Chartis Top Reads – Week of October 18 - 24, 2020

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: clinical quality and risk, 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.

Clinical Quality, Risks and Advances

The Buzz This Week

The U.S. is seeing its third COVID-19 spike since the virus arrived in early 2020, with the highest new case rate in the Midwest and West regions. We have averaged nearly 60,000 new cases a day in the last week — the most since early August. We’re getting uncomfortably close to the record: 75,687 new cases reported in one day, set on July 16, per a recent New York Times article. Public health experts in some states like Utah are claiming their health systems are “almost at a breaking point,” as reported by STAT on Tuesday.

There is evidence that the recent death rate is lower than when the virus first hit, in large part because we have found ways to more effectively treat patients such as the use of proning. However, we now have more cumulative deaths from COVID than any other country and have one of the highest cumulative per capita death rates. Within the U.S., Scientific American reported that COVID is now the third leading cause of death, behind heart disease and cancer.

Desperation for a solution is growing. Reportedly, an increasing number of people have placed hope in herd immunity or a vaccine to bring us out of the pandemic and into whatever is the “new normal.” However, last week 80 physicians, public health experts, and medical researchers deemed a herd immunity approach to be a “dangerous fallacy unsupported by scientific evidence” in a letter published in the Lancet, with a supporting letter (the John Snow Memorandum) signed by more than 6,200 additional scientists, researchers, and healthcare professionals as of the morning of October 23. The letter underscores that there is no evidence for immunity following natural infection, and many more deaths would occur during the time it would take to reach supposed herd immunity. Four companies in the United States are testing potential COVID vaccines in late-stage clinical trials: AstraZeneca, Johnson & Johnson, Moderna, and Pfizer. AstraZeneca and Johnson & Johnson have paused their trials for safety concerns. Moderna and Pfizer have said interim results can be expected in November, and emergency use could be authorized in November or December of this year, but not before the presidential election.

Why It Matters

We need to acknowledge that we are likely to be in our current COVID state for the foreseeable future. Herd immunity seems an unlikely and dismal solution. If a vaccine is released in late 2020 or early 2021, there are still many barriers we will face, including: production capacity constraints, distribution limitations, and likely disagreement over a prioritization model for vaccine recipients. There will also be many who do not wish to get the vaccine, extending well beyond the “anti-vaxxers.” A STAT-Harris Poll conducted in July found that 69 percent of Americans said they would likely get the vaccine as soon as one becomes available. The survey was repeated in early October, and the percentage has fallen to 58. There is also a stark disparity between responses of white and Black Americans — a gap of 17 percentage points, with Black Americans’ responses indicating that they are far less likely to get vaccinated as soon as possible. As we’ve noted in previous weeks (Week of August 30 and Week of September 13), Black Americans are more likely to contract COVID and have a higher risk of poor outcomes — this racial difference in vaccine acceptance would exaggerate the disparity.

The Thanksgiving holiday is just over a month away, and many will interact with friends and family they have not seen since the pandemic hit, and who may be from another state. There is a high risk of a continued spike in cases following the holiday and a rise in additional deaths in subsequent weeks, depending on how vigilant people are about following safety protocols. For the foreseeable future, we cannot relax efforts to prevent the spread of COVID. We should also follow the science — actual peer-reviewed studies, not reports (or mis-reports) of summarized results out of context.

Other References:

NPR
Studies Point to Big Drop in COVID-19 Death Rates

JAMA
COVID-19 and Excess All-Cause Mortality in the U.S. and 18 Comparison Countries

The Lancet
Scientific Consensus on the COVID-19 Pandemic: We Need to Act Now

John Snow Memorandum

New York Times
Pfizer Says It Won’t Seek Vaccine Authorization Before Mid-November

Wall Street Journal
Moderna CEO Expects COVID-19 Vaccine Interim Results in November

