Our research team breaks down this week’s top healthcare news.
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.
At the start of pandemic, many government and private sector leaders tried to make sense of the growing COVID-19 outbreak and determine the best course of action. While data is often a tool utilized to paint a picture of reality and inform better decision-making, the data needed on COVID cases, positivity rates, and deaths was scarce to non-existent. And reliance on bad data to make decisions may be even more problematic than not utilizing data at all. In March of 2020, we knew COVID was likely spreading throughout the U.S. based on how it had spread in other locations across the globe, but without comprehensive testing and case data to show the spread, decision-making stalled.
There were multiple issues with trying to make decisions from the initial data. Data needs to be created to be analyzed, and much of the data simply did not exist because the U.S. testing practices were woefully inadequate from lack of testing and underfunding of public health. Even when testing did occur, there was not a standard for reporting metrics at the state or federal level, so rather than a complete dataset, the information was more of a collection of anecdotes. Additionally, all data tells us about the past, not the future. The limited data that was accessible had a significant lag, so decisions about rising cases or fatalities were often made weeks after the increase had already taken place.
The lack of data that led to slow decision-making and vague public directives initially also meant that once it was clear COVID was already in our communities, extreme measures had to be taken to immediately slow the spread and flatten the curve. That meant all non-emergent care was delayed, often including cancer screenings, behavioral health services, and other preventative healthcare. The goal was to slow one public health crisis but at the risk another would later emerge.
Underinvestment in and undervaluing of public health and data set us up for the issues at the start of the pandemic. To avoid issues with data in future health emergencies, we must build expertise in data science. We need authorities who can skillfully gather, aggregate, and analyze the data across various regions and groups, and who can understand, explain, and try to solve for the limitations that exist in the data. Additionally, those data scientists will need to work across disciplines with epidemiologists and other health professionals, as well as government and business leaders to ensure the most well-informed decisions are being made.
It is also vital we invest in public health and seek innovative solutions for vulnerable communities that can be applied in future crises. Task forces of public health workers can imbed “community brokers” to educate and build trust among community members and also lead any distribution planning with their local knowledge (i.e., supporting a vaccine rollout). Innovation can also ensure that access to care exists even when physical interaction must be limited. Some communities used drive-through collected-at-home specimen drop-off to restart cancer screening in high-risk communities when in-person visits remained too risky, while others expanded digital behavioral health, including telehealth training for patients new to the technology. Finally, primary care providers should have a louder voice in how to deal with healthcare crises. They are the front line of our healthcare system and in many cases serve as the “last mile” for care delivery for the most vulnerable populations.
Before the pandemic, child and adolescent behavioral health was already in a desperate state. 20 percent of children had a diagnosable condition, but “most children who need mental health services or behavioral health intervention don't receive the care they need. Over half do not,” as Dr. Michael Sorter, director of the division of child and adolescent psychiatry at Cincinnati Children’s Hospital Medical Center, stated in a U.S. News & World Report webinar series, Pediatric Priorities: Improving Children’s Health in the COVID-19 Era.
The arrival of COVID-19 has increased mental and behavioral health needs across all ages of the United States’ population, but the long-term impact may be especially strong in children. Studies have shown that adverse childhood experiences, or “ACEs,” can contribute to the development of a variety of adverse physical and mental conditions later in life, such as cardiovascular disease, depression, and anxiety. In fact, if all ACEs could be removed or prevented, “we could prevent 44 percent of adult depression,” according to Dr. Melissa Merrick, President and Chief Executive Officer of Prevent Child Abuse America.
The experience of living through COVID has caused a significant increase in immediate behavioral health needs in children and adolescents; children’s hospitals have seen a significant increase in inpatient volume related to anxiety, depression, suicidal ideation and violence, as reported in The Chartis Group’s March 2021 Children’s Hospital Performance Report. Living through COVID also can be considered an ACE and could lead to an increase in long-term adverse health and mental health conditions that we will have to deal with for decades.
How will the immediate mental and behavioral health needs of children and adolescents be addressed, and long-term adverse effects mitigated? We have experienced a general shortage of mental health professionals for years, only to be exacerbated by the increase in demand for services during the pandemic. Vaile Wright, Senior Director of Health Care Innovation at the American Psychological Association, explained in a recent New York Times piece, “There’s always been more demand for services than there are mental health providers to provide them … I think what the pandemic has done is really laid bare that discrepancy.” That general shortage is also, if not especially, true for pediatric behavioral health providers. The Chartis Group’s report on children’s hospitals found that those institutions “do not have the capacity or services to accommodate [behavioral health] patients. This also is putting additional strain on staff who are not trained to care for children with these issues.”
With the rise in demand for services and the shortage of providers, along with the restrictions on in-person visits with COVID-19, the use of telehealth in behavioral health services has outpaced and outlasted every other clinical service, as per The Chartis Group’s Telehealth Adoption Tracker. Digital behavioral health solutions specifically developed for children and adolescents are beginning to emerge, such as Little Otter, which will launch in the spring. But pediatric experts caution that tele-behavioral health cannot be the entire solution. "There still was a large need for in-person care," said Dr. Abigail Schlesinger, Chief of Child and Adolescent Psychiatry and Integrated Care at UPMC Children’s Hospital of Pittsburgh, stated in the aforementioned U.S. News & World Report webinar. "[We have] just begun to scratch the surface … [and] we've got probably decades worth of learning to do there."
With increasing demand for behavioral healthcare, barriers to access and digital health solutions (not an all-encompassing solution), healthcare providers and public health leaders will need to get creative when trying to reach children and adolescents. In some cases, non-clinical providers may help fill the gap. The Chartis Group’s Children’s Hospital Performance Report found that some children’s hospitals are “exploring a variety of strategies and … contemplating how to work more closely with community partners to provide support and care.” And one group of teenagers started a podcast called “Teenager Therapy,” which had more than 100,000 downloads a few months after launching. Gael Aitor, one of the teen founders, said of posts they receive from their listeners, “People often start their message with, ‘I don’t know who to tell but you guys.’”
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.
To address the increased demand for behavioral healthcare, primary care practices should adopt evidence-based models, such as collaborative care, that integrate primary and behavioral healthcare.
This provider planning guide outlines ways to optimize access and enhance communication to encourage patients to seek urgent and elective screening.