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In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates. Private Medical Founder &amp; Managing Partner <a href="https://www.linkedin.com/in/drjordanshlain/" target="_blank">Dr. Jordan Shlain</a> is a practicing primary care doctor, a digital health entrepreneur, a writer, and respected thought leader.

COVID-19 Discussion with Dr. Jordan Shlain

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In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates.  About Dt. Tista Ghosh: Dr. Tista Ghosh, MD, MPH, is a medical director at Grand Rounds. She has specialized training in epidemiology and disease control and previously oversaw all outbreak response and preparedness activities for the state of Colorado. She has also consulted for the World Health Organization. HLTH Team: What are your future projections on how COVID19 will continue to spread throughout the US?  Dr. Tista Ghosh: I think that will depend on where you live. Typically, a novel virus that nobody has any immunity to will tear through an area and cause a fast spike in illness, unless we truly practice social distancing. So for example, the Bay Area, which was a couple weeks ahead in implementing social distancing policy, may see lower numbers of cases than New York City, which also has a much more dense population. I predict we will see spikes in cases throughout the country over the next few weeks, but they will be worse in places where social distancing policies were delayed or not implemented. And as a result, I think healthcare resources will become overwhelmed in many parts of the country, and virtual care options will become increasingly important. HLTH Team: What states and metro areas are of a particular concern for you? Dr. Tista Ghosh: We’re obviously seeing New York and New Jersey getting hit very hard with this virus. We’re also seeing spikes in Louisiana and Michigan. I think a great indicator to keep an eye on is the Outpatient Influenza-Like-Illness (ILI) monitoring system that the CDC has in place across the country. What that tells you is how many people are seeking outpatient care for flu-like symptoms (which in this case could be COVID-related). As those numbers surge in a certain location, it’s a pretty good indicator that we will start to see a surge in inpatient hospitalizations and deaths in those areas relatively soon. I also think those places that have been less stringent with their social distancing policies will be hardest hit. The Kaiser Family Foundation has a great resource summarizing policy actions taken in each state. In addition, I think parts of our country with the oldest populations may see the highest death rates. HLTH Team: Looking at NY, why do you think the virus spread so rapidly here and what lessons can other states learn from what happened in NY? Dr. Tista Ghosh: I think New York didn’t implement strong social distancing policies early enough. It was days behind other major metropolitan areas like San Francisco. Given that and how densely packed the population is, it’s not surprising to see such high numbers of cases and deaths. Other states can learn from this by acting quickly with regards to social distancing. HLTH Team: When do you predict the shelter-in-place and other self-quarantine orders will begin to relax? Dr. Tista Ghosh: I’m assuming it will be location-dependent, and will depend on how ravaged the healthcare system is in each place. Shelter-in-place is hard on everyone, but the longer we can maintain it, the less likely we’ll see a resurgence in cases. HLTH Team: Many experts are saying that those who have had COVID19 and recovered are now immune, is this certain and what evidence is backing this up? Dr. Tista Ghosh: We don’t know yet if infection with the novel coronavirus results in long-lasting immunity. A recent study in rhesus monkeys did see some short-term immunity. However, other studies of common coronaviruses in humans have been shown to result in only partial, short-term immunity. Whether natural infection with this novel coronavirus will result in short-term or long-term immunity in humans is still not clear. HLTH Team: Do you predict that the warmer weather will slow the spread and if so, will there be another wave come the Fall? Dr. Tista Ghosh: We don’t know yet. We’ve seen that type of pattern with other viruses, but we are also seeing this virus in countries with warmer climates, like Costa Rica or Australia (where it is summer right now). That said, if we do see a decrease during warmer months, we may see another wave in the fall. HLTH Team: Switching to the front lines of the crisis, where do you think we failed to support our healthcare workers and what can we do to better support them as the coronavirus continues to spread? Dr. Tista Ghosh: We have really failed healthcare workers with regards to Personal Protective Equipment. We are asking them to put themselves at risk, without appropriate masks or other equipment. And as those healthcare workers get sick themselves, clinicians will become a limited resource as well. It’s shocking to see this happening in America. We should have been ramping up production of masks and other medical equipment weeks ago. While I feel hopeful because many companies are voluntarily stepping up to producef masks and ventilators now, I still worry that this will be too late in some parts of the country. HLTH Team: What can leaders across the health system, and perhaps executives outside of healthcare, do to contribute to the solution? Dr. Tista Ghosh: I think access to virtual health services will be key in offloading the traditional, in-person healthcare setting. Health systems should consider expanding virtual methods to answer questions for the worried well or those with mild symptoms, and to serve people with chronic conditions like high blood pressure, asthma, or diabetes who may have difficulty getting their medications refilled or getting their regular checkups during this time. If you are an employer in any industry, augmenting virtual health options could be the best thing to offer your employees. Consider making virtual guidance available through telephone support lines, clinician chat services, or other digital methods. In many cases, this will help offload the worried well from the overstretched healthcare system, and help those who are really ill get the healthcare they need.  For those employees who are having difficulty getting into their doctor for routine visits or regular medication refills, consider what telehealth options or mail-order/delivery pharmacy solutions you might offer. And think about tele-psych or virtual behavioral health support options that you might offer your employees through this intense and difficult period. Another way to support employees is by offering virtual town halls or webinars with experts in infectious disease or epidemiology to help address questions and quell panic. HLTH Team: Keeping in mind that things will rapidly change over the next few months, what do you feel have been the three biggest lessons learned so far stemming from this pandemic? Dr. Tista Ghosh: <ol><li>More social distancing early on is incredibly important in lowering the impact of a novel virus. </li><li>We need to prepare better for the potential next wave of this virus, by increasing production of masks and ventilators in advance. We should not be caught flat-footed next time. And we need to better support our healthcare workers. </li><li>We, as a country, need to invest more time, effort and capacity-building in the telehealth space to better respond to emergencies.</li></ol>

