Chartis Top Reads – Week of April 25 - May 1, 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.

Health Disparities

The Buzz This Week

While the fatality rate for men from COVID in most locations has been higher than women, women have faced other disproportionate impacts from the pandemic, like access to healthcare and economic burden, as discussed in Top Reads last month. Women are also experiencing higher levels of mental health or socioeconomic risks than men. According to a study recently conducted by the University of Chicago last April, 49 percent of women had “new or worsening health-related socioeconomic risk” during the early months of the pandemic. 29 percent of these women were experiencing these issues for the first time. The most commonly reported risks for women were food insecurity (40 percent), anxiety or depression (29 percent), transportation difficulties (17 percent), and interpersonal violence (12 percent). A separate study found that 27 percent of females had moderate to severe levels of stress, while only 10 percent of males reported the same.

Part of the discrepancy comes from the fact that women represent the majority of the healthcare workforce, so they have seen additional emotional tolls from the pandemic. However, women outside of the healthcare profession are also at increased risk for mental health concerns because they often are the primary caregivers. “They are key to managing and recovering from this pandemic, and now are afflicted by very significant socioeconomic risk levels that appear to be drivers of anxiety, depression, and traumatic stress,” said Marie Tobin, MD, a professor of psychiatry at UChicago Medicine.

Why It Matters

The Biden Administration has tried to focus in their first three months on policy to address the safety net and women and families who have been hard hit by the pandemic, specifically women of color. The American Rescue Plan provided immediate financial support to the lowest income families, increased the child tax credit, put money into schools for reopening, and improved Medicaid funding for programs providing home care for those who are sick or disabled. These efforts may reduce stress and mental health burdens that come from caregiving, and the additional support may allow some women the ability to rejoin the workforce.

The Biden Administration also issued a proclamation making April 11 - 17 the first ever Black Maternal Health Week. The proclamation also came with initial concrete actions, including issuing a Medicaid waiver to Illinois to extend postpartum coverage to one year rather than just six weeks. This is vitally important for many health reasons, including providing coverage for mental health screening and support services for postpartum depression and anxiety.

However, it remains concerning that half of the women in the University of Chicago survey experienced socioeconomic risks, especially given one quarter of those were not at risk prior to the pandemic. The safety net is not adequately protecting women, and there is not enough capacity in the mental health system given the number of women in need of services. Historically, policy has overlooked women’s health, especially for women of color. The Biden Administration has taken vital first steps, but continued policy and care improvements and increased mental healthcare capacity is needed to ensure appropriate support for women through the remainder of the pandemic and beyond.

    Health Ecosystem of the Future

    The Buzz This Week

    As COVID-19 raged in the United States (and still does in some places), health system leaders had to focus on getting through the next 24 hours or few days — thinking further ahead was not possible, and many strategic planning efforts underway were paused. Now, as some parts of the country begin to emerge from the pandemic, some health systems are looking to the future. In addition to strategic initiatives underway pre-pandemic, some are thinking about how they might truly re-design and transform their hospitals for the future.

    Some changes being considered directly relate to the pandemic experience. For example, several academic medical centers — including Mount Sinai Health System in New York, Cleveland Clinic, and the University of California San Francisco Medical Center — are establishing post-COVID clinics for patients who may need specialized ongoing care after having the virus. Those sites may also be used for COVID-related research. Other health systems are (re)designing to prepare for a potential future pandemic. Robins & Morton, a construction firm, reported in a recent Modern Healthcare piece that they are designing flexible operating rooms that can convert to isolation rooms if needed, preparing for a future viral outbreak or pandemic.

    Other hospital design changes relate to healthcare trends underway — either introduced or accelerated by the pandemic — including:

    The rise of consumerism: Hospitals are designing around consumer needs and preferences, gaining an understanding of the population they serve and what they desire and expect. For example, some hospitals are responding to an expressed desire for more private spaces for patients and families. Others are improving wayfinding — directly through construction, or digitally like the Mayo Clinic’s wayfinding app, which helps patients navigate around their health system and around town. Most large health systems now offer some form of online patient portal, with some including the ability to self-schedule visits.

