A so-called “tripledemic” — the convergence of flu, RSV and COVID-19 — led to significant morbidity and mortality, and it also forced the cancellation or delay of numerous medical procedures at overwhelmed health systems. This year, there’s an RSV vaccine joining flu and COVID-19 vaccines, and it could help Americans avoid repeating history — but only if patients get recommended vaccines. 

The events over the last several years have impacted the way many people view vaccines, sometimes negatively. Vaccinations are a cornerstone of preventive care, yet data from the Centers for Disease Control and Prevention (CDC) show coverage for age-appropriate vaccines in adults has declined over time. A similar trend is happening in young patients, where one in six toddlers have not completed their childhood vaccine series according to a recent study in the journal Pediatrics. Research from the American Academy of Family Physicians painted a similar trend in incomplete HPV vaccination, with only 64% of girls and 60% of boys receiving their final dose by age 15.

There’s increasing importance and urgency with this work, too. The CDC recently warned that funding for states’ child vaccination programs will see cuts. Consequently, there may be less support available to prevent and manage infections in children.

Providers and public health agencies must remind patients about the health benefits of vaccines and the importance of remaining adherent to recommended vaccine schedules. As I explain below, technology can be a valuable support tool.

How Technology Can Help Promote Vaccine Adherence

Technology — from data analytics platforms to automated outreach tools — can help inform, target, and deploy effective patient engagement strategies to boost vaccination rates. Here’s how:

1. Providers can leverage technology as a tool to sift through medical records to identify patients who may not be current on vaccines or are at risk of poor health outcomes because of non-adherence to recommended vaccines.
2. Once an appropriate patient population is identified, engagement and outreach tools can help organizations inform such patients that a recommended vaccine is needed and deliver educational materials about the benefits of receiving needed vaccinations.
3. Data analytics tools can track vaccination compliance and ensure series completion.

It’s not hypothetical — the pandemic proved this was possible. When COVID-19 vaccines first became available, health systems were able to leverage massive data sets and advanced algorithms to identify and inform patients who should be at the front of the line.  Robust outreach programs were also deployed to patients to encourage preventive care, raise awareness of the availability of telehealth, and promote insurance enrollment. 

Some health systems that leveraged technology saw delivery rates exceeding 80% for text-based campaigns. Moreover, as many as one in four patients acted on the information that was shared with them — such as using a digital COVID-19 screening tool.

Then and now, data analytics can help providers target resources toward the patients with the highest potential for impact. For example, healthcare organizations might invest in sending higher-touch notifications, such as text messages, in an outreach campaign to higher-risk patients. As annual, scheduled, and new vaccines become available, this approach could be leveraged to identify patients with a high risk of complications, educate them about the availability of a vaccine, and engage them to get vaccinated. 

Applying Pandemic Learnings to Broader Vaccination Efforts

In the aftermath of a world- and industry-changing pandemic, it’s critical that we carry forward the key lessons learned. COVID-19 vaccinations helped healthcare refine some important best practices, including:

1. Identify high-risk cohorts of patients for specific vaccine outreach campaigns. You may want to survey patients to understand SDoH-related risk factors (like occupation), and incorporate this data into your stratification approach.
2. Be sure to incorporate race, ethnicity, and census block data to ensure you are surfacing high-priority vaccine candidates in historically underserved communities.
3. Run targeted outreach campaigns to nudge patients to get vaccinations, such as information on scheduling appointments. Outreach should include support for multiple languages.
4. Some patients may receive vaccines administered outside of your health system. You will want to use assessments to capture this information and move these patients to a different patient engagement campaign, focused on ensuring series completion. When feasible, consider alternate sites of vaccine delivery such as partnering with local pharmacies in the community.

As we look ahead, health systems should routinely leverage technology and preventative interventions to improve the health of our communities and patient outcomes. The application of technology to develop and deploy effective vaccination adherence campaigns shouldn’t be limited to COVID-19. Organizations can expand lessons learned during the pandemic to other critical vaccination pushes like seasonal flu, the anticipated rollout of RSV vaccines, and available but underutilized vaccines, such as HPV. 

About Dr. Kate Behan

Dr. Kate Behan is the Chief Medical Officer at Arcadia where she applies a clinical perspective to the design and implementation of strategies that enable healthcare organizations to succeed in value-based care. In addition to serving as a strategic advisor to physician leaders at Arcadia’s clients, she provides clinical input into the development of Arcadia’s technology and service programs. She brings more than two decades of healthcare experience in both clinical and administrative leadership roles at academic, large health systems, and payer organizations to her role.  

Prior to joining Arcadia, Dr. Behan served as Senior Vice President and Chief Population Health Officer at Jefferson Health, where she led the organization’s value-based care strategy and implementation. She’s passionate about enabling efficient and effective patient care through technology for physicians and healthcare providers. She firmly believes the path to success in value-based care is rooted in technology, and she helps organizations scale and accelerate care delivery transformation.

Dr. Behan received her bachelor’s degree from Providence College and her medical degree from MCP Hahnemann School of Medicine. She’s also certified by the American Board of Internal Medicine, a fellow of the American College of Physicians, and a member of the Pennsylvania State Medical Society.

One of the most pressing issues in healthcare today is the growing talent shortage of qualified medical professionals. These critical staffing talent shortages could jeopardize communities’ access to care and result in dire consequences. The staffing shortage existed before the pandemic, but it’s only worsened during the past few years. According to government reports, 23% of hospitals are experiencing a significant staff shortage. 

Since February 2020, hospital workforces have been reduced by more than 105,000 employees. Many hospitals increasingly rely on contract labor from healthcare travel staffing firms to mitigate these talent shortages. While there are pros to this approach, such as allowing providers to expand their offerings, this type of labor is often more expensive, increasing hospital and patient costs.

This is making hospitals face even more financial challenges. This talent shortage affects the quality of patients’ care and poses a significant threat to their safety. A 2021 Mercer study revealed that the healthcare industry had experienced a workforce loss of 20-30%. The study also forecasts that many remaining workers will consider changing jobs this year. Furthermore, it predicts that 900,000 nurses will permanently leave the industry by 2026. Twenty-nine states face a nursing talent shortage, and if current trends persist, they will be short by nearly 100,000 nurses in the next five years.

This talent shortage has serious implications for patients, as it can lead to longer wait times, reduced access to medical services, and an increased burden on existing healthcare professionals. Staffing shortages are truly a matter of life and death, potentially increasing patients’ risk of death by 4% to 6%. Areas with struggling hospitals can expect higher death rates and co-morbidity in their communities.

The shortage increases costs and leads to burnout

Significant shortages of physicians, allied health professionals, and behavioral health care providers will likely occur in areas serving marginalized urban and rural communities. Research from the Annals of Internal Medicine shows physician burnout and turnover cost $4.6 billion annually. The Syntellis Performance Solutions 2023 CFO Outlook for Healthcare shows that total labor expenses increased by 20.8% from 2019 to 2022. 

Additionally, studies reveal that the healthcare worker shortage can contribute to higher rates of physician burnout, lower job satisfaction, and increased healthcare costs. In a survey by the American Hospital Association’s American Organization for Nursing Leadership, the “emotional health and well-being of staff” was one of the top challenges and reasons for nursing staffing shortages.

How to address the shortage

Too often, healthcare workers flee rural communities for the perks that big healthcare organizations and cities can provide. But rural providers don’t have to stand pat; they can take matters into their own hands. Today’s job market is as competitive as ever, making it challenging for providers in communities to retain skilled professionals. Urban and rural providers have similar challenges in this arena, particularly as both often have higher populations of at-risk patients.

Rural and urban healthcare providers need to rethink their incentives and how they recruit talent. While it seems simple enough to suggest that increasing salaries and benefits packages is the solution to the staffing shortage, it’s not that simple. Workers today also want opportunities for professional development and career growth, and right or wrong, they often perceive a lack of opportunities in rural and urban environments.