Health Disparities

The Buzz This Week

Systemic racism in the U.S., including Jim Crow laws and housing discrimination and redlining, has led to both socioeconomic disadvantages for a disproportionate percentage of Black Americans as well as bias towards Black Americans. The impact of those disadvantages on health equity are many and include access to healthcare and providers. Limited healthcare access often means that Black and Hispanic patients utilize the system less frequently, regardless of actual health need. Predictive health analytics software, the use of algorithms to try to identify those with the greatest future healthcare need, relies on historical data, specifically previous healthcare spend. Thus, Black and Hispanic patients may have different healthcare use patterns, and often simply using and spending less on healthcare than white patients of the same severity of illness. This unintentional bias in predictive analytics is limiting Black and Hispanic patients from being picked up by algorithms that may target them for necessary additional healthcare services.

Why It Matters

Many predictive analytic algorithms work as they were written from a cost perspective, but they do not truly identify the sickest patients. In one example, when historical costs were used to determine who needed additional care, 82 percent of the patients were white, and only 18 percent were Black. However, once the algorithm was modified from forecasting cost to predicting illness, the software identified 46 percent Black patients and 54 percent white patients. Incorporating social determinants of health and illness into an algorithm rather than relying solely on historical spend may better track patients who need additional intervention.

In addition to software algorithms, other digital tools can help to overcome historical inequities if they are built thoughtfully and used with consideration for impact on race. Diverse populations should be included in testing products that are built by diverse teams. Health organization leadership should define measurable goals and outcomes for equity in their platforms so that bias in technology can be identified and adjusted. Healthcare technology must be developed to support breaking down the walls of historical injustices, not building them higher.

Provider Enterprise

The Buzz This Week

COVID-19 has put incredible strain on clinical care teams throughout the country, most certainly on our country’s nurses. Even with the lowest patient volumes many health systems have seen in many years, COVID increased the need for critical care nursing during surges because of the high touch requirement of COVID patients and specific skill set to treat them. Nursing burnout and fatigue was an issue long before the pandemic. COVID added new responsibilities, stress in caring for individuals with COVID, and added pressure at home because of fear of infecting the household and other financial strains. In some cases, the burdens have been too much, and nurses have chosen to exit the field. Many newly trained nurses who are needed are being forced to delay graduation because they cannot get required in-person clinical hours, further prolonging the nursing shortage and burnout being experienced.

The nurses who have continued to work through the pandemic have been one of the greatest sources of innovation and care. They quickly adjusted to do whatever was needed. Nurses that were previously ambulatory became inpatient nurses, critical care nurses trained others, and many came out of retirement or crossed state lines to treat patients in hot spots. Nurses designed new models of care to preserve PPE while still providing the highest level of patient care.

Why It Matters

Now non-COVID inpatient volumes are growing again, and while not back to pre-pandemic levels, they are significantly higher than the historical lows of the spring. At the same time, outpatient volumes are above 2019 levels (though varied across specialties), and high-touch care is still needed in COVID outbreak locations. Nursing will be a lynchpin in hospitals and health systems returning to pre-pandemic volumes, while also treating ongoing COVID patients.

Hospitals and health systems must recognize and take precautions against nursing burnout. Starting or expanding programs like Employee Assistance Programs and wellness support and encouraging self-care can be helpful short-term goals. Many nurses may have more severe effects like PTSD from what they have gone through during the pandemic, so mental health support is vital long term. States and nursing schools will need to be creative in ensuring nursing students can graduate on time and fill the nursing gap. Some options that may allow nursing candidates to graduate on time include reducing necessary in-person clinical hours, allowing for longer training shifts, and allowing telehealth hours to count for trainees. Nurses were a pillar of support during COVID, and now hospitals and health systems must ensure nurses are getting the support they need by addressing burnout and staff shortages.


Contributors

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

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

Abigail Arnold
Research Manager
[email protected]


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Week 1

SEPTEMBER 2020
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AUGUST 2020
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Chartis Top Reads - Week of October 18 - 24, 2020 - The Chartis Group