Op-Ed by Andy Ellner
from Commonwealth Magazine, July 24, 2020
THE COVID-19 PANDEMIC has significantly altered the way Massachusetts residents live and work. Our healthcare system also changed nearly overnight as traditional medical groups scrambled to develop capacity to see patients remotely via phone and video visits. Blue Cross Blue Shield of Massachusetts reported a hundredfold increase in telehealth visits within the first six weeks of the health crisis. While prioritizing the coverage and expansion of telehealth in Massachusetts is a good first step, ushering in the primary care of the future will require providers to look beyond transactional care.
In a state with nearly the highest per capita healthcare costs in the country, we must do better than simply converting mostly unnecessary in-person doctors’ visits to a telehealth platform that encompasses solely telephone or video visits when a patient is ill. As Massachusetts continues Phase 3 of reopening, there is an unprecedented opportunity to address the overwhelming need for affordable, accessible healthcare. This can be done by accelerating the transformation from a centuries-old, reactive, transactional, and doctor-centric model towards a proactive, personalized, digitally-enabled approach that supports healthy behaviors to drive better outcomes and lower cost.
In short, we need to rethink how we provide care while avoiding the use of telehealth technology as a Band-Aid. We must move from sick care to true, long-term healthcare built to serve people in their homes and communities.
Massachusetts has long discussed how to control costs and increase access to important healthcare services and has previously set a model for national reform. Gov. Charlie Baker’s forward-looking 2019 comprehensive healthcare reform bill prioritized spending on primary and behavioral healthcare, citing the importance of increasing access to care, refocusing on disease prevention and management, and reducing costly procedures and hospital stays.
The benefits of going beyond transactional care and focusing on virtual primary care and behavioral health through telemedicine are greater than ever as our healthcare system deals with the backlog of patients who avoided routine care because of fear of being exposed to COVID-19. Critical procedures have been delayed and those with chronic illnesses like diabetes and hypertension have had limited access to providers. Continued delays in primary care may lead to increased hospitalization rates at a time when we must keep patients healthy and ensure our hospital systems are not overburdened.
Additionally, the pandemic has dramatically added to the unmet need for behavioral healthcare, with nearly half of Americans reporting the coronavirus crisis has harmed their mental health, according to a Kaiser Family Foundation poll. At Firefly Health, a fully virtual Massachusetts-based primary care group, we saw a threefold increase in inquiries for depression and anxiety in March 2020 alone.
With chronic conditions accounting for 75 percent of total health spending, there is an opportunity to use the increased acceptance of virtual care to replace most doctors’ visits with frequent, light-touch interactions using sophisticated technology and a team of health guides, nurse practitioners, and mental health specialists. This model has already proven to be convenient and effective, as the majority of primary care interactions can be done from the safety and comfort of peoples’ homes. Vital signs can be taken at home and most ailments can be properly assessed and diagnosed by a combination of Bluetooth, chat, photos, and video visits.
Team-based virtual primary care models can increase access to mental health services by successfully incorporating a behavioral health specialist into care teams. Following an approach scientifically proven to work, the primary care team is able to diagnose, treat, and manage the vast majority of mental health concerns, such as depression and anxiety, without a separate referral.
This model of care—focused on integrating a full care team and easy-to-use technology to create meaningful patient-clinician relationships—will be especially critical as Massachusetts continues to reopen. Employers are now obligated to guarantee their workforce’s health prior to coming into the office to be in compliance with local regulations, assuage employees’ fears of returning to work, and mitigate future outbreaks. This includes instituting innovative new processes focused on their physical and emotional health to determine who can and cannot return to the office.
Our long-established primary care and behavioral health systems proved unprepared for the initial surge in COVID-19 cases. Moving forward, the Commonwealth’s healthcare delivery system must be ready to serve patients who will require virtual access to a wide range of preventative care, beginning with primary care. The primary care of the future must prioritize the coverage and expansion of telehealth care, and our providers must move towards integrated, tech-enabled care delivery to prevent and manage disease, reduce costly procedures and hospital stays, and increase access to behavioral health care across the state.
Andy Ellner is the co-founder and Chief Clinical Officer of Firefly Health, a Massachusetts-based virtual primary care and behavioral health provider. Not a member yet? Get started by signing up on our website, or giving us a call at (855) 869-9284.