Two major developments regarding the challenging state of health care have received in-depth public scrutiny recently.
Their apparent overlap seems to indicate at least a partial resolution of the problem that divides Massachusetts from most other states.
During last week’s Massachusetts Association of Health Plans conference, Gov. Charlie Baker said that given chronic staffing shortages, the health care industry needs to rethink how it delivers services.
In October, the Massachusetts Health and Hospital Administration estimated that the commonwealth’s hospitals had about 19,000 full-time job vacancies.
Staffing issues also affect health care payments, Baker said. Understaffed rehab and long-term care facilities cannot accept new patients from hospitals, leaving patients stranded while they wait for an opening at their next treatment facility.
Tim Foley, executive vice president for 1199SEIU, which represents more than 70,000 health care workers, said the staffing shortage is a “system-wide issue,” across hospitals, nursing homes, home care and other care facilities. which requires a “whole system. solution.”
“Some of these jobs will not be replaced; we need to come together and think about new models of care delivery,” Foley said.
A study of the viability of such an alternative delivery model also just came to light, telehealth, which was apparently not discussed at that Health Plans conference.
The use of telehealth as a regular method for care illuminated the digital divide across socioeconomic lines, according to a new report from 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 education, public health, and health administration.
Noting the long-standing health disparities that the COVID-19 pandemic brought to light, the Massachusetts Association of Health Plans launched the study early in the pandemic to explore the disparate uptake of telehealth use, said MAHP Vice President of Advocacy and Engagement, Elizabeth Leahy.
The researchers concluded that the state’s oldest and youngest residents see a doctor in person more often, 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, the low use of telehealth may be caused by a combination of technological barriers and the routine and convenience of seeing their doctor in person.
The researchers spoke with some people — including seniors and English language learners — who don’t own a cell phone or, if they do, don’t know how to use the video feature, McIntosh said. “Audiophone visits were really helpful” for these populations, she said.
For younger adults who weren’t using telehealth, McIntosh said it wasn’t an issue 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 use was highest in greater Boston and other densely populated areas of eastern Massachusetts, and lowest in central and western Massachusetts—with the exception of some cities and towns in the Pioneer Valley, where telehealth accounted for more than 43% of visits.
An encouraging development that offers a potential solution to the general shortage of health care providers, telehealth was widely used across the state for behavioral health care, averaging 75 to 80% of all mental health visits. carried out almost every month.
This high percentage likely 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.
Focusing on ways to increase telehealth services among young people without access to a primary care physician, elderly patients, and those with socioeconomic challenges can significantly bridge that health care staffing gap.
For the MAHP/Harvard study, researchers recommended that health plans increase screening for digital affordability and simplify 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 writing. training.
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 possibility of permanent staff shortages would be penicillin for this chronic condition.
