Chartis Top Reads – Week of July 11 - July 17, 2021

Our research team breaks down this week’s top healthcare news.

Top Reads Overview

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.

COVID-19 In Brief

The Delta variant is spreading rapidly. New hot spots in the United States are occurring primarily in the Southern and Western states, predominantly in communities with very low vaccination rates.

Pfizer asserts that booster shots for vaccinated people will be needed within 12 months of initial vaccination. Anthony Fauci noted that boosters may be necessary in the future, but it was still too early to recommend a third dose. More data is still needed to determine when and if boosters will be needed.

Provider Enterprise

The Buzz This Week

Direct care workers (also known as home health aides, personal care attendants, certified nursing assistants, general caregivers, and private duty companions) operate on the periphery of healthcare and are often not regarded as part of the healthcare continuum because they do not typically hold a medical or nursing degree and receive limited healthcare training. Their services include help with bathing, dressing and eating, light house cleaning and meal preparation, medication management, general companionship, and liaison support with medical providers and family members. These services are much-needed support for people with chronic conditions, disabilities, and/or those who are willing to pay for a general companion, and all can be important contributors in maintaining and/or improving health and wellbeing. However, direct care workers are often overlooked. As a vice president at Cooperative Home Care Associates said in a recent piece by The Commonwealth Fund, “I don’t think … we really understand the value of caregiving in keeping people well” in the United States’ healthcare system, which currently values (and reimburses) services to treat the sick.

The direct care worker labor force is challenged for several reasons, the first of which is arguably that workers are significantly underpaid. Government reimbursement to any agency providing direct care services is low, which impacts wages for the workers themselves. The median hourly wage is between $9.50 and $12 and does not typically increase with time and experience. This contributes to inequity in the healthcare workforce, particularly because of the demographic of those who most often fill these roles. In the United States, as reported by The Commonwealth Fund, more than 85 percent of direct care workers are female, nearly 60 percent are people of color, more than one-quarter are immigrants, and 15 percent live below the federal poverty level. A leader of a caregiving advocacy and research group recently stated to Michigan public radio, "The unfortunate reality is these jobs are considered low quality … performed by women, women of color, and immigrants — which make up the majority of the direct care workforce." Underpayment and lack of support and advancement also contributes to the instability of this workforce, where the turnover rate is between 40 and 60 percent.

Why It Matters

Direct care workers are and will be imperative in keeping the United States’ aging population healthy and cared for, particularly as younger family members cannot take on the role of full-time caregiver as those in previous generations have (though there are some government programs that provide small financial incentives to do so).

In addition to suggested policy changes that would directly increase direct care workers’ wages and overtime eligibility to help bolster a more secure workforce, other approaches should also be considered to support and grow these important contributors to our healthcare ecosystem. These approaches, described in several reports (see featured links), include:

  • General training requirements for direct care workers can be increased, elevating their roles, better preparing workers for the challenges they will encounter and justifying higher wages.
  • Health systems can build direct care training programs with opportunities for advancement, specialization, and leadership positions, providing more attractive long-term career options.
  • Direct care workers can be better integrated into the constellation of healthcare providers and care team members for patients and consumers, especially as value-based care models expand and maintaining and improving health is valued. This can be done within a health system, within a clinically integrated network, or through partnerships.
  • Direct care workers can be empowered with better tools to improve services and outcomes (e.g., applications to communicate with other healthcare providers or family members via video, technology to lock and unlock patients’/consumers’ doors, and automated medication dispensers).

High Reliability Care

The Buzz This Week

Provisional data released Wednesday by the Centers for Disease Control and Prevention (CDC) confirms the grave and concerning news that drug overdose deaths in the United States hit record highs in 2020 and saw an increase of nearly 30 percent over 2019. It is suspected that the upsurge stems from two causes: a proliferation of fentanyl and the COVID-19 pandemic, which brought isolation and, for many, employment and/or health insurance loss. Overdose deaths due to fentanyl saw an uptick in the fall of 2019 that was further exacerbated at the beginning of the pandemic. The growth in overdoses has been widespread across both geography and demographics. While the opioid epidemic has often been described as a problem in white, rural communities, the truth is few communities have been spared. The majority of states saw an increase in drug-related overdoses fairly consistent across the United States as a whole, and white, Black, LatinX, and Native American communities all saw large increases in overdoses in 2020.

Why It Matters

The opioid crisis is another stark example that COVID’s impact is broader than even the tragic loss of more than 600,000 lives directly from the virus. The start of the pandemic saw shutdowns and disruptions to drug addiction treatments at a time when many were dealing with anxiety and stress of an unknown disease, deprivation of social interaction, and potentially job loss and the trauma of death or illness of close family members and friends.

Despite an extremely difficult initial stretch at the start of the pandemic, eventually COVID was an impetus for a few positive steps that had been much needed, such as allowing people to get access to medications that treat opioid addiction (like methadone) for more than one day at a time, and providing access to behavioral health and other addiction services via telehealth. However, these changes are not enough, and the rising death toll clearly shows more comprehensive measures are urgently needed. Some of the key actions experts suggest include:

  • Widely implementing evidence-based harm reduction tactics, including access to sterile syringes, medication to reverse drug overdoses, and fentanyl test strips.
  • Increasing flexibility for approved treatments for opioid addiction (like methadone and buprenorphine), including reducing cost; making medications available in pharmacies and community clinics; and removing barriers like prior authorization, provider prescription limits, refill restrictions, and step therapy.
  • Ensuring the litigation monies states and cities are expected to receive from opioid manufacturers is focused on treatment, prevention efforts, and other public health tactics.
  • Expanding Medicaid in states that have not yet done so to ensure insurance coverage for the most vulnerable populations.

Now is the time to take steps to make treatment easier for those in need so that 2020 is the heartbreaking peak on the overdose curve, not the new normal.


    Roger A. Ray. MD
    Chief Physician Executive
    [email protected]

    Alexandra Schumm
    Principal, Vice President of Research
    [email protected]

    Abigail Arnold
    Senior Research Manager
    [email protected]

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    Past Top Reads

    Chartis Top Reads – Week of July 11 - July 17,… | The Chartis Group