Talent management is a two-part proposition. First, it requires attracting the right talent; secondly, it requires keeping the right talent. Incentives aren’t always about higher salaries. Sometimes it’s about the intangible benefits that attract people to a job.

Addressing this issue requires a concerted effort from stakeholders, including healthcare organizations, policymakers, and patients. No option, such as increased resources to provide incentives to attract and retain healthcare workers, is off the table. Enhancing loan repayment and other incentive-based programs are ways to make working in a rural environment too enticing to pass up.

Once on board, health institutions need to think with an eye toward the long term. Providing career growth opportunities and opportunities for employees to gain new skills will help improve the work environment. Additionally, reducing administrative tasks is the best way to prevent burnout and make the best possible environment. The easiest way to accomplish this is through the deployment of technology.

Technology has a potential two-fold benefit. It streamlines the bureaucratic red tape patients must navigate just to seek care, and it frees up doctors and nurses to focus on what matters to them the most: patients. The pandemic has prompted many providers to make necessary changes to address long-standing challenges.

To succeed, providers must invest strategically in solutions enabling digital transformation, particularly in cybersecurity, analytics, and cloud-based platforms. These investments will pay off for years to come. The demand for healthcare services will continue to rise, and unless the industry takes decisive steps to address this critical challenge, it will reach a tipping point where it’s no longer possible to address the issue. We’re not there yet, but it’ll be here before we know it if we don’t act soon.

About Khue Tran

Khue Tran is the Chief Strategy Officer at Azalea Health where she is responsible for driving growth opportunities, business development, and strategic partnerships. With a decade of expertise in healthcare IT, she has excelled in diverse roles encompassing product strategy, business operations, and customer success.

What You Should Know:

• Deloitte has published some new research about how government can advance biomedical innovation and improve public health.
• The report shares insights from various government leaders and biomedical industry experts on lessons learned from the COVID-19 pandemic, what’s driving innovation, the challenges and opportunities in partnerships, and the government’s role in sustaining the biomedical industry.

Understanding How the Government Can Catalyze Biomedical Innovation

The COVID-19 pandemic showcased a successful collaboration between the government and its partners in advancing care for various diseases. This involved prioritizing affected patients and communities, facilitating real-time information sharing, collectively setting targets, incorporating regulatory guidance, and planning for the dissemination of discoveries. The rapid development of COVID-19 therapeutics demonstrated a transformative approach by the government in promoting innovation. Preserving these practices is crucial to sustain the momentum for faster innovation, treatments, and cures. A new study by Deloitte examines how the government can utilize the lessons learned from collaborative innovation during COVID-19 to expedite biomedical innovation.

A literature review and interviews were conducted with 15 leaders from various sectors, including government, biopharma, nonprofits, academia, and philanthropy, with the objective being to analyze the lessons derived from the COVID-19 response, identify the main factors driving innovation, explore challenges and opportunities in partnerships, examine the government’s role in discovery and development, and propose strategies to maintain the momentum of accelerated biomedical innovation.

Key findings generated showed the 3 ways the government can catalyze biomedical innovation, which are mentioned and explained below:

1.  Leverage the full continuum of collaboration to help foster innovation: In retrospect, partnerships played a pivotal role in the COVID-19 response, fostering breakthrough innovation. To avoid squandering valuable discoveries, it is essential to codify the lessons learned from these collaborations. The ACTIV collaboration, which coordinated multiple clinical trials and shared its findings, serves as an exemplary model for future biomedical science collaborations. The intensity and focus of these partnerships during the pandemic resulted in unprecedented speed and success in developing therapeutics and vaccines. Additionally, optimized partnerships provide a structured framework for innovation, requiring the identification of suitable partners, clear goals, and effective agency coordination. Addressing ecosystem-wide problems incentivizes collaboration, while the dissolution of silos is necessary to overcome obstacles. Evaluation and measurement of collaboration progress can inform future efforts and drive better outcomes. Supporting academic research partners through investments and providing them with time and aligned incentives are crucial for fostering innovation.
2. Prioritize patients and communities in the innovation pipeline: A co-creation process involving multiple stakeholders can effectively address ecosystem-wide problems by sharing responsibility and working together. Incorporating patient and community perspectives in research is undoubtedly crucial for improving efficiency and effectiveness. Initiatives like the NIH Community Engagement Alliance (CEAL), Clinical and Translational Science Award (CTSA) program, and Patient-Centered Outcomes Research Institute (PCORI) have made progress in involving patients in research and decision-making. Designing for equity ensures that the benefits of innovation are accessible to all, especially marginalized groups. Community-based participatory research programs, such as the Community Based Participatory Research Program (CBPR) and All of Us Research Program, emphasize equal partnership and diverse participation. Patient-centricity and community collaboration build trust and generate impactful outcomes. Nonprofits play a vital role in addressing patient needs throughout the innovation process. Government coordination and patient inclusion are essential for efficient decision-making and problem-solving. ARPA-H could benefit from a Patient Advisory Council to incorporate real-time input and scale the organization.
3. Implement last-mile infrastructure to support high-risk research endeavours: Government’s contribution to the last mile of the research and development pipeline can be categorized into three main mechanisms:

1. Quicken the pace of innovation:

• Offer researchers the space to take bigger risks with programs like ARPA-H, complementing traditional NIH-funded research.
• Create a culture of experimentation and measured risk-taking, fostering breakthrough disruption areas.
• Focus on eliminating ideas likely to fail early in the process, reducing overall development costs.
• Leverage lessons from DARPA and ARPA-E to generate new capabilities and platform technologies in the health sector.

2. Fund place-based innovation ecosystems:

• Avoid systemic traps and fund a diverse pool of researchers, not just well-known institutions or areas with high funding.
• Recognize the importance of local community-based ecosystems in driving innovation.
• Support innovation clusters in new locations by funding promising new investigators and providing specialized infrastructure.

3. De-risk the commercialization process through incentives and subsidies:

• Government investment in biomedical areas does not reduce private spending on R&D.
• Subsidize research and development in high-risk, high-expected social return areas.
• Push incentives reduce development costs through financial, tax, and technical incentives.
• Pull incentives ensure developers’ financial viability by rewarding relevant and scientifically viable developments.

Over the past several years, urgent care centers nationwide have opened their doors to millions of patients in need of COVID-19 testing and treatment, driving an increase in daily patient visit volumes and new, challenging patient care demands. To accommodate this rapid influx, urgent care centers developed new workflows that prioritized efficiency and transitioned to a reimbursement model that rewards providers for the number of patients treated per day. As a result, urgent care centers across the country are now facing a new challenge: the degradation of their scope of care – a serious threat to the future of the on-demand care industry.

In order to maintain their acuity edge and remain competitive with telemedicine, retail clinics, and on-demand primary care, it is imperative for urgent care leaders to recognize the shortcomings of this new reality, develop a comprehensive plan to reverse its diminishing scope of practice and restore its original purpose of providing high-quality, high-velocity care to the masses.

Education and Training for Advanced Practice Providers

Over the last several years, the industry has seen a huge influx of advanced practice providers (APPs), accounting for approximately 84% of urgent care providers. Prior to the pandemic, newly hired urgent care APPs went through a training period, alongside a physician or highly experienced APP, where they were given time to learn robust procedural skills. Out of necessity to handle the increase in patient visit volume, the pandemic essentially eliminated this training period.

APPs are now experts in caring for COVID, but this has come at the cost of losing many essential skills that were once an everyday part of urgent care, such as on-site laceration repair, fracture care and radiology. In order to restore essential services and enable urgent care centers to operate at the top of their scope of practice, providers need to expand their capabilities and have confidence in their skill set. One promising solution is comprehensive education and training for APPs to serve as an across-the-board refresher and expansion of clinical skills and services. An urgent care training continuation will help to decrease inconsistencies among urgent care clinics and ensure APPs and nurse practitioners are operating within a consistent skillset.