COVID-19 Updates with Dr. Tista Ghosh

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Chief Clinical Officer

Overview of the Stats of 988 Since its Launch in July of 2022  The National Suicide Prevention Lifeline made history in July 2022 with the launch of the newly renamed 988 Suicide &amp; Crisis Lifeline, a three-digit easy-to-remember dial code akin to 911 for behavioral health crises and other needs. Since its launch last summer, 988 has made great strides in making vital behavioral health care accessible to individuals in the moments they need it most.  In fact, in December 2022 vs. December 2021, calls answered increased by 48%, chats answered increased by 263%, and text answered increased by 1,445%, according to <a href="https://www.samhsa.gov/find-help/988/performance-metrics" target="_blank">Substance Abuse and Mental Health Services Administration (SAMHSA) and the U.S. Department of Health and Human Services (HHS)</a>. Although 988 is still in its infancy, the increase in volume and improved response has been very encouraging.  Despite the initial reported success, the unfortunate reality is that there is still much work to be done to ensure equitable access to the 988 Suicide &amp; Crisis Lifeline and associated behavioral health treatment. This is especially true for the members of historically underserved populations who have experienced lack of crisis response and overall healthcare services including BIPOC (Black, indigenous, and people of color) communities, LGBTQ+ (lesbian, gay, bisexual, transgender, and queer) communities, neurodiverse individuals, disabled individuals, older adults, non-English speakers, refugees, immigrants, and more. For example,<a href="https://www.thetrevorproject.org/survey-2022/#intro" target="_blank"> a study from The Trevor Project</a> found 45% of LGBTQ+ youth seriously considered suicide, while 14% attempted suicide. Additionally, 60% of LGBTQ youth who wanted mental health care in the past year were not able to access it.  988 FROM A HEALTH EQUITY PERSPECTIVE: DEMOCRATIZING ACCESS TO BEHAVIORAL HEALTH The vision for 988 is for it to provide those in crisis or with other behavioral health needs to have someone to call, someone to respond, and a safe place to go. The goal is for behavioral health to be treated with a behavioral health response, instead of with law enforcement or a necessary ambulance trip or emergency room visit. This is particularly of importance from a health equity perspective as traditionally marginalized populations are at higher risk of a mismatched response. From a national perspective, SAMHSA is taking steps to address health equity and disparities in care among vulnerable populations. Among several health equity initiatives, SAMHSA is putting a large focus on Certified Community Behavioral Health Centers (CCBHCs) to increase behavioral health access. These centers play a significant role in providing culturally sensitive/competent care for communities across 46 states. CCHBCs are often partnered with school systems and are connected to crisis stabilization units for referrals for individuals in need of crisis care. CCHBCs will continue to a vital resource for crisis care in the future thanks to a <a href="https://www.whitehouse.gov/briefing-room/statements-releases/2022/07/29/fact-sheet-biden-harris-administration-announces-two-new-actions-to-address-youth-mental-health-crisis/" target="_blank">$300 million increase in funding </a>announced in August 2022. TECHNOLOGY INFRASTRUCTURE AND ITS ROLE IN 988 HEALTH EQUITY While the work to date has been positive steps forward, technology plays a vital role in bridging gaps in our current behavioral health system. An effective behavioral health crisis response system is an essential component for enabling communication and coordination among stakeholders and services at the city, county, or state level. With technology, providers can quickly and accurately assign individuals in crisis to the appropriate level of care, improving patient outcomes and driving clinical efficiency. Technology-enabled, real-time behavioral health data offers patient-level analytics and decision support to give providers more control, confidence, and insight than ever before to help address many of the behavioral health challenges states commonly face including: <ul><li>Emergency department (ED) boarding</li><li>Per capita overdoses and suicides</li><li>Unnecessary ED visits and inpatient encounters </li><li>Prevention of individuals from progressing to more acute states and increased risk scenarios</li></ul> This is where technology and interoperability are paramount. A solution that creates an interoperable infrastructure among key stakeholders can expedite access to assessment and treatment for those in a behavioral health crisis. A closed-loop referral system also plays a critical role in helping to close gaps in care. By tracking the initial call all the way until treatment, stakeholders can ensure patients do not fall through the cracks, and instead, get the care they need the most. For example, operators answering the phone or responding to a text waste valuable time entering multiple systems to direct a caller to care. Technology can help states connect the dots and thread the response process together, ensuring there is no-wrong-door access for those who call 988. About <a href="https://www.samhsa.gov/sites/default/files/national-guidelines-for-behavioral-health-crisis-care-02242020.pdf" target="_blank">20% of crisis line calls</a> cannot be de-escalated over the phone. In these instances, technology can enable clinicians to conduct digital intake and assessment, dispatch mobile crisis teams using GPS-enabled technology, and gain situational awareness about the availability of treatment resources using digital networks to get every caller to definitive assessment and treatment.  Through real-time care coordination, mobile crisis response teams, local community organizations and other behavioral health stakeholders can coordinate their efforts, ensuring integrated access to the appropriate level of care for all.  THE FUTURE OF HEALTH EQUITY FOR 988 988 is proving to be a vital tool for shining a light on behavioral health crisis response in the United States. To truly tackle our nation’s behavioral issues head on, it is imperative that our country can connect anyone facing a crisis with the right care in real time, and this starts at the local level.  While technology alone cannot wipe away the mental, economic, and physical pain present, innovative technology solutions available today can play a critical role in amplifying the human moments, bridging critical connections, and elevating how life-saving treatments are delivered to those most in need – toward a future of behavioral health equity for all.

