Risk & Resilience in the Time of COVID-19

The coronavirus is reshaping norms across society and the economy as different actors are adapting to these changes and uncertainties. The second installment of this podcast series focuses on national resilience, the rise of telehealth and the potential post-COVID-19 world.

Kavitha Hariharan, narrates our latest podcast episode on risk and resilienece in the time of COVID-19. 

Richard Smith-Bingham and Dan Kaniewski of the Marsh & McLennan Advantage discuss how countries might reconsider their approach to national resilience preparedness in light of COVID-19. 

Mary Kay O’Neill, a Health & Benefits Partner at Mercer and Bruce Hamory, M.D. and Chief Medical Officer for Oliver Wyman’s Health & Life Practice, discuss how the public's relationship with telehealth has changed, what still needs to happen to maximize its impact, and whether the changes arising from this crisis are likely to last.

Mike Poulos, Managing Director of Marsh, and President of Marsh Risk Consulting shares his predictions for the long-term impacts of COVID-19..


Kavitha Hariharan: As the COVID-19 pandemic continues and evolves, it's clear its implications for our society, economy and culture will persist for years to come. As we navigate this changing landscape, we are adjusting the patterns of daily life, rethinking how we interact with the world and use every day services. I'm Kavitha Hariharan, Director of Healthy Societies in Marsh & McLennan. Welcome to the Marsh & McLennan Advantage. Marsh & McLennan is the leading professional services firm in the areas of risk, strategy and people. Advantage is not just the name of our podcast, it's the spirit and endeavor that harnesses expertise and insights within our four businesses, to master the interconnected dynamics of risk, strategy, and people. The coronavirus reshaping norms across the society and economy. This episode will focus on how different actors are adapting to these changes and uncertainties.

Kavitha Hariharan: We'll also look at how the adoption of new technologies could shape a post pandemic future. Certain large complex risks threaten or stretch the affected arrangements at the heart of government. Rarely has this been as evident as it is now. The COVID-19 is forcing countries to rethink their approaches to resilience. The crisis has tested the limits of existing crisis management strategies in every pocket of the world. My colleagues, Richard Smith-Bingham and Dan Kaniewski of Marsh & McLennan Advantage sat down to discuss this dilemma. Both Richard and Dan worked on a timely report titled, Building National Resilience: Aligning Mindsets, Capabilities and Investments. They shared their insights and how their views have changed as COVID-19 has reshaped our world.

Richard Smith-Bingham: Building national preparedness against key big risks is a critical function of government. And it's clear that in many countries, the COVID-19 pandemic has really stretched existing resilience arrangements, from healthcare system responsiveness, through containing the evolving economic fallout, to alleviating broader societal consequences. I'm Richard Smith-Bingham, Head of Insights and Emerging Risks at Marsh & McLennan Advantage and I'm joined today by Dan Kaniewski, who spearheads our public sector work. Since his timely arrival from FEMA, the US's federal emergency management agency earlier this year. Dan, thanks for joining.

Dan Kaniewski: Thank you, Richard. I think it's also important for us to clarify what we mean by national resilience. In short, it's about preparing for these risks that may threaten our national security, our economic prosperity and our societal wellbeing. And these risks might become apparent as sudden events, or as long-term impacts. By which we mean everything from terrorism and cyber-attacks, through social unrest, hazardous material incidents, fiscal crisis, extreme weather, climate change, and of course, pandemics.

Richard Smith-Bingham: And this whole risk landscape has become increasingly challenging. Global change is happening very quickly and in complex ways, disasters are getting more expensive, and political conditions in many countries have become increasingly volatile. And governments seem ever more on the hook at a time when their capabilities and balance sheets are under high pressure. Now, you can speak about this from the government coalface but as we know, a lot of this discussion in this area has moved on from an all of government approach to an all of society approach. But governments can't be responsible for everything. So countries really need to look hard at how that risk burden can be shared across government, the private sector and households more effectively. And to use that engagement to understand risks, and understand impact through different lenses, and how they connect and the different measures and incentives that may be tried out.

Dan Kaniewski: Yeah, this is a considerable exercise within the US government you know the focus has traditionally been on response. And we need to change that conversation so that we get people to take actions before a disaster strikes. And I say people, but I mean government officials and all of us. But to do that, it's going to take a lot of effort, change isn't easy. We need to balance a desire from being really   comprehensive in our approach, with what is actually feasible and so for me, I try to often be pragmatic about this but also at the same time, we need to challenge ourselves on whatever blind spots we may have out there. So beyond the traditional emergency management focus areas, an area I pushed in government wasn't just the operational response. In other words, mustering a response to a disaster but also resilience and if we really drill down into it’s not just this operation resilience, it's not just preparing to respond. It's also making sure we can be resilient no matter what kind of crisis we face.