Proper education and training should be unique to the needs of every individual operation. In order to develop a training and education program that properly identifies and addresses the current deficits of care, urgent care leaders must take a comprehensive look at their businesses to understand where their inefficiencies lie by evaluating what types of patients they once treated that they no longer do; surveying whether their experienced providers agree with the workups and care being provided by your less-experienced providers; understanding how their physicians and APPs feel about their skills and ability to perform complex procedures; and assuring their clinics have the necessary supplies to treat higher-acuity patients. With the right training and focus, urgent care across the country can achieve a higher scope of care.

Profitable Reimbursement

At the core of acuity degradation was the shift in reimbursement policies to emphasize high productivity and labor cost savings. When urgent care was first popularized by emergency medicine physicians more than 20 years ago, the focus was on keeping patients out of the emergency room. With a staff composed of highly skilled and trained ER physicians, urgent care centers could perform laceration repairs, casting, EKGs, fluid hydration, and other “complex” procedures. These services were reimbursed by insurance companies under a fee-for-service (FFS) model, offering urgent care clinics a lucrative payout while still presenting value to consumers versus a trip to the emergency room.

Over the last several years, payers started shifting away from the FFS model and started using a case rate reimbursement model which offers a flat fee based on the weighted average of all services for each visit. In response to this, the industry started to focus on cases that could be treated most efficiently, and patients per hour per provider became the main KPI in urgent care.  The COVID-19 pandemic catalyzed this trend as millions of patients looked to urgent care for testing and treatment options, leaving patients with non-COVID related, “complex” issues waiting for hours in a sea of COVID patients, or being directed to the emergency room for treatment- a complete reversal of the intended value proposition of urgent care.

As urgent care clinics try to recover lost revenue by increasing their efficiency, they take on more low-acuity cases, and the cycle continues. To break this sequence and to restore the original purpose of urgent care, clinic leaders should prioritize reducing the number of patients they refer out of urgent care centers and restore their clinic’s ability and willingness to treat higher-acuity patients. To achieve this, clinics can implement referral standards and limitations for high-acuity injuries and offer financial incentives to providers to perform certain “complex” procedures. Doing so will help encourage providers to increase their scope of complex care and will restore urgent care’s credibility to treat a robust range of higher-acuity patients. As the number of higher-acuity cases increases, especially among established patients, reimbursement per visit will start to increase once again.

When operating at the top of their scope of practice, urgent care centers nationwide offer tremendous value to their patients. Through robust provider training programs, coupled with additional clinic resources and changes to their profitable reimbursement models, urgent care centers can continue elevating their scope of care, and maximizing their value to an increasing number of patients. 

About Monte Sandler

As a dynamic leader on the Experity Executive Leadership Team, COO Monte Sandler is committed to building and maintaining collaborative partnerships with urgent care organizations across the country to ensure Experity’s Operating System helps them reach their operational and financial goals in this competitive healthcare market. Monte is a CPA and holds a BS in Accounting from Indiana University Kelley School of Business.

What You Should Know:

• Three years after COVID-19 was declared a public health emergency, many healthcare supply chain leaders and frontline professionals are operating in survival mode, according to new industry research from Deloitte Consulting LLP.
• Ongoing challenges include economic pressures, multiple resource shortages, data visibility and labor issues.

Key Findings

To gain greater insight into these impacts, Deloitte expanded its study by conducting site visits to healthcare facilities, interviewing frontline professionals and re-interviewing supply chain leaders in private and public sectors across government, healthcare, academic institutions, and humanitarian non-governmental organizations (NGOs) from November 2022 to March 2023.

Key findings include:

• 70% of interviewees cited data visibility as a concern.
• 73% of those interviewed indicated that disruption is the expectation, impacting their ability to focus on strategic initiatives, such as health equity.
• 60% of post-pandemic interviewees believe that healthcare supply chain will remain a focus for their organizations.

3 Recommendations to Increase Healthcare Supply Chain Resilience

To increase healthcare supply chain resilience and enable healthcare organizations to focus more on implementing long-term strategic initiatives, Deloitte recommends:

1. Developing a robust risk management framework and continuously monitoring supply networks to prepare for possible disruptions.
2. Focusing first on supplier relationship management for critical products.
3. Leveraging a Human-Centered Design approach to identify opportunities for improvement.

What You Should Know:

• Today, the Drug Enforcement Administration (DEA) and the Substance Abuse and Mental Health Services Administration (SAMHSA) issued the “Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications” – a temporary rule that extends telemedicine flexibilities adopted during the COVID-19 public health emergency (PHE).
• ·         The temporary rule will take effect on May 11, 2023, and extends the full set of telemedicine flexibilities adopted during the COVID-19 public health emergency for six months – through November 11, 2023. For any practitioner-patient telemedicine relationships that have been or will be established up to November 11, 2023, the full set of telemedicine flexibilities regarding the prescription of controlled medications established during the COVID-19 PHE will be extended for one year – through November 11, 2024.

Background

On March 1, 2023, DEA, in concert with HHS, issued notices of proposed rulemakings (NPRM) to allow for prescribing of certain controlled medications via telemedicine without an in-person medical evaluation of the patient under circumstances that are consistent with public health, safety, and effective controls against diversion. The NPRMs received over 38,000 comments from the public and DEA, in collaboration with SAMHSA, is actively reviewing input in order to develop a permanent rule.

What You Should Know:

– A nationwide U.S. study of more than 893,000 adults provides solid evidence confirming that mRNA booster immunizations extend protection against moderate and severe COVID for four to five months. 

– These findings, published in The BMJ, provide a more complete understanding of the effectiveness and durability of third and fourth doses of the mRNA vaccines, informing policymakers and providing individuals with confirmation of the importance and value of boosters.

Evidence-Based Research Supports the Need For Additional Boosters

Vaccine effectiveness provided by boosters waned less against severe disease than against moderate disease in all age groups according to the new study which was conducted by the Centers for Disease Control and Prevention’s (CDC) VISION Network.

“While there have been recommendations for booster shots for a while until now we haven’t had strong evidence of their effectiveness and how long that effectiveness lasts,” said study co-author Brian Dixon, Ph.D., of the Regenstrief Institute and Indiana University Richard M. Fairbanks School of Public Health. “In our new study, we looked at tens of thousands of patients in multiple states, seen over a year and a half. Our analysis provides compelling evidence, both of the effectiveness of boosting to increase immunity, and that this immunity begins to wane after four or five months, indicating additional booster doses are necessary.

“The recommendations to get boosted that were issued by the CDC months ago, were, in fact, the right recommendations,” said Dr. Dixon. “Booster doses are necessary to maintain a high level of immunity to severe COVID.”

The bivalent booster, available since early September 2022, targets both historic strains of the SARS-CoV-2 virus and the Omicron variants (BA.4 and BA.5) currently circulating in the U.S. and globally. he authors found that in the Omicron period mRNA vaccine protection against severe COVID-19 was initially high (89 percent) but waned after primary vaccination. Focusing on the durability of boosters against hospitalization, (i.e., severe disease), the study found that effectiveness increased markedly after a booster shot, waning again about four to five months after the booster. Protection increased again following a second booster. The protection and waning pattern with Moderna and Pfizer boosters were similar.

“If it has been four months or longer since your last COVID booster, or if you had the initial two shots and have never received a booster, you should strongly consider a bivalent booster, which targets ancestral strains of the COVID virus plus subvariants Omicron BA.4 and BA.5,” said study co-author Shaun Grannis, M.D., M.S., Regenstrief Institute Vice President for Data and Analytics. “The evidence that boosters can keep you healthy is compelling. Combining a COVID booster with an annual flu shot will help you make it through the respiratory disease season.” Dr. Grannis also is a professor of family medicine at IU School of Medicine.