988: Bridging the Gap to a Future of Behavioral Health Equity for All

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Chief Executive Officer and Co-Founder

In the United States, we spend significantly more of our GDP on healthcare than our peer nations. Yet, we rank at the bottom when comparing the quality and efficiency of healthcare delivery in our country – we all can agree that this is a problem that must be addressed. And it could be partially to blame for why one in five healthcare workers are walking away from the profession. One silver lining of the COVID-19 pandemic has been the added visibility given to alternative methods of healthcare delivery and sites of care. By reconsidering how we deliver care, namely the superior efficacy of care in the home, we are finally on the cusp of transforming the stifling cost of medicine in our country, while addressing our nation&#39;s overall health and well-being.  In Washington state, the epicenter of the U.S. coronavirus outbreak, the state&#39;s largest community-based non-profit health system MultiCare, partnered with DispatchHealth to address COVID-19 related surges in hospital capacity and fear-based deferral of health care. We worked collaboratively to meet the changing needs of the community by launching two pivotal programs, Hospital at Home and Clinic Without Walls. Two different Hospital at Home models launched: one under the CMS Waiver Program where patients were admitted from the hospital ER and one through DispatchHealth’s &quot;Advanced Care&quot; offering where patients were admitted through Dispatch’s on-demand, in-home mobile ER services. Clinic Without Walls addressed patients deferring treatment out of fear or inability to leave home by bringing the care to them. These patients were typically inappropriate for a simple video visit due to memory impairment or the complexity of their medical conditions. Leveraging technology and an enhanced video visit facilitated by an in-person, highly trained medical technician, the strategy allowed providers to remotely complete a more complex exam on those patients with chronic disease and comorbidities without the patient ever leaving home. An early snapshot of data revealed unprecedented patient satisfaction in both programs with an NPS score of +98. The partnership enabled MultiCare, a health system with more than a centuries-long legacy of excellence, to quickly right-size its care model while still focusing on a superior patient experience and the high-quality care its community expects.    In the United States, our healthcare system spends an unsustainable four trillion dollars (17% GDP). Research and experience back an estimation that 60% of patients in the emergency room setting, 25% of inpatient admissions and 20% of skilled nursing facility stays, roughly $340 billion of our annual spend, qualify for substitutive care in the home, where costs are 20% to 40% lower on average. Imagine the ability to use those dollars for issues like homelessness, hunger, and education.    To say the COVID-19 pandemic sparked a boom in complex home-based healthcare is like calling the musician who has worked years at mastering their craft an overnight success –DispatchHealth has been perfecting the practice of high acuity healthcare in the home for almost a decade and that work was built on the shoulders of maverick clinician-pioneers who came before DispatchHealth. And globally, we&#39;re late to this party! For example, every metropolitan and regional hospital in Victoria, Australia, has a hospital at home program. What the pandemic has done is raise broader awareness of care outside the four walls, as well as the inequity of care for some of our homebound and access-challenged populations. We&#39;ve witnessed hundreds of thousands of patients use telemedicine for the first time or have their first house call in the case of DispatchHealth. ER utilization hasn&#39;t rebounded to pre-COVID levels. I suspect that those patients got a taste of a more convenient personalized care solution that costs a lot less.    For executive leaders managing health systems, meeting the changing demands of patients is time sensitive. The value of partnering to scale complimentary service lines that enable fewer avoidable emergency room visits, hospital admissions, or stays at skilled nursing facilities using an evolved hospital-like setting without walls. This enhanced approach to care empowers clinicians to go beyond traditional clinical treatment settings and meet patients where they are, with the type of convenient care they are growing to expect.

We're Late to the Party and Don't Even Know It: An Immediate Fix for America’s Ailing Healthcare Delivery System

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