Their apparent overlap seems to indicate at least a partial solution to the problem that Massachusetts shares with 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 Department of Health and Hospital estimated that Commonwealth hospitals had about 19,000 full-time vacancies.
Employment issues also affect healthcare payments, Baker said. Understaffed rehabilitation and long-term care facilities cannot accommodate new patients from hospitals, leaving patients where they are while they wait for an opening at the next treatment facility.
Tim Foley, executive vice president of 1199SEIU, which represents more than 70,000 healthcare workers, said staffing shortages are a “whole system problem” across hospitals, nursing homes, home care and other care facilities, which requires a “whole system” solution. .”
Some of these positions will not be replaced. “We need to get together and think about new models of care delivery,” Foley said.
There has also been a study on the feasibility of one of these alternative delivery models, telehealth, which was apparently not discussed at the Health Plans conference.
The use of telehealth as a regular method of care has illuminated the digital divide across different socioeconomic lines, according to a new report from researchers and health plan organizations.
As defined by the Health Resource Services Administration, telehealth uses electronic information and communication technologies to support clinical telehealth care, occupational and patient health education, and public health and health administration.
Noting the long-term health disparities highlighted by the COVID-19 pandemic, said Elizabeth Leahy, MAHP’s vice president of advocacy and engagement, she began the study early in the pandemic to look at the unequal acceptance of telehealth use.
The state’s largest and youngest residents visit a doctor in person more frequently, as do low-income, minority and rural residents, researchers concluded, after analyzing data from 1.8 million health plan members from January 2019 to December 2021.
For older adults, the reason for the decline in telehealth use could be a combination of technological barriers, red tape, and the convenience of seeing a doctor in person, said Natalie McIntosh, senior director of programs and research at Massachusetts Health Quality Partners.
Macintosh said the researchers spoke to some people — including the elderly and English language learners — who didn’t own a cell phone, or if they did, didn’t know how to use the video feature. “The audio phone visits have been really helpful” for these residents, she said.
For younger adults who did not use telehealth, McIntosh said this was not an issue of digital literacy, but rather an indication of limited access to primary care providers in general.
“To do a telehealth visit, you really need a regular source of care, because it’s a scheduled visit,” she said.
Regionally, telehealth use was higher in Greater Boston and other populous areas in eastern Massachusetts, and lower in central and western Massachusetts—except for 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 has been used extensively across the state for behavioral health care, conducting an average of 75 to 80% of nearly all mental health visits each month.
This higher percentage may reflect recent payment improvements as a result of law signed into law by the Governor in January 2021 mandating permanent payment parity for telemental health services.
Focusing on ways to increase telehealth services among young people without access to a primary care physician, older patients, and those with socioeconomic challenges could significantly close this healthcare staffing gap.
For the MAHP/Harvard study, the researchers recommended that health plans enhance digital affordability screening and streamline enrollment in underutilized public benefit programs to make the Internet and devices more affordable, as well as build referral partnerships with community organizations that can provide digital literacy trainings.
As our governor and former CEO of Harvard Pilgrim Health Care warned, the medical industry may never return to its pre-pandemic state.
It may not be a panacea, but encouraging telehealth as a way to offset the potential for permanent staff shortages would be penicillin for this chronic condition.