Critical condition: The worrisome state of the health care industry

We asked readers, “What impact do you think the current strain on health care staffing and the exodus of workers will have on health care access?” Here’s what you said:

Support systems

While access to care (due to plan design, provider exodus, etc) is a reality that will plague us for years to come, advocacy is a crisis of equal concern. During the pandemic, patients who have had to endure loneliness and no advocacy have been caused great harm. We have seen case after case of patients suffering and dying alone. We also see patients who are unable to make rational or knowledge-based health care decisions in medical facilities, who must rely on the limited and stressed-out staff to do so for them. That is a recipe for disaster.

Related: The health care industry’s labor shortage is only getting worse

Advocates and family should never have been kept away from the thousands who perished, suffered from loneliness, or could not fight for their own medical decisions over the COVID long-haul. Patients have lacked advocacy and information for decades and very few health plans and health systems include services for such. COVID only magnified this existing issue.

Karen L. Kirkpatrick, owner, On Your Mark Consulting

You say you want a revolution

Health care workers may be flocking away from the bedside, but many of them are finding new homes at innovative solution companies. Most haven’t lost their passion for patients and taking care of people, they are just fed up with the administrative BS! They are figuring out what I learned 30-ish years ago: Too much money goes into the pockets of administrators and “fluff” rather than into actually taking great care of patients. Administration decides to chase the next shiny object (despite it not improving clinical outcomes) or decides that rather than investing in fixing the actual quality-of-care problem, they will invest in advertising to proclaim (lie to the public about) how good they are. And for that, administrators get paid millions.

They are fed up and they are going to do something about it. I welcome them to the health care revolution. Because of their decisions, we will see massive innovation and improvement in health care. Sometimes, you gotta break the bad to replace it with good, and IMHO, that is what’s happening right now.

Deb Ault “Nurse Deb”, president, AIMM

Spread the word

The only way to assist our clients and their employees with access to care is by educating them on their current options and advising them of new ones at renewal. What better way to avoid access-to-care issues than to speak directly to a nurse concierge who can help them define their issue and find the right place to go at the right price? We have ERISA plans that were designed by employers to cover specific conditions or treatments, but if an employee does not know this, they will eat up resources as they take the long way through the health care system to figure it out. Even an emergency dental visit can now be done through telemedicine. What use are these time and money-saving strategies if employers and employees do not know that they exist or how to use them? Education is the foundation for better access to care, for those that have alternate resources.

It is important to note that prior to the pandemic and the Great Resignation, unbridled access-to-care issues have been the norm for certain populations, usually based on geographic location, race and ethnicity, class, sex and even language spoken. In the big picture, recipients of employer-sponsored health care are fortunate to have these additional options, they just need to know how to use them.

Chelsea Whalley, COO, partner, J Donovan Financial

Have need, will travel

Access to care has obviously been an issue, as elective procedures were put on hold because of COVID, but staffing issues could become an even bigger problem. My concern is that this will have an adverse effect on the quality of care patients receive. Getting a patient set up with providers who offer the highest level of care was a full-time job in normal times, so what does this look like when surgeons are performing fewer procedures because they don’t have the support staff they need?

Losing nurses and hospital staff has the potential to leave a huge hole in the hospital system, which ultimately hurts the patient most. Our goal is to work with innovative employers who are willing to look into allowing members to travel domestically to receive care. As long as the quality rating of the performing surgeon is extremely high and we’ve exhausted our options locally, it’s a no-brainer to allow the patient access to them, even if it’s a few states away.

Nick Hansen, senior benefits consultant, PSG Washington, Inc.

The gospel of telehealth

Health care has been forced to change drastically in a matter of months in order to respond to the ongoing pandemic. Health care workers have made heroic efforts to adapt and support the influx of patients and maintain clinical guidelines and policies. I mean, did we ever think about a pandemic?

Well, maybe some did. I have always been a huge proponent of telehealth. As a working mom who can barely get dinner and homework done on time, adding in an allergic reaction, or a new bump or bruise means my evening is pretty much shot.

My benefit strategy in the past year has been to preach the gospel of telehealth and specialty telehealth. If you have a chronic condition and have questions, you no longer need to wait 6 to 12 weeks for an appointment; you can send a secure message or schedule a telehealth visit. You can also take charge of your condition. Most carriers have offered case managers to support patients through chronic illnesses or mental crises for quite some time now. Our job as benefits advisors is to stay informed and get the word out there. Our job as humans is to stay accountable and take care of ourselves (both mentally and physically) before anything else.