The BMJ study authors estimate that booster shots to counteract waning could prevent 300 hospitalizations in the U.S. for severe COVID per week.

They note that the strengths of their new study include the “number and diversity of sites and inclusion of outcomes of varying severity as well as a sample size large enough to detect modest waning of vaccine protection.” Cases were compared with controls tested during the same week in the same geographic area, allowing the researchers to distinguish differences in vaccine effectiveness attributable to the waning of vaccine-induced immunity from those attributable to the ebb and flow of variants.

What You Should Know:

– Healthcare profit pools are expected to grow 4 percent annually resulting from $654 billion in 2021 to $790 billion in 2026, according to a new McKinsey report.

– The report reveals inflation is not transitory and the economic outlook has meaningfully darkened due to a healthcare worker shortage and endemic COVID-19.  

What to expect in US healthcare in 2023 and beyond

The US healthcare industry faces demanding conditions in 2023, including recessionary pressure, continuing high inflation rates, labor shortages, and endemic COVID-19. But players are not standing still.

Key findings from the report are as follows:

1. Healthcare services and technology is expected to be the fastest growing sector in healthcare at 10 percent annual growth between 2021-2026 (potentially landing at $81 billion by 2026).  On the other hand, the outlook for some segments has worsened compared with the previous analyses, including general acute care and post-acute care within providers and Medicaid within payers.

2. The Government segment’s profit pools are projected to land nearly 50 percent greater than the Commercial group segment by 2026 ($33 billion compared with $21 billion). In July 2022, it was estimated that  2021 payer profit pools to be $40 billion, however, actual 2021 profit pools were $5 billion higher Higher Medicaid EBITDA margins due to the extended public health emergency accounted for the majority of the increase, although it was partially offset by lower-than-expected commercial margins with the return of deferred care.

3. Increased labor costs and administrative expenses are expected to contribute to reduced earnings before interest, taxes, depreciation, and amortization by about 60 basis points in 2022 and 2023 combined. Previously, in July 2022, it was estimated that provider profit pools would grow at a 7 percent CAGR from 2021 to 2025. The current forecast is that of a 3 percent CAGR from 2021 to 2026 in updated and expanded estimates, with the decline primarily due to increased costs owing to high inflation and labor shortages.

4. Payer profit pools are expected to grow at 11 percent annually reaching $75 billion in 2026. Growth in 2021 resulted from making up for care deferred from the first year of the COVID-19 pandemic as well as additional healthcare demand attributable to COVID-19. Provider profit pools faced substantial pressure in 2022 and are likely to continue to do so in 2023 as a result of inflation and increased labor costs.    

5. Payer profit pools are likely to see slower than normal growth between 2022-23 due to inflationary pressure and provider reimbursement rate increases.  

6. Provider profit pools are also expected to see slower growth annually than previously predicted (3 percent growth annually from 2021-26, compared to the 7 percent figure previously predicted).  Three factors account for the anticipated faster growth in HST. First, analysts expect higher demand from payers and providers to improve efficiency and address labor challenges. Second, payers and providers are likely to be willing to absorb vendor price increases where there is clear value. Third, experts expect HST companies to make operational changes that will improve efficiency, including through the use of technology and automation across services.

7. Increased labor costs and administrative expenses are expected to contribute to reduced earnings before interest, taxes, depreciation, and amortization by about 60 basis points in 2022 and 2023 combined.

It’s often said that the National Health Service is the closest thing Britain has to a unifying religion. If that is the case, then the faith of the population is being tested like never before,

With budgets already stretched before the COVID pandemic, additional cost pressures since heaped on health boards across the country by double-digit inflation have brought the NHS closer to breaking point than at any time in its history.

Every passing day seems to bring bleaker news for the beleaguered service, with a seemingly endless roll call of damning statistics and publication of official reports charting yet higher levels of institutional failure. 

If anything, the relentless flow of anecdotes of patient betrayal, breathlessly reported in the pages of the local press, is more shocking.

In the past few weeks we learned that four patients had waited more than 20 hours in the back of ambulances outside Royal Shrewsbury Hospital in England; that GPs in Peterborough are now responsible for the care of more than 2,000 patients each; and that Stockport NHS Foundation Trust is offering food bank vouchers to hospital workers struggling to get by on poverty wages. 

In the same week, a British Medical Association (BMA) survey found that 44% of senior doctors are planning to leave their roles “in some capacity” over the next 12 months, while the Care Quality Commission (CQC) reported 132,000 NHS and 165,000 social care vacancies, meaning a workforce the size of the population of Newcastle-Upon-Tyne is needed to fix the logjam. 

Meanwhile, the average wait for category two, 999 calls for an ambulance — including for chest pains and strokes — in England and Wales is now 60 minutes, compared with a target of 18 minutes. And in Scotland, throughout August, one in ten operations was canceled due to a lack of resources.

Traditionally, the response of politicians to complaints of a ‘crisis’ in the NHS has been to throw more money at it, and right now there’s no money to spare.

While both Conservative and Labour governments have previously toyed with reform, none has dared challenge the universally free, taxpayer-funded model upon which the health service was founded – until now. 

This week it was reported that NHS chief executives in Scotland – one of four autonomous health service areas in the UK – have discussed abandoning its founding principles by having wealthier patients pay for treatment.

The prospect of the first ‘two-tier’ health service in the UK since its founding in 1948 is raised in draft minutes of a meeting of NHS Scotland health board leaders in September. They also discussed the possibility of curtailing some free prescriptions.

While Humza Yousaf, Scotland’s Health Secretary, sought to play down the reports – insisting NHS Scotland would stay publicly owned and operated and free at the point of delivery – the reports represent something of a watershed.

Yousaf’s comments were only to be expected. If there is a single, immutable reality of British political life it is that the NHS is an untouchable shibboleth, and any party that says otherwise risks courting electoral oblivion.

Even if there was a prime minister mad, or drunk, enough to suggest privatizing the service, they would surpass the ends of the earth several times over before finding a private operator madder, or drunker, enough to take on the job.

Yet, there is a dynamic to the latest spot in which the NHS finds itself, which appears materially different to anything in the past. Again, you need only scroll through some of the local press articles to discover that waits are longer, levels of basic care poorer and patient experiences grimmer than ever before.

Figures published by NHS Wales last week revealed more than 60,000 patients are waiting more than two years for treatment. Ian Hembrow, 53, from Maesteg, in Bridgend was told the waiting list for his urgent hip operation was four-and-a -half-years.

In Bonhill, West Dunbartonshire, 69-year-old grandmother Mary Travis has already lived in crippling pain for more than two years, waiting for a back operation to straighten her twisted spine.  Earlier this month she was told that, despite being at the top of a waiting list, she could face a further, two-year wait. 

The NHS has endured because there is an almost spiritual belief in its universality. People of all classes and backgrounds accept the same level of treatment as a right and consequence of being British. 

Those principles have survived because NHS care, as well as being universal, was also universally excellent. That can no longer be said to be the case. The withholding of treatment for years is worse than receiving poor treatment and those who can afford to pay privately for better service will inevitably opt to do so.

The most compelling argument against privatizing the NHS has always been that the provision of healthcare should not be left to the vagaries of market forces. The irony of the current crisis is that those very market forces may now compel its demise. 

No matter how strongly Britons support the NHS, few will be prepared to wait months or years to have an ingrowing toenail treated or a cyst removed if they can have it done privately the following week for a few hundred pounds.

And while we may be happy and willing to pay European levels of taxes in return for a European-style health service, we’re unlikely to do the same for a US-style system.

