Healthcare is beset by “The Big Squeeze,” a confluence of factors creating a burning platform for change at a time when financial health is at an all-time low. Labor pains are of particular concern due to demand that outstrips the current supply of skilled and unskilled workers, rising wages, and an increased reliance on contract labor. In order to ease the squeeze, health systems need to consider harnessing people, data, and technology in ways that improve care access.
Stretching scarce resources is a necessity
Healthcare systems continue to bleed staff due to burnout and the great resignation. It’s estimated that the nursing and physician labor force could fall short of demand by 10-20% and 6-10%, respectively. Staffing expenses continue to rise due to the need for contracted labor to fill those gaps, with contract labor costs nearly 500% higher than pre-pandemic levels. Meanwhile, the need for clinical services is only increasing, as pent-up demand, post-COVID conditions, and a tripledemic of COVID-19, influenza, and RSV put pressure on an already strained system. Mental health care has been hit particularly hard; the U.S. as a whole has only enough mental health providers to meet the needs of just 27% of those needing help. Providers are unevenly distributed across the country, with some states woefully understaffed and often concentrated in urban areas, leaving many populations greatly underserved.
Access to mental health care continues to be an area of concern as it has tremendous effects on a person’s physical health and quality of life. Mental disorders are among the top 10 leading causes of burden worldwide, with 21% of adults experiencing a mental illness and adolescent rates of depression and anxiety doubling during 2020 and the first quarter of 2021 compared to pre-pandemic levels. Yet, 55% of adults with a mental illness, or more than 28 million people, do not receive treatment, and 28.2% of adults with a mental illness were unable to receive the treatment they needed.
With rising care needs, health systems need to do more with less, such as:
- Creating workflows that allow providers to work at the top of their licenses. For example, a psychiatrist, psychologist, or licensed clinical social worker provides oversight and leads a team of mental health professionals, including mental health technicians, health coaches, and care coordinators in the delivery of direct care and care coordination, leveraging licensure and skill to best effect and lessening crisis care occurrences.
- Balancing staff-centric scheduling with continuity of care can boost staff morale while ensuring patient satisfaction.
- Deploying a command center or a team-based care model with clearly defined roles and responsibilities with clear escalation pathways can lift the burden on providers and best utilize existing staff.
- Utilizing carefully thought-out integrated care strategies is key to expanding access, decreasing stigma, and promoting high-efficiency care delivery while allowing staff to work at the top of their license. Integrated care strategies have proven to be highly efficient and promote significant access and cost savings by providing care directly to where most of the population receives their care, in primary care locations.
Bringing care to where people are
Technological advancements have provided new pathways to care; telehealth is one of those that has a strong body of evidence for efficacy. In 2021, the Centers for Medicare and Medicaid Services (CMS) permanently altered the Physician Fee Schedule (PFS) to allow greater use of telebehavioral health. This includes audio-only telephone calls, which benefits older individuals and those who rely on landlines or ‘flip phones’ as well as helping to eliminate geographic barriers. Organizations such as the National Alliance on Mental Illness (NAMI) continue to advocate for relaxing regulations, as was done during the COVID-19 pandemic, to allow providers to practice across state lines. With increased federal funding for rural Wi-Fi infrastructure, there’s an inherent need to continue building the clinical backbone to support this growing access for patients who may otherwise have no other option for care.
Remote patient monitoring (RPM) is proving to be a worthy option to alleviate provider strain. Data from sensors that track activity levels, such as smart scales, sleep trackers, or heart and sweat monitors, can be examined for depression, anxiety, and other symptoms remotely. The use of mental health, stress management, cognitive behavioral therapy (CBT), depression, and other emotional health apps can assist in connecting patients to support whilst, in many instances, still sharing information with primary care providers. Using a team-based care model with solid operational and escalation pathways to monitor data and intervene with patients appropriately further frees up providers, allowing them to use their in-person time more efficiently and effectively.
With early diagnosis and treatment facilitated by technology, the care burden is decreased.
Digital diagnostics, for instance, continues to be an area of growth as the use of chatbots and other similar technologies increases. With anonymity often a patient concern, their use can alleviate social stigma while being cost-effective and providing easier access to CBT. Chatbots can fish out the undiagnosed, speeding up treatment and improving outcomes.
Data are the most useful way to predict those needing care before the crisis stage is reached. These data can and should incorporate social determinants of health data for a whole-person approach. The more data, the better the chance to identify patterns and provide interventions. For example, prediction models using electronic health record (EHR) data combined with self-reporting questionnaires can identify suicide risk. Patient prioritization and program planning can be managed with purposeful reports, highlighting who is most at risk and needing proactive outreach and closing care gaps. However, getting data where it is most needed can be challenging based on the size of the provider. Most mental health providers are small practices that can’t afford to implement the larger EHRs, leading to a lack of data integration. This again speaks to the importance of care integration, as partnering with a larger health system to access their EHR can open that data gateway and provide a more holistic view of the patient's health journey to provide better, more efficient care.
The changing landscape of healthcare post-COVID continues to bring unending pressures due to labor pains, increasing clinical demands, and market forces. Mental health care is just one area sorely in need of additional support. With an increase in demand and a shortage of providers, more work needs to be done to ensure the availability of resources to manage both from a preventive and crisis standpoint. Leveraging a combination of people, data, and technology to address mental and behavioral health needs before it affects a person’s physical well-being will improve both adult and pediatric health outcomes, thereby reducing the strain on clinical staff and operations.
If you or someone you know needs mental health services, reach out to Nami.org or dial 988 to reach the Suicide and Crisis Lifeline.