians an expedited way to obtain licenses to practice in multiple states, limits additional licensing paperwork, and reduces costs for treating patients in other states.

Address reimbursement challenges   

Invest in telehealth infrastructure