There’s no denying that America’s healthcare system is broken. The United States spends three times more per person on medical expenses than the average developed country does, and yet our life expectancy is lower and costs for the patients are higher. What’s more, we have no cost transparency, poor access to care, glaring inequity in treatment, and mediocre outcomes.
There’s no easy way out of this mess, even with the massive amounts of innovation being driven by the private sector, adoption is moving far too slow. While discouraging, the landscape isn’t hopeless, with forward-thinking legislation and increased pressure from the public, we can begin to fix the system.
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Stephanie Tilenius Stephanie Tilenius is Founder & CEO of Vida Health, a virtual care platform that treats a whole person – and a whole population – by addressing a full range of chronic conditions and the behavioral conditions that accompany them. Vida is deployed in Fortune 500 companies and large insurance carriers and health plans. […]
Here are five relatively simple things the government can do now to get U.S. healthcare on the right track:
1. Reimburse telehealth visits at the same rate as in-person care. At the onset of the pandemic, CMS expanded telehealth reimbursements to beneficiaries across the country and observed extraordinary increases in telehealth services. These expanded payments accelerated telemedicine use by about 10 years but are set to expire at the end of this year. We need to make this equal reimbursement permanent.
Studies show that telemedicine improves patient outcomes through advanced monitoring and increased clinical decision support systems. The result is shorter hospital stays and decreased mortality. With investments and technology in place, we’re set for a future of telemedicine that serves a wider network of patients with more accessible care. Removing those expansions would be a foolhardy step backward.
2. Institute a virtual-first approach for primary and chronic care. When patients have more convenient access with fewer barriers to care, providers can take a more preventative approach.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
Virtual-first care gives consumers more control over their health. With a shortage of primary care providers in the US, appointment wait times can be prohibitive — not to mention the logistical challenges of calling, confirming, and traveling to appointments. As a result, many patients avoid seeking care until their symptoms become unbearable and then resort to high-cost options like emergency rooms. When consumers can easily access a provider from the comfort of their home, they’re more likely to seek care sooner and avoid drastic, costly consequences.
Similarly, evidence suggests that virtual care is more efficient when it comes to chronic disease management. Patients are more likely to attend regular appointments when they can do so virtually, and greater patient adherence leads to better outcomes with more cost savings.
Chronic diseases like diabetes, obesity, depression, COPD, and hypertension are especially well-suited for a virtual continuous care approach. These conditions often require adjustments on a weekly, daily, or even hourly basis which can be hard to manage when a patient is only visiting their PCP once or twice a year. With continuous virtual care a patient and their provider can quickly adjust things like medication, blood pressure control, and diet.
3. Establish parity for mental and physical health. For centuries, philosophers and healers have exhorted the mind and body connection, and modern scientific studies consistently prove the impact of emotional stress on the body. But investment remains low in mental healthcare, so the roots of many common chronic illnesses are left untreated. It’s time that our healthcare system reflects the science and provides equal access to mental and physical care.
The Mental Health Parity and Addiction Act of 2008 was a step in the right direction, but we’re far from meeting its standards. A 2019 Milliman report shows increased disparities between mental healthcare and physical healthcare, signifying a lack of compliance among insurance carriers. In 24 states, the reimbursement rates for primary care office visits were more than 30% higher than those for mental health office visits.
Despite lower reimbursement rates, the demand for mental healthcare remains high. Americans have reported significantly higher rates of anxiety and depression since the start of the pandemic, with potentially disastrous effects on long-term health. Nearly 75% of practitioners who treat anxiety disorders are reporting an increased demand for treatment and 88% of Americans suffered at least one symptom of depression last year. We should be meeting that need with increased coverage of mental healthcare.
4. Provide universal mental health screening. Regular mental health screenings allow for early identification and treatment. When easier access to screening is available, we work toward eliminating the stigma associated with mental illness. Unfortunately, stigma and discrimination often exacerbate a person’s mental health problems and delay them from getting the help they need, especially in men.
We know +, digestive disorders, and chronic pain among other ailments. With early screening and treatment, we can avoid the long-term effects of many chronic diseases, saving patients from years of suffering.
While addressing the need for mental health screening we also need to address our lack of mental health providers in the US to meet national demand. According to a new access report, only 12% of therapists are accepting new patients and those who are taking patients have an average wait time of 19 days. While waiting nearly three weeks to be seen might be okay for certain conditions, it’s unacceptable for someone suffering from depression or anxiety. While we absolutely do need more licensed therapists in the field, we also need to do a better job of triaging less severe cases to trained mental health coaches. Just like not all conditions need to be treated by a doctor, not all mental health ailments need to be treated by a therapist.
5. Shift pricing to a value-based model. We need to move away from our outdated fee-for-service reimbursement model that actually rewards providers for not focusing on outcomes. This model has resulted in providers taking on heavier patient loads and doesn’t hold providers accountable to outcomes.
Value-based initiatives can improve the quality and lower the cost of care. When pricing is based on patient outcomes instead of service fees, it helps align incentives between payers, providers, employers, and consumers.
The industry should follow the lead of CMS’s expanded Medicare Advantage benefits, which allow for flexibility to build on social determinants of health. Covered benefits like personalized nutrition coaching, therapeutic massage, and fitness training promote and sustain long-term health. These integrated care teams allow everyone to work at the top of their license and enable a comprehensive mind and body approach. Even with these expanded benefits, the overall costs decrease for all parties.
We have a long way to go, but new machine learning and artificial intelligence technology is helping us connect the dots between physical and mental health in a way that hasn’t been possible before now. If we can continue to expand telemedicine by emphasizing a virtual-first care approach and shifting pricing to a value-based model, we’ll improve patient outcomes while cutting excess costs. Now that’s a healthcare system for the future.
Stephanie Tilenius is Founder & CEO of Vida Health, a virtual care platform that treats a whole person – and a whole population – by addressing a full range of chronic conditions and the behavioral conditions that accompany them. Vida is deployed in Fortune 500 companies and large insurance carriers and health plans. Before starting Vida, Stephanie led large consumer and enterprise platforms and P&Ls at Google, eBay and PayPal. She sits on the Board of Seagate Technology.