With the growing development of robotics and telemedicine, as well as an expansion of over-the-counter diagnostics, more people are now seeking remedies, for a greater range of treatments, from their local chemist or from a private therapist or practitioner.

By spending a small amount each month, they can have more or less unlimited telephone or video access to a private GP. 

More is being done online than was the case a few years ago. Much of it remains minor, but the direction of travel is such that, before long, more serious illnesses will be diagnosed remotely and by high street providers. 

If patients can be diagnosed with prostate or breast cancer sooner and treated more effectively, then the way in which the health service is configured and funded will no longer be as important.

We may end up with something approaching the German health service model where a private service handles minor and routine complaints, while accidents and serious illnesses are treated by a publicly funded service, similar to the NHS, which is free at the point of delivery.

It’s unlikely the NHS will ever be wholly privatized, but we could see – slowly and over time – some of its more routine functions being taken over by private companies. 

Even the most traditional religions are forced to adapt and evolve to remain relevant and the NHS is no different. How it responds to the current crisis will determine its role in treating the next generations of patients and whether they will hold it with the same reverence for another 70 years.

About Ivor Campbell

Ivor Campbell is the CEO of Snedden Campbell, a UK-based recruitment agency for the global medical technology industry. IvorIvor has been in a candidate search for more than 30 years. Prior to launching Snedden Campbell, in 2001, he held senior roles for some of the UK’s biggest recruitment companies. Fed up with men in grey suits, pointless KPIs and sharp practice, he decided to launch a new kind of retained medical technology search consultancy that would bring approachability to headhunting, where clients and candidates would be treated equally, and where nobody ever said ‘touching base’. He now spends his time meeting clients and delivering on projects around the UK, Europe and worldwide.

The material cost of COVID-19 has been at the center of public discourse since the early days of the pandemic. In 2020, growth in federal government spending on healthcare increased 36 percent, compared to the 5.9 percent bump in 2019. While the distribution of vaccines has allowed for a version of pre-pandemic life to resume, hospitals are still not recovered from the high rates of hospitalizations that occurred in March 2020, and the indirect costs of the pandemic continue to loom over the American population as a result of strained health systems. 

During the early days, the cost of hospitalizing a patient seemed obvious: the sheer volume of long stays, expensive ventilators, a lack of one-size-fits-all treatment solutions, and the pause of elective surgeries. Now, Covid-19 continues to wreak havoc on our health systems, but in a more covert way. With only 4% of Americans fully boosted as we move into this winter’s ‘triple-demic’ – and long covid impacting the lives of as many as 16 million people on a daily basis – it’s clear that public health officials need to do more in order to support the American population and our struggling health systems. 

The Cost of Healthcare Provider Burnout 

Across the country, healthcare providers are reporting extreme rates of burnout. It is important to underscore that healthcare providers and hospital systems were stressed prior to Covid-19, but the pandemic has exacerbated it. Employment across healthcare is down 1.3 percent, or 223,000 jobs, from pre-pandemic levels. Over 90 percent of nurses said they are considering quitting their jobs by the end of 2022 in a survey, with 72 percent of nurses stating they had already experienced burnout before March 2020. In addition, the increased stress that doctors have experienced is resulting in worse patient care – with 28% of doctors who reported burnout sharing that the quality of care they are providing has significantly declined. 

We are amid a mass healthcare provider exodus, and, according to estimates, each instance of physician turnover costs healthcare organizations at least $500,000, and each instance of staff registered nurse (RN) turnover costs $46,100. Without proper staffing, hospitals are at risk of closure and patients’ health is at risk of worsening. 

The Cost of Hospital Closures 

Before the pandemic, hospitals closed for several reasons, including insufficient staffing, lack of funding, and/or having a large uninsured patient population. Since March 2020, 21 hospitals across the United States, predominantly in rural areas, have closed. Health systems are still recovering from the significant loss of revenue from canceled appointments – according to a report from The Chartis Center for Rural Health, 82 percent of the rural hospitals surveyed said suspension of outpatient services resulted in a loss of at least $5 million per month. 

So, what happens when hospitals and health systems close? 

Rural areas experience more Covid-19-related deaths than urban communities and public health experts attribute these deaths to the rampant hospital closures, as well as a general lack of healthcare providers. It is a vicious cycle: Covid-19 strains hospital systems, healthcare professionals leave, hospitals close, and more patients will die from infectious diseases like Covid-19, the flu or respiratory syncytial virus (RSV) – not to mention the other reverberating public health complications that come as a result of these closures. Vaccinations have helped these hospitals stabilize, but to keep up with covid fatigue and the ever-evolving variants we need a variety of treatments in our arsenal. 

More Covid-19 Treatments Will Bolster Struggling Health Systems  

Increasing the number of vaccinated individuals around the world, in addition to broadening access to effective non-vaccine treatments, such as antivirals and monoclonal antibody therapies, will significantly lessen the impact of the disease on individuals and lessen the burden on the healthcare system. Antiviral treatments have proven to reduce hospitalization, but diversity in treatments is essential to keep up with the ever-evolving Covid-19 variants. Dr. Andrew Pavia, chief of pediatric infectious diseases at the University of Utah Health, was quoted on the effectiveness of antivirals: “If there is anything we know about viruses and antiviral drugs is that eventually, we will see some sort of resistance.” For the time being, antivirals are effective – this is not a call to leverage one type of therapy over another – this is a call to help patients and our health systems survive by equipping healthcare professionals with as many treatments as possible. 

One such treatment that has proven highly effective when applied properly are neutralizing monoclonal antibody therapies. Like antivirals, monoclonal antibodies reduce hospitalization, the risk of death, and shorten the length of the infection – resulting in better patient outcomes and stronger health systems. 

According to Yale Medicine, it is estimated that about three percent of the United States population, or up to 25 million individuals, is considered moderately-to-severely immunocompromised, making them more at risk for serious illness if they contract Covid-19, or other viruses. Monoclonal antibodies are a highly safe and efficacious treatment, which is extremely important for this vulnerable population, especially as a complement to vaccines for prevention. An infusion can reduce the risk of hospitalization by 80 percent or more in a high-risk person, and unlike antivirals, monoclonal antibodies target specific parts of the virus spike protein leading to fewer side effects and interactions with other drugs. 

Collaboration between the government and the biotech industry will be essential for creating a portfolio of therapies to treat a variety of patient profiles who experience a range of Covid-19-related health issues. With our healthcare systems in such a precarious state, investing resources in the development of these treatments will prepare hospitals for future variants that threaten the health of our nation. The hope is that by bulking up our Covid-19 hospital response strategy, our already volatile health system will have a chance to recover, increase individuals’ access to quality healthcare, and ensure a healthier population. 

About Eugene Y. Chan, MD 

Dr. Chan is a physician-inventor. He is currently Chairman, Co-Founder of Abpro, CEO of rHEALTH, and President, CSO of DNA Medicine Institute, a medical innovation laboratory.  He has been honored as Esquire magazine’s Best and Brightest, one of MIT Technology Review’s Top 100 Innovators, and an XPRIZE winner. His work has contributed to the birth of next-generation sequencing, health monitoring in remote environments, and therapeutics. Dr. Chan holds over 60 patents and publications, with work funded by the NIH, NASA, and USAF.  Dr. Chan received an A.B. in Biochemical Sciences from Harvard College summa cum laude in 1996, received an M.D. from Harvard Medical School with honors in 2007, and trained in medicine at the Brigham and Women’s Hospital.  He is one of few individuals who has been in zero gravity. 

What You Should Know:

– NRC Health, the leading partner in building Human Understanding through personalized healthcare solutions and data-driven insights, released findings from its national Market Insights study that reveal that people trust local hospitals and health systems far more than they trust federal, state, and local government to handle the COVID-19 pandemic.

