• Fri. Dec 1st, 2023

Health Administration

Come One, Come All To Health Administration

Digital health care an answer to staff problem

Two major developments regarding the challenging state of health care received in-depth, public examinations recently.

Their obvious overlap would seem to indicate at least a partial solution to the problem Massachusetts shares with most other states.

During last week’s Massachusetts Association of Health Plans conference, Gov. Charlie Baker said that given the chronic staffing shortages, the health-care industry needs to rethink how it delivers services.

In October, the Massachusetts Health & Hospital administration estimated the commonwealth’s hospitals had about 19,000 full-time vacancies.

The staffing issues also affects health-care payments, Baker said. Understaffed rehabilitation and long-term care facilities can’t take in new patients from hospitals, leaving patients lingering in place while waiting for an opening in their next treatment facility.

Tim Foley, executive vice president for 1199SEIU, which represents over 70,000 health-care workers, said the staffing shortage is a “whole system issue,” across hospitals, nursing homes, home care, and other care facilities, which requires a “whole system solution.”

“Some of these jobs are not going to be replaced; we need to get together and think about new care delivery models,” Foley said.

A study of one such alternative delivery model’s viability also just came to light, telehealth, which apparently wasn’t discussed at that Health Plans conference.

The use of telehealth as a regular method for care illuminated the digital divide across different socioeconomic lines, according to a new report by researchers and health-plan organizations.

As defined by the Health Resources Services Administration, telehealth uses electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration

Noticing the longstanding health inequities that the COVID-19 pandemic brought to light, the Massachusetts Association of Health Plans began the study early in the pandemic to research the uneven acceptance of telehealth usage, said MAHP Vice President of Advocacy and Engagement Elizabeth Leahy.

Researchers concluded that the oldest and youngest state residents visit the doctor in-person more frequently, as do lower-income, minority and rural populations, after analyzing data from 1.8 million health plan members from January 2019 to December 2021.

Nathalie McIntosh, senior director of programs and research at Massachusetts Health Quality Partners, said for seniors, low telehealth use could be caused by a combination of technology barriers and the routine and comfort of visiting their doctor in person.

Researchers spoke to some people — including seniors and English language learners — who do not own a cellphone or, if they do, don’t know how to use the video feature, McIntosh said. “Audio telephone visits were really helpful” for these populations, she said.

For younger adults who did not use telehealth, McIntosh said this wasn’t a matter of digital literacy, but rather an indicator of limited access to primary-care providers in general.

“To have a telehealth visit, you really need to have a usual source of care, because it’s a scheduled visit,” she said.

Regionally, telehealth usage was higher in greater Boston and other densely populated areas of eastern Massachusetts, and lower in central and western Massachusetts — except some cities and towns in the Pioneer Valley, where telehealth made up more than 43% of visits.

An encouraging development offering a possible solution to the overall health-care provider shortage, telehealth was widely used across the state for behavioral-health care, with an average 75 to 80% of all mental-health visits conducted virtually each month.

That high percentage probably reflects recent reimbursement improvements as a result of a law signed by the governor in January 2021 that mandated permanent payment parity for tele-mental health services.

Concentrating on ways to increase telehealth services among young adults without access to a primary-care physician, older patients, and those with socioeconomic challenges could significantly bridge that health-care staffing gap.

For the MAHP/Harvard study, researchers recommended that health plans enhance screening for digital affordability and streamline enrollment in underutilized public benefit programs to make the internet and devices more affordable, as well as building referral partnerships with community-based organizations that can provide digital literacy trainings.

As our governor and former CEO of Harvard Pilgrim Health Care warned, the medical industry may never return to its pre-pandemic state.

It may not be a panacea, but encouraging telehealth as a way to offset the likelihood of permanent staff shortages would be penicillin for this chronic condition.


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