Elsa Glorioso Vice President, Insurance Services, PeopleStrategy, Inc.

Weighing options

I was recently very sick with COVID pneumonia, and trying to make the decision to go to the hospital or stay home and be cared for by my family was something I really had to weigh. This “strain” on our system was a factor in deciding who I wanted to take care of me, and what level of attention I felt I needed. I chose to be cared for at home, by my family, at the direction and instruction of my primary care doctor. In hindsight, I know my decision to be cared for at home was right for me, but it was hard to make in the moment.

A facility’s ability or inability to properly care for the sheer volume of patients coming in is certainly causing access issues. We also see it in things like eligibility requirements for specific treatments like monoclonal antibodies. If I had had COVID pneumonia one week earlier than I did, I would have qualified to receive antibody infusion treatment. But because the eligibility requirements changed the very week I came down positive, I no longer qualified, and I didn’t receive the treatment.

I have adjusted our communication strategy with our clients to include tips and knowledge I personally gained through my COVID experience. People are already focusing more on “at home” care alternatives, and it has been a trending topic for some time. We are helping educate and prepare our clients and their employees who will undoubtedly face access issues in the near future. People need resources and information on how to treat COVID, and other illnesses, at home. This access issue doesn’t just affect COVID patients, it affects any patient who may need acute care. People need to prepare for that situation.

Josh Butler, president, Butler Benefits

Primary care solutions

While we are seeing more cases of COVID and fewer hospitalizations, the damage is already done. The shortage of staff and the increased risk of illness has made it more difficult for many to receive the care they need when they need it. Surgeries are constantly postponed and it can take months to get a doctor appointment for routine care. Prolonging medical care can lead to conditions worsening as people put off necessary care and visits, thus increasing costs down the road. While telemedicine has been able to fill a lot of the gap and is now a lot more widely accepted and utilized, it cannot be everything. This is why I believe we will start seeing a lot more virtual primary care (VPC) and direct primary care (DPC) options in the near future, allowing us to access routine and chronic care without interruption.

We also now have the fastest-growing amount spent on health expenditures since 2002. Not only are we spending more on care, but we have increased spending on COVID testing, and now reimbursement for home COVID testing kits. While this may not be as big of an expense under normal circumstances, we are seeing people get multiple tests, even if they are just possibly exposed with no symptoms. The overtesting is caused by fear and the wide and fast spread of COVID. When the health plan is required to pay 100%, people are not going to be smart consumers and only get tested when required or symptomatic. Instead, we’ll see overtesting and overspending, which will result in higher health plan expenses and increased costs to employers and employees.

Daniel LaBroad, president & CEO, Ovation Health & Life Services, Inc.

Critical communication

I am deeply disturbed by the drain of health care workers that our country is currently experiencing. In the long term, this poses a great risk to our stability as a society. In the short term, however, it makes clear and effective benefits communication all the more imperative. We often translate guidance as to what type of provider (primary care, telemedicine, ER, etc.) is appropriate in what type of situation, but when a family has what feels like an emergency, they’re not going to go back to that page in their benefits booklet (if they even read it in the first place) and research how to respond. Unless they have received and retained really impactful communication, chances are they will go straight to the ER.

We have worked with clients where employees never choose a primary care provider and rely on the ER as their first line of defense. Before the pandemic, this was merely fiscally detrimental; now it is life-threatening. The more we can prevent unnecessary ER visits, the better we can ensure that those on the “front lines” are able to care for patients who are in danger. Conversely, the better we can educate employees to take advantage of telemedicine, nurse hotlines, and urgent care, the better off everyone will be.

In addition, I believe that many of the growing number of innovative trends (direct primary care, BenTech, etc.) in the industry will only help. But they do nothing if employees don’t understand them or utilize them appropriately. Effective education and onboarding, in an employee’s preferred language and delivered in a medium they will use is now more critical than ever. In the meantime, I fervently hope that folks much smarter than I am (and there are plenty of them out there) are developing a long-term solution for rebuilding our health care workforce.