– NRC Health also found through its experience surveys that patients’ language preferences are a strong predictor of trust in individual healthcare providers and that, in terms of political environment, trust in providers is not reliably related to political party.

Analysing Trust in Individual Healthcare Providers, and How It Depends Largely On Patients’ Language

For more than 40 years, NRC Health has led the charge to personalize healthcare and support organizations in their understanding of each unique individual. NRC Health’s commitment to Human Understanding™ helps leading healthcare systems get to know each person they serve not as point-in-time insights, but as an ongoing relationship. Guided by its uniquely empathic heritage, NRC Health’s patient-focused approach, unmatched market research, and emphasis on consumer preferences are transforming the healthcare experience, creating strong outcomes for patients and entire healthcare systems. 

The findings released by NRC Health are as follows:

Language Preference is a Strong Predictor of Trust in Individual Providers

NRC Health works directly with health systems across the nation to collect feedback from their patients, usually within 48 hours of a clinical encounter. NRC Health’s experience surveys gauge multiple factors, including the level of trust that people have in their doctors and other providers responsible for their care. Findings from a random sample of 1 million surveys collected since March 2020 showed that language preference is a strong predictor of trust: People who prefer English are 29% more likely to say that they “definitely trust” their provider, even when controlling for age, sex, race, marital status, county-level income, and political context. “Our analysis highlights the importance of building trust by bridging interpersonal barriers, especially when it comes to language preference,” says Dr. Makoul. “This is an issue of equitable and effective care, not politics.”

At the Country Level, Trust in Individual Providers is Mixed

To assess aggregated results at the county level, NRC Health combined its experience-survey data with county-level voting and Claritas demographic data. NRC Health had provider trust data and patient-level demographic data for 3029 of the 3243 U.S. counties (or county equivalents). Two trust-related questions were combined to maximize the number of respondents and the representativeness of the sample from a national perspective. Of the 20 counties with patients reporting the lowest level of trust in healthcare providers, 17 voted predominantly red, while three voted predominantly blue. Interestingly, among the 20 counties with patients reporting the highest level of trust, 17 represented red and 3 represented blue as well. “Red counties outnumbered blue counties by almost five to one overall, so counties where trust was extremely high or low followed the overall voting pattern,” says William England, PhD, Strategic Analyst at NRC Health. “If high or low provider trust was more prevalent among members of a particular political party, we’d have expected to see a significant difference in the voting patterns at the extremes.”

Trust in Local Healthcare is on the Rise

The pandemic challenged the healthcare industry dramatically, but even in light of unprecedented circumstances, trust in hospitals and healthcare systems rose significantly during the pandemic. More specifically, based on responses from 682,217 consumers from across the country between April 2020 and August 2022, NRC Health found that the proportion of people reporting trust in their local hospitals and health systems increased from 20.7% to 35.8%. In contrast, the proportion who trust the federal government to handle the pandemic declined from 10.6% in April 2020 to below 10% in every subsequent month until rebounding in May 2022 and reaching 13.2% in August 2022. Trust in state government dropped from 13.8% to 7.2%, while trust in local government hovered in the 5% range during the study period. NRC Health will be releasing its annual Trends Report early next year, offering an in-depth analysis of trends and predictions in the healthcare industry.

What You Should Know:

– A new report, “Private Equity Firms Rebrand Prison Healthcare Companies, But Care Issues Continue,” by the Private Equity Stakeholder Project (PESP) focuses on healthcare company Wellpath and the regulatory risks that the company continues to take in local jails and prisons. 

– Wellpath is owned by private equity firm H.I.G. Capital and is among the largest healthcare companies serving U.S. prisons and jails. Wellpath has had a litany of staffing and access to care concerns that have followed the organization in multiple states, and the company continues to be mired in regulatory and reputational risk related to the poor conditions of its incarcerated patients. Even so, the organization is currently in the process of expanding beyond traditional correctional settings, recently beginning to provide child psychiatric services, mental health treatment, and substance use services to the general population.

Private Equity Firms Rebrand Prison Healthcare Companies, But Care Issues Continue

Key insights from the report are as follows:

1. Wellpath is owned by H.I.G. Capital, and is among the largest healthcare companies serving U.S. prisons and jails: Privatisation and its attendant harms continue in other forms and places, such as within immigration facilities. Federal and state correctional authorities also continue to privatize specific services within facilities, such as phone services, commissary, and healthcare. In 2020, there were estimated to be over 4,100 corporations profiting from mass incarceration in the U.S. In 2016, the Justice Department’s Office of Inspector General found that federal prison spending on outsourced healthcare increased 24% to $327 million between 2010 and 2014, while the overall prisons budget increased only 11%. In 2016 it was estimated that half of all state and local prisons and jails had outsourced healthcare to an industry worth more than $3 billion annually. As of 2022, correctional healthcare is estimated to be worth $9.3 billion. In a 2020 report, Reuters estimated that over 60% of jails outsource their healthcare to private companies.

The report also reviewed deaths in more than 500 jails from 2016 to 2018, and found that “those relying on one of the five leading healthcare contractors had higher death rates than facilities where medical services are run by government agencies. This report examines Wellpath, a company that claimed more than 15,000 healthcare professionals serving over 300,000 adult and juvenile patients across the United States and Australia in 2019. The report also looks at Wellpath’s private equity owner H.I.G. Capital, and more generally examines private equity’s healthcare profiting from prisons, jails, and mass incarceration. As discussed below, Wellpath has been found by regulators and watchdogs to provide inadequate healthcare in some of its facilities and has continued to staff some facilities to levels inadequate to provide adequate care.

2. H.I.G.’s Dubious Track Record in Prisons and Healthcare: Wellpath was formed in 2018 from the consolidation of H.I.G. Capital-owned companies Correct Care Solutions (CCS), which H.I.G. acquired in 2018, and Correctional Medical Group Companies (CMGC), acquired by H.I.G. in 2013. In the year before H.I.G. acquired Correct Care Solutions, the company also came under scrutiny from the U.S. Department of Homeland Security Office of Inspector General and members of Congress for poor conditions at an immigration facility where it provided healthcare in Adelanto, California.

The inspector general’s report raised concerns about “untimely and inadequate medical care” and 80 detainee medical care grievances filed between November 2017 to April 2018. At another facility in Texas, the U.S. Justice Department found CCS failed to meet federal staffing standards more than 90 percent of the time. In addition to the healthcare provider, H.I.G. Capital also owns TKC Holdings, which provides food, commissary, and telecom services to jails, prisons, and immigrant detention centers. The company was formed by combining Trinity Services Group, which H.I.G. acquired in 2012, and the Keefe Group, acquired in 2016. Before that, H.I.G. helped make Securus Technologies one of the largest correctional telecommunications companies in the U.S., before selling the company in 2011.

Recently, Wellpath came under scrutiny from the U.S. Department of Justice, which in 2021 published an investigation of California’s San Luis Obispo County Jail and found reasonable cause to believe that the jail failed to provide constitutionally adequate medical and mental health care, and denies prisoners with mental health disabilities access to services, programs, and activities.  Justice Department investigators were accompanied by medical and mental healthcare consultants for visits to the jail in January 2019 and August 2019. The county health agency provided and mental health services to the jail until Wellpath began providing services in February 2019. The report includes comparisons of before and after Wellpath began providing the jail’s healthcare services.

3. YesCare/Corizon Health – BlueMountain Capital Management, Flacks Group: One of Wellpath’s largest competitors is YesCare, which was known as Corizon Health until the company rebranded in May 2022. YesCare/Corizon was previously owned by private equity firm BlueMountain Capital Management until its 2020 acquisition by the Flacks Group. According to a press release at the time of its acquisition, YesCare/Corizon provided primary medical services, behavioral health, dental care, and pharmacy services to 149 facilities in 16 states, employing more than 5,000 people and generating approximately $800 million in annual revenue.

