By George W. Chapman
The pandemic has served to highlight and exacerbate the ongoing crisis in mental access and delivery in the US. Historically, mental health has been the underappreciated and underfunded stepchild of both government and private insurers. To make matters worse, people are often uncomfortable talking about mental health issues with their families, let alone providers.
There has always been a stigma attached to mental health. Consequently, many mental health professionals have either left the field altogether or dropped out of participating in insurance plans, causing patients to foot 100% of the bill.
It is projected that in just four years, 2025, there will be a nationwide shortage of 15,000 psychiatrists and 27,000 other providers like psychologists, counselors, therapists and nurses. Anyone who has recently tried to find a mental health provider for themselves or a family member, knows firsthand how frustrating and bad it is. Experts in the field believe access can be improved with increased funding of mental health, (it has improved lately due to the scarcity of providers versus an epiphany) and the effective integration of digital apps into clinical practice. Personalized digital programs complement easier access to and support from “telecounseling.”
Care can be accessed when needed versus a prearranged appointment. (Most patients do not see their provider in person.) Behavioral issues such as anxiety, stress, PTSD, depression, panic disorders, family marriage, grief, eating disorders, substance abuse and ADHD can effectively be treated with the digital telecounseling model.
Employers Taking Charge
Recognizing and understanding employers’ frustration with rising premiums and employee indifference to healthy lifestyles and habits, companies are rushing in to provide solutions. Upstart company Firefly Health recently raised $40 million from investors to start a new model health plan for employers looking to lower costs AND improve employee attitudes towards their health. The plan rewards employees for smart lifestyle and provider choices, which in turn saves money for everyone involved in the new digital network. Firefly is betting most employees are not necessarily loyal to their current providers and will be willing to enroll in a plan that improves their health while delivering significant out-of-pocket savings. Each member is assigned to a care team consisting of in-person and virtual providers, urgent care, home care and specialty clinics. So far, the employer-sponsored Firefly digital networks have reduced expensive and unnecessary ER visits by an average of 52% and lowered overall costs by 30%. Four-year-old Firefly intends to expand outside current markets in New York, New Jersey, Massachusetts and Maine.
Outpatient Surgery Growing
In 2020, hospitals were forced to postpone elective surgery due to the pandemic. While most hospitals suffered significant losses last year, conversely, most insurance companies had very profitable years due to the decline in claims. The pandemic has directly contributed to an outburst in the construction and development of ambulatory surgery centers by hospitals, insurers and private investors. The fear of getting COVID-19 in an inpatient center coupled with the fact that outpatient procedures cost far less than inpatient procedures are driving the surge in ASCs. Experts predict ASCs will grow by 8% a year for the foreseeable future. Each year, thanks to technological advances, Medicare adds to the list of procedures that can be performed safely and efficiently as ASCs.
Healthcare providers can’t catch a break. As if COVID-19 wasn’t bad enough, ransomware attacks are up 45% from last year. Despite investing heavily in cyber security, hospitals and medical practices are preferred targets of criminals because the data they can steal is invaluable. The average attack costs about $8 million after figuring disruption to operations and paying the ransom. It takes about 10-12 months to recover and return to normal operations. The larger the healthcare provider-target, the larger the cost. The University of Vermont Medical Center was attacked last fall. It was costing $1.5 million a day. UVM predicts an eventual loss of around $64 million when all is said and done. Hackers infected 5,000 interconnected computers and 300 employees were furloughed because of the breach. While there is breach insurance, there are also limits to the liability insurers will pay. The extortionists threaten to completely destroy all files unless the ransom is paid; so, paying the ransom is the lesser of two evils. As more and more attacks occur, breach insurance premiums are understandably surging. Criminals demand to be paid via cryptocurrency, like bit coin, so the ransom is not traceable. Thirty-two bills have been introduced in Congress to monitor and prevent illegal payments via cryptocurrency and block chain.
A recent survey of 2,000 consumers by a health marketing company revealed a high satisfaction with care received virtually via telehealth. 60% of us have had at least one telehealth encounter this past year versus just 19% of us in March 2020. 66% of the survey respondents said they had doubts about telehealth before the pandemic. But since the pandemic, 88% are very satisfied and prefer telehealth for non-urgent care. The top advantages of telehealth expressed by the respondents were: no commute or parking hassles 41%; increased access and communication 85%; and lower cost 31%. 74% believe telehealth is the new norm for non-urgent care and a surprising 64% are OK with parts of a physical being done virtually. Experts predict telehealth will continue to grow 21% annually.
NY Excelsior Passport
New York is the first state to develop a digital vaccine passport. It can be used for entry into major sporting events or privately owned venues and businesses looking to be 100% open while protecting both staff and patrons. Madison Square Garden will require the passport. It is based on IBM’s digital health pass platform. It does not contain any underlying medical or personal information. It is a smart phone wallet app with a QR code similar to an airplane boarding pass. It can also be printed out.
George W. Chapman is a healthcare business consultant who works exclusively with physicians, hospitals and healthcare organizations. He operates GW Chapman Consulting based in Syracuse. Email him at email@example.com.