Chartis Top Reads – Week of September 6-12, 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

Among the many viruses in the world, what makes COVID-19 so special is its rapid human-to-human transmission after jumping from animals to humans; many other coronaviruses (such as avian flus) are not known to rapidly transmit from human to human. A wide variety of symptoms also have come with puzzling inconsistency among patients. Many are placing hope in a vaccine, with some even anticipating one may be ready this fall, though most experts say that timeline is highly unlikely. But history suggests that few infectious diseases are eradicated via vaccine — even if the required 60-80 percent of consumers are willing to get one. Polio is one example of a successfully controlled virus thanks to vaccination, but other infectious diseases have persisted due to low vaccine effectiveness. Tuberculosis, for instance, has required medical advances, therapies and improved protocols to control its spread over time.

Why This Matters

As we continue learning about COVID-19, we should not place all of our bets on a highly effective vaccine — particularly one ready in short order, with mass production and distribution. Instead, a multi-pronged approach needs to continue in earnest. We should continue efforts to find more effective treatments, such as proning patients and delaying ventilator use, which have demonstrated improved outcomes. Other therapies also should be studied, such as antivirals, which may help reduce the disease’s initial intensity and could help limit its spread. Safe testing and standard clinical trial protocols still should be followed, though accelerated as much as possible. Public health initiatives, which historically have been vastly underfunded, should be better supported by and embedded in our health system as a whole.

Health Disparities

The Buzz This Week

As a result of historical and ongoing systemic barriers, Black Americans have a higher disease burden and experience worse health outcomes than white Americans in areas such as maternal care, oncology and chronic conditions (including high blood pressure, asthma and diabetes). Further exacerbating poor outcomes is the disproportionate financial impact COVID-19 has had on non-white Americans, widening the economic gap and intensifying health inequity as those with the greatest need have more limited access to health services. Studies show that outcomes for Black Americans improve when treated by Black clinicians, which could be one way to help reduce health disparities. But currently only 5 percent of physicians in the U.S. are Black. Increasing the number of Black physicians is not as simple as it might seem due to steep barriers. For example, the debt burden of medical school and financial requirements of the application process limit the number of Black candidates. This collective dynamic, if not altered, sets the stage for a continued cycle of health disparities.

Why This Matters

Because Black patients fare better with Black clinicians, and systemic barriers have prevented growth in the abysmally low proportion of Black physicians in the U.S., it is imperative we find better ways to diversify clinical care teams. The financial burden on Black medical school applicants likely will be exacerbated in the years following COVID-19 and may deter many from applying, given the negative economic effects disproportionately affecting Black families. Part of the solution will include reducing financial stress for applicants of color through fee waivers, student debt forgiveness and increasing scholarship funds dedicated to Black candidates. Additionally, the current medical school admissions process is expensive and heavily reliant on testing, which can be disadvantageous to students of color. Shifting the admissions process away from standardized testing and toward holistic evaluation of potential success can help limit additional bias. Growth in the proportion of Black practitioners will not happen overnight. In the meantime, training current clinicians to be culturally competent and creating more diverse care teams (nurses, advance practice professionals, care managers, midwives and others) can begin the process of overcoming disparities.

Provider Enterprise

The Buzz This Week

The sharp rise in mental and behavioral health issues in the U.S. since the arrival of COVID-19 is staggering. For example, a Kaiser Family Foundation poll in April found that almost 50 percent of respondents reported that the pandemic was having a negative effect on their mental health. A more recent study found that the U.S.’s government-funded Disaster Distress Hotline, which provides emotional support and counseling, saw a 335 percent rise in calls between May and July as compared to the same period in 2019. This increase is present in COVID-19 patients, among the general population and among healthcare practitioners themselves. Even as the need for mental and behavioral health services has multiplied, a new survey reports that 20 percent of primary care physicians (who increasingly work in tandem with behavioral health professionals in a Collaborative Care Model or as the referral gateway to such specialists) are in enough financial distress that they may close their practices.

Why it Matters

While we continue learning about short- and longer-term effects of COVID-19, it is clear that related mental and behavioral health needs will continue to rise. A drop in practicing primary care physicians will reduce access to behavioral health practitioners, which will exacerbate a pre-existing shortage of these clinical services. The result could be a serious long-term public health crisis. Efforts to mitigate this risk should include identifying ways to optimize primary care and behavioral health professionals’ capacity and expanding the number of available professionals through a variety of potential means, including financial incentives, cross-training of other clinical specialists, and increasing education and training capacity.


Contributors

Roger A. Ray. MD
Physician Consulting Director
[email protected]

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

Abigail Arnold
Research Manager
[email protected]


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Chartis Top Reads - Week of September 6-12, 2020 - The Chartis Group