Gerard Boyle, the Wellpath founder who pleaded guilty of bribery in 2021,52 started his correctional healthcare career at a company that would eventually rebrand as Corizon Health. In the five years leading up to April 2020, YesCare/Corizon paid at least $16 million in fines, penalties, or lost revenue due to inadequate staffing levels and failures to improve patient healthcare around the country. At one facility in Arizona, a judge-appointed expert observed that “recruitment and retention are an ongoing issue, resulting in staff being stretched too thin to provide coverage. At the same facility, staff described the situation in an email to management with the subject line, “IN NEED OF HELP!!

4. Wellpath’s inconsistent and harmful medication practices: Wellpath facilities have also been accused of medication mismanagement. In January 2022, the Disability Law Center in Massachusetts issued a report on Bridgewater State Hospital, where it has conducted oversight for almost eight years, finding “Wellpath is now subjecting [persons served] to all forms of restraint and seclusion in unsanctioned circumstances, particularly the use of manual holds, seclusion, and chemical restraint”. The DLC report also describes a “culture of intimidation” at the facility. One individual reported that Wellpath staff would “supply the disturbance”—through offensive comments or by instigating conflict—in order to justify the use of chemical restraints.

In July, Disability Law Center published a follow-up report on Bridgewater, identifying involuntary medication administration absent emergencies and a “significant number of [emergency treatment orders] administered for reasons that do not comply” with state law.” “Wellpath continues to use vague terms, which often lack any reference to harm whatsoever” to justify restraints and seclusion. In May 2022 at Norfolk City Jail in Virginia, a Wellpath psychiatrist resigned citing disagreements over issues at the jail, including what he perceived to be overmedication of people incarcerated at the facility.

In August 2019, a “psych tech” at the jail administered “a high one-time dosage of an anti- psychotic that could have caused an overdose.” According to the report, despite exhibiting signs of overdose, there is no indication the man was physically evaluated, and a psychiatric nurse practitioner did not evaluate him until a week after the high dosage of medication. In another example from an Iowa jail, in 2021 Wellpath was sued for allegedly refusing to administer prescribed mental health medication. In one such case, Wellpath agreed in a settlement to finally provide prescribed mental health medication to an incarcerated man.

5. Difficulty accessing care at Wellpath facilities: Beyond intake an early screening, persons served by Wellpath have faced additional difficulties accessing care. In San Luis Obispo County, the Justice Department observed “Neither of the Jail’s two channels for prisoners to notify staff about medical concerns— medical request forms and healthcare grievances—function properly. In reviewing medical request forms, “medical staff frequently overlook prisoners’ concerns, fail to provide prompt care, or fail to provide care at all.”

Patients at the facility have encountered obstacles when attempting to raise concerns: “the Jail routinely fails to give prisoners grievance forms, or provide them timely, even after repeated requests.” For the grievances that were completed, “a significant proportion raise medical issues, including missed or unfilled medications, failure to provide follow-up care, and inability to access care through the sick call slip process.”

The Justice Department also identified failures to provide adequate specialty care, ancillary services, and follow-up treatment and care. Specialty care appointments, laboratory draws, and other tests “are frequently ‘rescheduled’ for no discernable or documented reason, resulting in very long delays or the failure to perform tests or deliver follow-up care entirely.” The report also noted, “Wellpath also refuses treatment for chronic conditions when prisoners are purportedly to be released soon, even though many of them have release dates weeks or months away or requested treatment months earlier.”

6. Wellpath’s inadequate staffing and oversight: Inadequate staffing is one contributing factor to Wellpath’s issues in providing care. “Wellpath fails to provide adequate staffing to prevent delays in medical care that place prisoners at substantial risk of serious harm,” observed the Justice Department in San Luis Obispo’s jail. The investigators noted inconsistencies in reported hours, for example a nurse practitioner who reported an average of 18.7 and 13.4 hours per calendar day in July and August 2019. In an interview, the nurse said she had worked about 50 hours per week during this time, substantially less than reported.

“No matter the actual number of service hours, as illustrated above and below,” the Justice Department wrote, “existing staffing appears inadequate to ensure timely access to various types of care.” In San Luis Obispo’s jail, “[t]he onsite Health Services Administrator told us that she assigned the psychiatrist 50% more patients per day than the psychiatrist felt comfortable seeing.” Additionally, “[t]he psychiatric nurse practitioner said that previously she sometimes had as many as 30 patients on her list per day even though she could only see between 10 and 12.” In Sonoma County, California, the National Union of Healthcare Workers sent a letter to county officials in April, outlining a number of issues related to understaffing at the county jail.

At the time, nurses estimated 300 cases that had gone more than 14 days without being addressed by a healthcare professional. And despite Wellpath’s recent contract renewal with the county, only 59% of registered nurse hours that Wellpath was contracted to fill were staffed from the end of 2021 to March 2022. Nurses reported working shifts alone, despite requirements that Wellpath have six nurses in the jail per day shift.

7. COVID-19 response from Wellpath and H.I.G. Capital: In July 2020, PESP discussed COVID-19 outbreaks reported at 10 facilities where Wellpath provides care, including facilities in Massachusetts, Kentucky, California, and others.98 At one facility in Arkansas, nurses described understaffing issues that could leave Wellpath prison infirmaries hundreds of sick calls behind. In April 2020, PESP joined partner organizations in asking that private equity firms invested in prison and detention service companies to halt those companies’ predatory practices during the COVID-19 pandemic.

As part of that effort, a letter was sent to H.I.G. Capital regarding Wellpath and TKC Holdings. In a response letter, H.I.G. objected to accusations that it engaged in “predatory behavior” or using the pandemic “as an opportunity to further exploit incarcerated people”—saying that these descriptions were “insulting and couldn’t be further from the truth.” In 2021 in Polk County, Iowa, a Wellpath social worker agreed to a $65,000 settlement after being fired in the pandemic’s early months, allegedly for criticizing how the facility handled COVID-19 restrictions, characterizing the protocols as “a clusterf—” and alleging that patients with mental illness were being poorly treated.111 According to county data released two days after her firing in May 2020, at least 89 patients and nine staffers at Polk County Jail had tested positive for the virus.

What You Should Know:

– Summer Health, the first text-based pediatric care provider designed to offer parents support, prescriptions, and referrals within just 15 minutes, today launched free trials to combat the U.S. tripledemic plagued by the rise of RSV, Flu, and COVID cases amongst children.

– Amid a growing pediatric-care crisis that has caused an overflow in emergency rooms and doctor’s offices across the country, Summer Health aims to help relieve the overwhelming burden and be the first point of contact for parents assessing which illnesses are truly urgent. 

The First Text-Based Pediatrics Care Provider Launching Free Trials

Launched in July 2022, Summer Health is the first step and ongoing tool for anyone navigating health concerns, offering timely text access to high-quality healthcare professionals who provide expert answers and reliable advice over text in 15 minutes, 24/7. The company is on a mission to radically simplify the healthcare experience for parents. 

“Summer Health was born out of my own experience dealing with the healthcare system for my two young sons, and over the past month I have experienced firsthand how this tripledemic is affecting pediatric care today,” said Ellen DaSilva, CEO and Co-Founder of Summer Health. “I firmly believe that no family should have to wait several hours to receive necessary care for their children. So many children can get assessed and cared for virtually, thus easing the wait times in emergency rooms and clinics for those who truly need in-person care. I’m excited to offer parents access to Summer Health for RSV, Flu and COVID, beginning today, and truly supply them with a doctor at their fingertips available on-demand.”

At Summer Health, parents can now sign-up for a free trial and Summer Health will connect them via text to licensed pediatricians in all 50 states. The pediatricians will use photos, videos and texts to assess if the child needs an in-person visit, and where clinically appropriate, provide a prescription.

