In an age of unprecedented change, staying current has never been more important. Our team at Chartis is curating news most relevant to the healthcare industry and tracking the topics that are trending on seven key issues: high reliability care, digital and advanced technology, financial sustainability, health disparities, the health ecosystem of the future, partnerships, and the provider enterprise. Each week, we break down what’s happening and why it matters.
Preliminary jobs reports from the U.S. Bureau of Labor Statistics for April indicate that healthcare employment, which prior to the pandemic had been steadily increasing for years, is still down 3.3 percent from its height of 16.5 million in February of 2020 — an employment loss of 542,000. There has been some recovery since healthcare employment plunged to its nadir of 14.9 million in April of 2020, but employment in certain sectors like nursing (particularly in nursing home, home health, and other residential care settings) is still on the decline.
Even prior to COVID, many nursing staff reported physical and mental health stressors from work. Researchers at Ohio State University College of Nursing studied more than 700 critical care nurses in 2018 and 2019, finding that nearly two-thirds scored their physical health a five or lower out of 10, and over half scored their mental health as a five or lower. There was a correlation between low self-reported mental and physical health scores and an increase in medical errors. Since COVID, mental health numbers have only worsened. A survey by NYU Langone indicated 25 percent of all nurses reported anxiety post-pandemic, and anxiety and depression were unsurprisingly significantly higher in nurses caring for COVID patients.
There are many factors contributing to mental health concerns and burnout among nurses. They have experienced excessive stress through witnessing patients dying from COVID and have often served as the only connection back to loved ones of those hospitalized. They have had to deal with fear of acquiring COVID or spreading it to family and friends, an anxiety made worse by limited personal protective equipment (PPE). Many nurses have had to quickly change roles and adapt to where they are needed, often with little training. They have done all this while sometimes having to self-isolate away from family and support networks.
Additionally, healthcare workers — and nurses specifically — experienced health consequences from the pandemic. This group was the largest occupation hospitalized with COVID, and 10 percent of healthcare workers have long COVID symptoms. Despite these factors, most research has focused on physician burnout with nursing burnout being relatively understudied.
This week, we observed International Nurse’s Day, a day to celebrate the contributions of nurses. It’s vital for hospitals and health systems to focus on burnout, staffing shortages, and mental health of their nurses through examination of all elements of their workforce management to ensure their organizations are prepared for a post-COVID world. If not addressed, nursing burnout is likely to continue over the long term and have significant impacts on the healthcare system. A recent study showed that nearly one-quarter of nurses may leave their current role in the next year, with more than half planning to switch careers or leave the workforce if nothing changes, potentially worsening nursing shortages at a time when the population is aging and nursing needs are likely to increase.
Behavioral health, including both mental health and substance abuse disorders, has received increasing attention in recent years as rates of depression, suicide, substance use disorders, and drug overdoses have increased across most age groups. COVID-19 has further exacerbated these trends among the general public, which has endured more than a year of living through enormous life changes, hardships, and tragedies, as well as among healthcare professionals, who are experiencing high levels of burnout and an increasing prevalence of post-traumatic stress disorder.
Meeting the increased need for behavioral health services will not be easy. Behavioral health has had a longstanding shortage of clinicians, estimated to be 4 million in 2019, per the Substance Abuse and Mental Health Services Administration, as referenced in a recent Modern Healthcare piece — creating substantial barriers to access for many needing and seeking behavioral health services. The shortage has become more exaggerated as supply is evidently decreasing, as was found in a recent Government Accountability Office (GAO) report featured in Kaiser Health News. Despite the passing of the federal parity law preventing insurance plans from imposing more restrictive benefits for behavioral health services as compared to medical and surgical services, claims continue to be denied, billing issues persist, and lack of payment assurance and/or parity is a leading reason that some providers have decided to scale down behavioral health services. The GAO report referenced a survey of members of the National Council for Behavioral Health, an organization that represents treatment providers. The study found that 27 percent of responding providers reported they laid off employees during the pandemic, 35 percent had reduced hours, and 45 percent said they had closed programs.
Despite the persisting imbalance of supply and demand, recognition that adequate behavioral health services are vital to the overall health of the population may have finally arrived. People also are recognizing that there may be savings in overall health expenditures by providing such services – the evidence of which has been published in several studies. Last year, Kaiser Permanente began referring patients to six digital health startups, and two weeks ago, Cigna announced it would cover Ginger’s mental health app as an in-network benefit for enrollees. CVS Health announced last week it would be piloting mental health services at some of its stores in underserved areas, an in-network service for Aetna members (which was acquired by CVS in 2018).
The collective acknowledgement that behavioral health services are vital to population health, that adequate reimbursement (and enforcement of the parity law) positively impacts supply, and that demand will likely still outpace supply for the foreseeable future, are at least small steps in the right direction. There still lies the problem of an insufficient number of clinicians and barriers to access.
One solution to better balancing the supply of clinicians and services may be digital behavioral health (DBH). The pandemic accelerated the adoption of telehealth across most specialties, but as care could return to an in-person setting, many specialties began reducing the proportion of virtual visits. Behavioral health has been an exception, maintaining a high level of virtual care, per The Chartis Group and Kythera Labs’ Telehealth Adoption Tracker. As was stated in Chartis’ recent piece on the subject, DBH “enables providers to perform screening and triage on a larger scale through digital interfaces, with centralized care teams overseeing follow-up using remote monitoring tools.” This means scaling services, enabling providers to triage and treat more patients than they would typically be able to in a traditional office-based setting, could help offset the shortage and barriers to access.
A word of caution: As behavioral health app start-ups explode in number, it is important to critically examine the quality of individual apps, and what services are included (e.g., access to a licensed therapist or other clinician, or simply a set of coping skills, meditations, or light guidance from non-licensed “coaches”). Certainly, in the clinical world, not every service can be delivered virtually. DBH should be viewed as delivering substitutive care, providing complementary care, scaling delivery, and enhancing the consumer experience.
New York Mag
The Therapy-App Fantasy
Many organizations no longer have the workforce they need, thanks to the physical, emotional, and financial ramifications of the pandemic. On top of unprecedented exhaustion and burnout, staff are covering vacancies and doing more with less. This situation can rapidly become a downward cycle from which it is difficult to break free.
The pandemic has only exacerbated the U.S. behavioral health crisis, but deploying digital behavioral health affords an opportunity to re-think the delivery of behavioral healthcare in a way that addresses the growing access issue.
What is the new normal rate for telehealth adoption? And how is telehealth best utilized by specific service lines and for specific patients and use cases? This new report analyzes 6 key areas to identify trends and practical insights.