    The digital transformation of medicine and healthcare: Beyond online patient portals, hospitals are beginning to incorporate artificial intelligence (AI) to make back-office functions more efficient, support some clinical areas (e.g., AI-driven imaging reading support for radiologists), and create safety protocols like AI-powered scans for body temperature and other signs of sickness or distress when a person enters a building. Telehealth looks as if it is here to stay post-pandemic, not only for many types of clinical visits but also for post-acute care. At UCLA, heart surgery patients are sent home with a “cardiac telehealth kit” so clinicians can remotely monitor the patients as they recover. It is likely that hospitals begin creating teleconsultation rooms at the hospitals, so physicians have a private, digitally enabled space to conduct telemedicine consults and appointments.

    The shift to home-based care: Patients have increasingly expressed the desire to remain at home as they age and when receiving care. An AARP study found that nearly 70 percent of those age 65 and older expressed such an interest, and more than 41 percent across all age groups expressed this interest. The desire to stay out of the hospital increased during the pandemic and the fear of infection — not to mention the shortage of hospital beds in areas where COVID still surges. Health systems are going beyond traditional telehealth and remote monitoring to create a suite of home-based services. Hospital at home was pioneered at Johns Hopkins years ago, but was rarely adopted due to the complexity of standing up such a service and reimbursement restrictions. The Centers for Medicare & Medicaid Services (CMS) changed those restrictions as a result of COVID, and the programs expanded rapidly; as of April 5, 2021, CMS had approved programs in 53 health systems, 116 hospitals in 29 states.

    The anticipated shortage of physicians in certain specialties: Health systems have begun incorporating more advanced practice providers (APPs) into their staffing models and expanding training, enabling all health professionals to operate at the top of their license, and hedging against the present and worsening shortage of physicians.

    The growing prevalence of burnout: Burnout was an issue before the pandemic and has since increased among healthcare professionals. Pre-pandemic, Stanford created the country’s first Chief Wellness Officer position, hiring Tait Shanafelt, a physician-scientist and expert on burnout. Since the pandemic, Mount Sinai Hospital in New York converted some labs into “physician recharge rooms,” creating nature-inspired multi-sensory experiences that can reduce stress in 15 minutes.

    The need to reduce health disparities: A recent Harvard Business Review article advised redesigning around the “most vulnerable users,” thereby reducing disparities. They cited the NYC Healthy portal to sign up for a vaccine, which initially required over 50 questions and a scan of an insurance card— a potential roadblock for those who are not digitally connected or digitally savvy, including more vulnerable seniors. Vulnerable populations include Black Americans, with a historically high level of medical mistrust that still lingers. This mistrust may need to be addressed outside the hospital in order to get more Black Americans to seek medical care within a health system. The Commonwealth Fund reported earlier this year that an initiative called 3rd Conversation hosts clinicians and patients in a neutral setting for facilitated conversations around healthcare. UnityPoint has built a special LGBTQ-centric clinic within its health system, providing a safe and welcoming environment for that often-marginalized population.

    Why It Matters

    COVID made the U.S. healthcare system change almost overnight, forcing health systems to accelerate telehealth adoption, change safety protocols, and reorganize staffing models. The virus was (and still is) an incredible stress on our hospitals and health systems, but in some ways it gave them “permission” to break away from the historical way of doing things, get more creative, and plan for a very different health system of the future. While hospitals aren’t quite at the point where patients check in through facial recognition software and robots run much of the daily operations, hospitals should fully acknowledge healthcare trends and tackle problems with our health system that could be addressed with better design, planning for a better tomorrow rather than being held in the form of yesterday.


    Contributors

    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 April 25 - May 1, 2021 - The Chartis Group