Melissa Burkhart, president, Futuro Sólido USA

If you build it…

Over the past two years, we’ve seen how flawed and exposed our inefficient health care systems are. Though many companies quickly figured out how to operate large drive-thru sites with the help of government funding, a lot of those strategies were largely abandoned in the second and third waves of variants, putting the strain back onto the health care system. There is no excuse for the 2- or 3-hour wait times we saw in December 2021 and January 2022. A total lack of innovation from our large health care providers and an inability to move quickly even two years later is the sad story here. The old ways simply do not work; you can’t open enough urgent cares quickly enough, nor does it make any sense to pack symptomatic people into a waiting room to be tested for COVID. If they didn’t have it before, they will have it after that experience.

The major problem now facing nearly all employers is employee absenteeism. The CDC lowered the guidelines to a five day quarantine, but this latest variant has spread like wildfire. One of the employer’s best solutions is an onsite clinic. The bottom line is if the insurance plan is going to keep paying for “FREE” there will be no end in sight. The best way to stop those insurance increases is to go self-funded and provide those products and services onsite, where you want the employees to stay: the workplace.

Christopher A. Yarn, CEO, Walk On Clinic, Inc

If not us, then who?

For many of us, access is more than the business, finance and architecture of the health care industry. It is deeply rooted in and driven by an understanding of economics tempered by an understanding of stewardship and a duty to serve those who are vulnerable. We kneel beside, lift, carry, hold up, wipe, clean, feed, comfort, console and work for those who are not able to do these things for themselves. We speak a language that is not always understood by others. We come from and work with others from many different backgrounds, beliefs and cultures. So when you talk to a nurse or physician or other health care worker, access is multifaceted.

In terms of providers, an aging workforce carries so much experience that rising generations need to be able to assimilate in order to provide the robust care that yields a good outcome that is affordable. This depends on the ability to think critically and adapt proven principles to the individual within the parameters of things like policy and protocol. Access to quality care means that care is affordable, and that there are providers available with the skills and prowess to provide it. Good clinicians are driven to operate by a code of ethics, proven principles, metrics, and standards of care. We operate from a place of stewardship that dictates that we will not comply with policies, procedures or orders that we have reason to believe may do harm.

This kind of courage and passion runs deeply in our professions and is developed over time and experience. I want someone who will provide the same level of care for my mother as they would for their own loved one, not someone who robotically follows a dogma without careful thought as to how it will impact them. Wisdom comes with application of knowledge and experience in the trenches. As a new nurse or physician, we really only know enough to be teachable in our practices. Without enough wise practitioners to collaborate with, we have a younger, less-experienced workforce who will lack that benefit—and that affects all of us in terms of quality and cost.

Many sectors in our industry are often deemed inaccessible due to cost. I have a dear friend who died because she could not afford her cancer treatment—and countless more stories, as I am sure many of us can recall folks who deal every day with the dilemma of paying their electric bill, buying food or getting a prescription filled. Overcoming these issues will depend on enough of us working together who have the wisdom, skillset, and platforms to break down these barriers.

I am deeply saddened to see so many of my colleagues leaving professions that they love. This should absolutely concern all of us and cause us to be objectively and openly curious as to the root causes.

We are the best suited to tackle this dilemma; if you and I don’t, who will?

Kimberlee Langford, BSN, RN, CCM, CRMT, CPC, director of business development, Specialty Care Management

Tools to fix it

Nursing shortages cost lives. Hospitals with high patient-to-nurse ratios, sadly, often experience higher patient mortality rates. While turnover rates are on the rise at about 20%, burnout rate among nurses is over 70%, according to a study by the International Council of Nurses. The pandemic has only exacerbated stress levels for health care professionals — leading to burnout and, ultimately, more resignations. In fact, 1.1 million nurses left the workforce by then end of 2021, citing burnout as the main reason.

This has a profoundly damaging effect on the health care industry as well. Research from Harvard Business School estimates that burnout costs the health care system about $4.6 billion a year before the spread of COVID-19. Health care providers face the daunting challenge of hiring and retaining their staff to keep our communities safe.

Employers need to do everything they can to support their health care heroes. It is imperative to create a benefits package that eases stress and can have a positive impact on their employees’ day-to-day life. Leveraging the latest technology to make their lives easier is essential. Today’s HR tech stack should include tools for flexible scheduling, mental health support; financial wellness tools; digital learning, training and development, and on-demand pay. These benefits are proven to reduce stress, and positively impact talent attraction and retention.

Jeanniey Walden, workplace expert and chief innovation and marketing officer, DailyPay

Read more: 

• Physician practices buckling under financial stress of COVID
• Experts renew call for improvements, investment in primary care
• Workforce shortages continue to challenge health care industry