Richard Smith-Bingham: Have these sorts of issues, preparedness, and mitigation and financial resilience, are really written large, aren't they, Dan, when it comes to critical infrastructure.

Dan Kaniewski: That's right. Here in the US most of the critical infrastructure is owned and operated by the private sector, 75% of it is. So when you're talking about needing to be resilient, we're not just talking about governments needing to harden their infrastructure, the private sector does too.

Richard Smith-Bingham: I know we're both keen to talk about national resilience arrangements in the context of COVID-19, but perhaps I could just spend a few moments on that need for greater ambition, innovation and agility. Now, it may sound a little bit sort of abstract, but I think some of the challenges emerging or leaping onto government radars at the moment, really point to the value of stronger foresight efforts, and developing complex risk scenarios. Because these can really stretch thinking not only about impacts but also about the effectiveness of those response capabilities that you mentioned earlier, of course, you can't be developing a huge amount of response capabilities for each individual crisis. They need to be fungible across crises as well. And I think the government could, and arguably should think more innovatively about solutions. This may involve looking more upstream to address issues, which may involve different departments or different agencies. Maybe about considering different solution providers, or indeed deploying different or non-traditional policy tools and solutions, I think everything's got to be in the toolbox.

Dan Kaniewski: Now Richard, as you said, the report looks at how governments can grapple with a variety of different risks. It seems like the pandemic, and specifically what we're seeing right now, plays right into the report's hands. Doesn't it?

Richard Smith-Bingham: Well, it's fortunate timing maybe for a report that was conceived in advance. But I think the crisis really shows firstly, how important that national resilience endeavor is and then also how hard it is to get right as well. I mean, after all, we're in the throes of a multifaceted healthcare crisis that has become a multifaceted economic crisis. Which will have a profound fallout for businesses and societies alike.

Dan Kaniewski: Yeah, indeed, here in the US, pandemic has been on frankly, our radar for decades. No shortage of reports or studies have been done to say, this is a looming risk that we need to take action for and frankly, actions have been taken. Preparedness investments and planning, and training, and exercises. Funding to state local governments, and healthcare facilities and first responders has certainly happened. And those investments are paying dividends now, but it's clear that there's more to be done on this.

Richard Smith-Bingham: And a few things that have sort of struck me in particular about how things have developed. I think first is that sort of a significant gap between plans and reality. We've seen analytical exercises for pandemics that didn't lead into actual preparedness arrangements. Preparedness arrangements that are fallen short in execution when of course, to be fair, all pandemics have different characteristics. But it's clear that even some common factors such as PPE availability, and the procurement possibilities, have slipped through the net in terms of some of the thinking around that.

Dan Kaniewski: Honestly, I think everybody realized pretty early on that what we need for coronavirus response is more than what the government alone can provide. The private sector, and NGOs, and individuals, and this is along the lines of what FEMA is now calling the Whole of America Response. I really like that term. I think it's a synonym for a whole of society response that we talk about. And to give some specific examples with regard to the coronavirus response, that the Whole of America, our whole society, means the private sector. So automobile companies, look what they're doing, some of them are building ventilators. Other manufacturers retooling their factories, and they're suddenly churning out masks and other personal protective equipment. Silicon Valley, really innovative stuff comes out of there, like apps to assist with contact tracing. And NGOs are really the unsung heroes here, they're kind of operating quietly behind the scenes, but in communities, this is what individuals who are most vulnerable are truly relying on, which are those nongovernmental organizations providing everything from food to financial counseling. And then we look at us as individuals, what can we do to mitigate the impact of this disaster? Well frankly, mitigation is literally in each of our hands. It's hand-washing, it's social distancing, it's masks. So I think really at the end of the day, we need to realize we're all in this together.

Richard Smith-Bingham: We all have a role, and a strong role to play wherever we happen to be and the more that we have, should we say agility in our responsiveness, to be able to adapt to those changing circumstances and leverage our capabilities, the more we can all contribute to resilient countries. Again, these things aren't even just national issues, because there are sort of whole lot of international considerations at the same time.

Dan Kaniewski: Yeah, this crisis, I think has demonstrated that governments at all levels need to have a firm understanding of the risks that we all face and the mechanisms in place to operationalize resilience against those risks. So all the more reason to have a risk framework in place, like we call for in our report.

Richard Smith-Bingham: I think these are extraordinarily interesting times and very significant challenges for our risk governance arrangements and that interaction between governments, the private sector and populations as well. Dan, thank you very much for this chat.

