It's been 5 years since the pandemic. Here's what's changed

It was five years ago — Tuesday, March 11, 2020 to be exact — that the World Health Organization declared the COVID-19 outbreak a global pandemic. Two days later, the Trump administration declared a national emergency.

Healthcare organizations overwhelmed with patients found themselves and their burned-out employees tested. The pandemic led to invention, reinvention and loss.

Here are five key changes to healthcare that resulted from the pandemic.

Telehealth takes off

The pandemic turned telehealth from a concept that technologists hyped for the future into a viable way to provide care. On March 6, 2020, the Centers for Medicare and Medicaid Services said it would fully pay for telehealth medical visits under a temporary section 1135 waiver as part of the public health emergency. Commercial insurers soon followed CMS by paying for telehealth visits regardless of the state the doctor practiced in and type of care provided

The change led to a dramatic transformation. Telehealth usage jumped from 1% of all Medicare beneficiaries having a virtual visit in 2019 to 44% in 2020, according to CMS data. Health systems propped up their telehealth software programs and invested in virtual care centers since the technology helped increase patient access and deal with workforce shortages. Venture capital investors poured billions into funding companies that could provide virtual care either directly to patients or through insurer, employer or health system customers.

The telehealth flexibilities were extended by Congress multiple times across two presidential administrations. Five years later, they’re set to expire March 31 without any further action and advocates from numerous industry-led groups are fighting to extend them further. While telehealth usage peaked in 2020, it has settled into a new normal with around 12% of Medicare beneficiaries using it in 2023.

Many telehealth companies have staked their businesses on the temporary provisions and providers are not eager to return to a pre-pandemic world where virtual care is not reimbursed unless the beneficiary is in a rural area or in other limited circumstances. On Feb. 24, more than 300 groups including health systems, advocacy groups and companies sent a letter to Congressional leaders urging them establish permanent access to telehealth, calling it a “lifeline to patients across the country.”

Nursing homes fold

The nursing home industry is a smaller, more regulated sector since COVID-19 swept through skilled nursing facilities, infecting more than 2 million residents and staff and showing the nation the sorry state of some facilities.

More than 700 nursing homes have closed since 2020 and the industry has been a leader in bankruptcy filings for the healthcare sector for the past five years, according to research and advisory firm Gibbins Advisors. Occupancy rates at the beginning of 2025 were still nearly 2 percentage points below pre-pandemic levels, according to the National Investment Center for Seniors Housing and Care.

There also has been a spate of nursing home sales. Some hospital systems have exited the long-term care business to focus on core operations. Edison, New Jersey-based Hackensack Meridian Health sold 11 of its 14 long-term care facilities in 2022. Sioux Falls, South Dakota-based Evangelical Lutheran Good Samaritan Society, a unit of Sanford Health, reduced its footprint from 22 states to 7 in 2023.

The struggles during the pandemic led to a crackdown by the Biden administration. The Centers for Medicare and Medicaid Services put more teeth into its Special Focus Facility program for the worst performing nursing homes, stepping up enforcement actions and terminating some operators from Medicare and Medicaid participation. The Biden administration also imposed a minimum staffing standard of 3.48 hours of care per resident, per day, beginning next year. However, nursing home trade groups are challenging the regulation in federal court and momentum is building in Congress and within the Trump administration to rescind it.

Burned-out clinicians raise their voices

Front-line healthcare workers were labeled as healthcare heroes during the pandemic and the long, grueling work quickly took a toll on clinicians and their organizations. Thousands of nurses left the profession, and hospitals turned to higher-paid travel nurses and staffing platforms to fill positions, a move that deeply affected their bottom lines.

The clinicians that did stay have become more vocal in advocating for themselves, and interest in union representation has grown among nurses, medical residents and fellows. Strikes, including a three-day strike by 75,000 Kaiser Permanente workers in October 2023, put a spotlight on the demands for higher pay, better working conditions, increased career opportunities and a commitment by executives to address staffing shortages. Scattered strikes at hospitals across the nation continue with many tied to contract bargaining.

Health systems have curtailed their use of contract labor and some have established inhouse staffing agencies, using float pools to fill vacancies. Job cuts at hospitals with negative or razor-thin margins continue but most have not involved clinicians.

Hospitals retool their strategies

The pandemic caused health systems to revamp operations, allowing providers to treat more patients and better manage persistent surges in demand.

COVID-19 patients flooded emergency rooms and hospital intensive care units during the peaks of the pandemic. In response, hospitals set up tents in their parking lots to triage and test patients. Providers retooled medical-surgical beds to quickly convert them to intensive care and isolation rooms. Health systems staffed tele-ICUs with physicians and nurses who, via video, helped clinicians at overrun, understaffed hospitals. Providers increased their network of suppliers to limit their reliance on overseas manufacturers.

Hospitals are still using these strategies today, as they treat an aging population with complex healthcare needs. Still, health systems need to improve their inpatient discharge processes, bolster partnerships with post-acute providers and better forecast spikes in demand, executives said.

Providers are investing in artificial intelligence-backed software designed to identify capacity and staffing constraints as well as to overcome obstacles holding up inpatient discharges. Hospitals are expanding hospital-at-home programs to free up inpatient beds. Health systems also are trying to redirect emergency department patients with non-urgent illnesses to urgent care centers and clinics.

Hospital-at-home takes hold

The pandemic has been a boon for hospital-at-home and the technologies that extend care to where people live. The Centers for Medicare and Medicaid Services awarded waivers to more than 380 hospitals since 2020 to provide acute-level care to some patients at home. Despite uncertainty over the waiver’s future, health systems are still bullish on the model's potential because they say treating patients at home is cheaper than adding hospital beds.

Some large urban hospital systems have made big bets on hospital-at-home. Boston's Mass General Brigham announced plans in 2023 to shift 10% of its inpatient care to home-based care by 2028. The care model is also beginning to make inroads in rural health systems. Sioux Falls, South Dakota-based Sanford Health launched one of the first rural hospital-at-home programs at its medical center in Fargo, North Dakota, last year.

Technology companies, including Medically Home, Biofourmis and Vivalink, have been among the biggest winners as hospitals moved acute care into the home. They have forged partnerships with health systems to provide remote patient monitoring, telehealth support, command centers and other services to help health systems comply with the waiver. Other technology companies, such as New York-based MyLaurel, are partnering with health systems to offer in-home programs that provide hospital-level care but work outside of the Medicare waiver.

Technology and the success of hospital-at-home are encouraging some health systems to look for other ways to extend care to patients beyond their facilities. St. Louis, Missouri-based SSM Health launched a home-based skilled nursing program at St. Mary's Hospital in Madison, Wisconsin, last year and hopes to replicate the program at some of its 23 other hospitals in the Midwest.  Mayo Clinic is piloting a program that offers home-based chemotherapy and immunotherapy to patients in their homes around Jacksonville, Florida.