“Nationwide, RSV diagnoses are already 30 percent higher than last year’s peak. At Summer Health we are experiencing a surge in visits for respiratory concerns – in fact, we’re seeing a 400 percent increase from summer and early fall,” said Dr. Ali Alhassani, Head of Clinical at Summer Health. “Parents often ask us if they need to go to the clinic or the emergency room, but the reality is that Summer Health is able to help manage care at-home 85 percent of the time – saving parents time and money while also delivering peace of mind.”

My company recently celebrated its 10^th anniversary, which prompted me to reflect on the progress of the women’s health sector over the last decade. There has been so much change, so many technological innovations and clinical breakthroughs. And yet, two things haven’t changed all that much. Our outcomes in the U.S. have not improved; in fact they are in decline. This is true whether you are measuring maternal mortality, health equity, or complication rates.  And as an industry, we’ve yet to unlock true transformation, the type of “re-imagining” that is needed to deliver the very best, most equitable, safest care to all women in a consistent and cost-effective fashion. 

Meanwhile, recent events have cast even more clouds. The COVID-19 pandemic fully exposed the unsustainability of fee-for-service payment models. The Roe v. Wade reversal has the entire industry grappling with likely implications, which include growing disparities by race and income, decreased access to evidence-based healthcare services and additional burdens on OB providers. Clinician shortages have increased, while the number of available hospitals and birthing centers across the country have decreased.

Yet as much as I’m discouraged by looking back, I remain hopeful as I cast my eyes to the future. The very near future. That’s because I truly believe that the unsustainability of our current trajectory makes a complete rebirth of women’s health inevitable. This rebirth will be shaped by three seismic shifts that are coming soon. 

Shift 1: Finally, We Will Fully Unlock the Potential of Digital Health At the Point of Care

Whether it’s the spread of maternity care deserts, worsening clinician shortages, provider burnout or even declining health system revenues, many of the pain points for our system in general, and specifically in women’s health, can be addressed and improved by more effectively deploying technology. And after a decade of record-breaking funding in the digital health space,  the technology we need is already here.  However, to address our current crisis, that technology must live within the workflows of existing providers, not as an additional layer that further splinters the system while disrupting the relationship between patients and their clinical teams. 

While we have seen an avalanche of tech innovations emerge from the digital health space, this has also led to the creation of hundreds of point solutions that too often orbit providers,  operating on the sidelines instead of integrating with the system. The technology shift that is coming to women’s health will be led by solutions that deeply embed into medical practices and flow seamlessly into the daily lives of clinicians. Technology that makes providers more efficient. Technology that gives them the ability to more effectively manage and monitor their patients. 

I predict we will see massive adoption of technologies that operate in partnership with the providers who are actually delivering care to women. This will further the necessary transition to delivering personalized, curated, holistic experiences in a way that helps patients connect to care.

Shift 2: Value-Based Care Will Become The Prevailing Payment Model

Value-based care offers obvious potential for improving outcomes in women’s health. However, the transition from fee-for-service has proven to be extremely difficult. Momentum is building, but it is still a complex ask of payers and providers to collapse existing silos of care and transform existing payment models to properly align incentives. Not to mention the additional tools and technologies needed to manage data, engage virtually with patients and better coordinate care. Challenges aside, we continue to see movement and progress because this is the right thing to do: for patients, for providers, and for the entire system. 

Value-based models not only help align payers and providers to work together while ensuring appropriate rewards for quality outcomes. These approaches also serve as a way to fuel further innovation and prioritize unmet needs. Take health equity as an example. To be successful in value-based care, we must do a better job supporting all women, not just some of them. We also can include equity metrics in the financial model so that all stakeholders are specifically incented to improve in this area. 

I remain confident that value-based models will increasingly gain traction, starting within the maternity space, and quickly expand to other aspects of women’s health as both payers and providers become more comfortable with these approaches and see how powerful these models are for improving quality and reducing cost.

Shift 3:  A Holistic Model for Women’s Health Will Emerge

Until the age of 50, the majority of women rely on their OBGYN provider to serve as their primary care provider. But OBs aren’t currently empowered with the resources and tools to provide comprehensive care, and the financial incentives aren’t aligned to support that level of care. We have the opportunity to alter these realities.

Many experts believe that OBGYNs are in the best position to provide holistic care to women.At the same time, it is important to acknowledge that this shift would require changes to clinician training, payment models and use of the right technologies.

There is a real need for a care model that has continuity and comprehensively supports women through each age and stage, from family planning to menopause and beyond. With many women already viewing their OBGYN as their de facto medical home, it isn’t a far leap to imagine these clinicians operating as the hub in a hub and spoke model, where women get the care they need when they need it from various specialists under the purview of an already trusted provider. 

As I mentioned above, we will see much better digital connectivity and personalization for patients using technology. We will align all stakeholders so that high quality care is appropriately rewarded via value-based models. These two shifts help set the stage for a whole health model for women, quarterbacked by the OBGYN. 

When the dust settles from these seismic shifts, we will find ourselves in the midst of a new era for women’s health. And we will see dramatic improvements in access, equity, experience and outcomes. The time to prepare for this future is now. All three of these trends were set in motion many years ago, and they are coming together right before our eyes. Payers and providers who want to be part of the revolution need to be thinking strategically about how they can move at the speed of change. That pace is quickening with every passing day.

About Leah Sparks

Leah Sparks is a Rock Health Board Member and the CEO & Founder of Wildflower Health, a decade-year-old maternal health platform on a mission to transform women’s health. Leah has nearly 20 years of experience building innovative healthcare businesses in both venture-backed companies and Fortune 50 corporations.

What You Should Know:

– Mount Sinai researchers have developed an Employee Health COVID-19 REDCap Registry to address the need for contact tracing and agile exposure investigations to mitigate the spread of COVID-19 among hospital staff.

– Employee Health COVID-19 REDCap Registry is a cloud-based digital framework using the Research Electronic Data Capture web application—to track and reduce the spread of the virus across the Mount Sinai Health System including 8 hospitals and more than 400 outpatient practices.

– The development of this tool has provided a robust infrastructure for COVID-19 research as well as an easily deployable framework for institutions around the world to successfully control a deadly disease during a pandemic, building upon a platform ubiquitously available across the world.

Employee Health Contact Tracing Database Development

The database was built with an “event-based” model, where every exposure or “event” was recorded uniquely without deliberately linking it to previous events for the same person or department. This ability allowed Mount Sinai to associate certain events where cluster investigations were necessary to identify the pattern of disease spread. This specific design choice for the digital framework also adjusted and responded to significant changes in the COVID-19 disease with the spread of the Delta and Omicron variants.

The Employee Health COVID-19 REDCap Registry provided: employee health data collection using secure and user-friendly online forms; contact-tracing information for employees monitoring workflow; qualitative analysis of employee interviews; analysis and genomic sequencing integration; and the potential for machine learning in future research on exposures.

To date, there have been over 50,000 employee interviews and more than 500 revisions to the framework. The evolving design of the platform has created dynamic flexibility to incorporate the evolution of information and expertise around the virus transmission and helped facilitate changes in clinical recommendations regarding COVID-19.

Outcomes/Results

With the Employee Health COVID-19 REDCap Registry, Mount Sinai’s employee health services were able to reduce case follow-up times from days to hours. For example, after an employee reported COVID-19 symptoms to their supervisor, employee health services were able to: follow up with the employee’s manager, conduct the initial contact tracing interview and send the employee home for isolation within three hours. Follow-up contact tracing of this case led to the detection of an emerging cluster within the department and the directionality of transmission was determined by incorporating genomic sequencing data provided by Mount Sinai’s genomics laboratory.

For more information on the research, visit https://www.thelancet.com/journals/landig/article/PIIS2589-7500(22)00171-6/fulltext