Dan Kaniewski: Great. Thank you, Richard

Kavitha Hariharan: It's likely that the COVID-19 pandemic will create permanent changes in the way some types of work are conducted. With new approaches particularly likely in healthcare, the technology to meet with your doctor over the phone or by video is well established, but historically underused. Its moment may have finally come. Telehealth visits are on the rise. From routine medical advice to counseling and mental health services. More and more healthcare consumers are using telehealth for visits that were once largely in-office. The benefits of telehealth are clear, and policymakers have taken note. Millions of people are getting their first glimpse of telehealth and they may like what they see.

Kavitha Hariharan: Telemedicine seems like a simple proposition at first glance. Patients and doctors connect virtually to discuss medical issues without the need to meet in-person but technical and logistical roadblocks have stood in the way of widespread adoption. COVID-19 is accelerating that adoption and broad recognition of the need for telehealth has prompted legislators to clear some of the hurdles, at least temporarily. I'm joined by my colleagues, Mary Kay O'Neill of Mercer and Bruce Hamory of Oliver Wyman to discuss how the public's relationship with telehealth has changed, what still needs to happen to maximize this technology's impact, and whether the changes arising from this crisis are likely to last. It's so good to have both of you here.

Mary Kay O'Neill: Good to be here.

Bruce Hamory: Good to be here.

Kavitha Hariharan: We're seeing telemedicine become more prominent as we get deeper into the coronavirus crisis. Mary-Kay, can you explain why more people are adopting this health care platform now?

Mary Kay O'Neill: Well, first of all, since the beginning of the coronavirus epidemic, people have been advised to stay away from healthcare settings, if at all possible. But people of course have ongoing healthcare needs. And so they sought different ways to get their healthcare needs met and have been able to access either their own physicians or physicians through telehealth vendors to get the attention that they require.

Kavitha Hariharan: Thanks, Mary-Kay. Telehealth is for now at least an unfamiliar experience for most people. For those who haven't used it before, can you walk through a typical telehealth appointment?

Mary Kay O'Neill: If somebody's having a telehealth appointment with their regular physician, it can be as simple as a phone call or a video chat over very common technology. I think that's something that most people are familiar within their daily life so that wouldn't be so different, but if they are using a telehealth vendor for the first time and will be accessing physicians or other kinds of providers that way, they often have to go through a patient registration experience at least once before they can access the care that they need.

Kavitha Hariharan: Thank you. This one's for you, Bruce. It may seem intuitive to many, that you can talk to a doctor on the phone, or send a dermatologist a picture of a rash to help them treat you but in practice; telemedicine hasn't been always so simple. What other main challenges to adoption for telemedicine providers have had to overcome?

Bruce Hamory: There are a number. The most important recently has been the ability to get paid for seeing the patient or giving the patient advice over the phone. Other factors that have really contributed to this are the availability of telehealth broadband connection services from the home or the office to the main trunk line, that's called last-mile service. Another big one has been that the practice of medicine is controlled within each state separately by Board of Medicine, and so if you want to practice across the state line, you have to have another state license; and the last of course is that the majority of physicians are over 50 and have been less comfortable with tele stuff. Whether it's an iPhone, or an iPad or whatever and certainly the widespread use and availability of those technologies has improved from the medical end, the acceptability of these devices, as it has in the public.

Kavitha Hariharan: Thanks, Bruce. Some of these hurdles were directly addressed by the CARES Act. The coronavirus relief law that passed in late March. What exactly did that change and what still needs to happen to ensure broad access to telemedicine?

Bruce Hamory: It’s a great question. The CARES Act dealt in the short term with a couple of these issues. And most importantly, payment. Physicians and other providers are now getting paid for providing telehealth services and they're getting paid at a reasonable rate. The second is that the CARES Act allows the practice of medicine across state lines without having to be licensed in the other state and a number of the governors as they have passed their emergency proclamations, have included in those, the ability of physicians and other providers licensed in other jurisdictions to provide service in their state, either in person or by telehealth. That's not universal, of course, and the last of course is that patients have become much more accepting of this technology. Whereas, before they might've insisted on seeing the doctor in person. Now, they have had concern for their own safety and been told by the governor to stay home and so this has been a much more acceptable way of interacting with a physician or provider and getting advice.

Kavitha Hariharan: That's very interesting. Thank you. Mary-Kay, could you comment on this one?

Mary Kay O'Neill: I just would like to reiterate what Bruce said, is that what used to be a relatively limited amount of experience with this kind of interaction, is now very common and I think that this is going to have a profound change, both on how physicians think about practicing medicine, as well as how patients think about receiving it.

Kavitha Hariharan: Thank you. In the early days of the coronavirus crisis, telehealth vendors have seen an uptick in activity of as much as 30% already. Are they prepared for a usage spike? How should employers who include telemedicine in their employee health care plans, evaluate whether these providers are prepared?

Mary Kay O'Neill: Well, I'm not sure anybody was prepared for the coronavirus situation and what we were seeing in the early days with people calling into the traditional telehealth vendors was wait times in excess of an hour or two. The data that we have since then is that they have managed to expand their services and the wait times are down into a more reasonable range of about 15 or 20 minutes. I think that there was increased demand first because of the issues that we've already discussed, that people were told not to show up in healthcare settings to avoid getting exposed to infection. But also I think people were very concerned when they had any kind of symptom to make sure that they understood whether or not that was compatible with COVID-19 and whether they needed further evaluation. So I think as employers think about this kind of resource for their people, whether the capacity to take the calls is there, often indicated by wait times, as well as what kinds of services are being provided. But I think another angle that we need to think about that wasn't actually in play at all before all of this started was how many people are going to be using this channel of care, the telehealth channel, to access their regular physicians? And to see if that changes at all how people are thinking about the traditional telehealth vendors.

Kavitha Hariharan: Very true. While the coronavirus pandemic is driving a large increase in the use of telehealth, the pandemic will eventually pass. Bruce, do you expect a reversion to the pre-crisis status of telemedicine or is it largely here to stay? What long-term impacts do you expect on the healthcare system from this short-term spike in telehealth use?

Bruce Hamory: I think the general opinion is that despite a drop in the huge number of COVID cases, that we all continue to expect a lower level, but a continuous level of COVID circulation in a community. And that may be periodically punctuated by larger outbreaks. Nobody knows now. But with that continuing level of activity, and as you see in the CDC and White House plans for getting the country back to work, there is still a need, or will still be a need for the elderly and the high risk to shelter in place at home, avoid large public gatherings. We've spent three months scaring people about the risk of going to a doctor's office or a hospital. And so the sum total of that is that this need will continue at some level, and it will particularly continue if it can be paid for. And it will continue certainly for the medical specialties as opposed to the procedural ones. And in fact, data from South Korea after the SARS outbreak suggested that the surgical volumes and procedures didn't come back for three years. Meaning, that people are looking at alternate ways of receiving their healthcare.

Mary Kay O'Neill: I would also say after we get past the crisis phase of the COVID-19 situation, that people will realize that they can have meaningful interactions with their healthcare professionals without having to take time off work, drive over, park, all of those kinds of things and that this will be something that people will come to expect as both an efficient and meaningful way to interact with their healthcare providers.

Kavitha Hariharan: Thanks, Mary-Kay. This has been a great conversation. Thank you both for joining us today.

Bruce Hamory: Thank you very much for having us.

Mary Kay O'Neill: Thanks so much.

Kavitha Hariharan: Right now, the crisis is driving focus and solutions that can help today. But as we move forward, it's worth considering what this pandemic could mean in the long term. The effects of COVID-19 will certainly challenge social norms we have followed for years. Some of those impacts are clear, but many may not be apparent for some time. In the meantime, we can make educated guesses, acknowledge our uncertainty, and plan for a variety of possible outcomes. In this spirit, Michael Poulos, Managing Director of Marsh, and President of Marsh Risk Consulting, offered some predictions for the long-term impacts of COVID-19 in a recent Marsh Risk Management and Insurance podcast.

Michael Poulos: The preexisting trend towards nationalism and the emphasis on the nation-state will be intensified. Three years ago, it was a scandal at least among the elite class when the British voted to leave the EU. Similarly in the US, the elite class has spent four years decrying the forthright nationalism of Donald Trump as if it were some sort of historical aberration. Something like eight of the 10 candidates contending for the Democratic presidential nomination were willing to go on record supporting both open borders and free healthcare for undocumented immigrants. Positions like these will be untenable for the foreseeable future. Pandemic risk will display as climate risk as a focus of popular concern. Whatever the eventual risks of climate change might be, no one believes that they'll play out on a timeline that is shorter than decades. The current experience shows that pandemics can grow exponentially into existential threats in a matter of weeks. National policies will demand that limited resources be focused on preparedness for the next pandemic. The defalcate spending required to fund the various bailouts and stimulus programs from this crisis means that we are more likely to get an experiment with something like modern monetary theory sooner, rather than later. This is unchartered water for developed economies and is a source of significant macroeconomic risk over the next 10 years.

Kavitha Hariharan: While, we can't say for sure, which of my Michael's predictions will come true. What we can say is that our world will change as a result of this pandemic. Societies adapt under pressure and we are seeing glimpses of the post-pandemic future. The challenge we face is building resilience to ensure we have more tools in our toolbox, the next great threat. I'm Kavitha Hariharan. Thank you for listening to the Marsh & McLennan Advantage.

Kavitha Hariharan. Dan Kaniewski. Mary-Kay O'Neill Mike Poulos. Richard Smith Bingham