“It ain’t so much the things we don’t know that get us into trouble. It’s the things we know that just ain’t so.”
The above quote, attributed to Mark Twain and the nineteenth-century humorist Josh Billings eludes to the complex situation that patients and care providers find themselves in. When people experience threats to their health, they are usually quick to seek various care providers to maintain or restore health.
This has not always been a flawless process. There are many challenges facing the delivery and uptake of healthcare, most of which are avoidable. There are many stakeholders involved, and this is an attempt to review some of the challenges and suggest a possible solution.
Illness, just like health, is not static, and needs do shift over time. Levels of care exist, but they are not standardized. A continuum of care describes the management of patients by healthcare providers across the preventative, curative, maintenance, and rehabilitative stages.
This might involve using acute care hospitals, ambulatory care, or long-term care facilities, depending on the patient. For example, a patient seen at a community health center/federally qualified health center (FQHC) cannot take their records along when admitted as an inpatient in a neighboring hospital.
Thus leaving their doctor without access to medical history and possibly duplicating efforts by repeating the same labs conducted just a week prior. A suitable care continuum should avoid what some have described as a cookie-cutter approach where one has a model that tries to apply to every situation. Instead, there is a need for innovation and flexibility.
Moving Parts of Effective Treatment
Effective treatment over the continuum of care requires attention to many moving parts. This movement implies that, at times, one comes across the unexplored territory and is forced to adapt.
The recent pandemic, for example, exposed some of the persisting challenges like an overburdened and backlogged health system, which some thought had been resolved. Instead, compounded by the already costly and fragmented public health system, many healthcare systems have been depleted.
The United States Healthcare system is a fiscally driven entity that spends more on healthcare than any developed country. Yet, despite the limited access to basic health care by the millions of people who are not insured, health care costs continue to rise rapidly.
Even among the insured, many lack a clear understanding of the limits of their health coverage or have a lower health-seeking behavior caused by distrust and aversion from the many previous incidences of higher out-of-pocket expenses.
Healthcare services’ bellowing and exorbitant costs prevent many individuals from seeking help and sometimes result in inadequate or inconsistent care. Unfortunately, finances remain the most common barrier to individuals needing care for behavioral health issues, with over 42% of Americans citing cost and poor insurance coverage.
Faced with that, focusing on curative medicine rather than seeking preventive services appears analytical and critical, while it is, in fact, arid and unprofitable. As a result, some individuals opt for the cheapest care options, which are not always the best. Moreover, in the long run, they end up spending more time because of the poorer quality of services and lack of a continuum of care as they hop between hospitals.
Barriers to Mental Health Care
Access to behavioral health has been one of the pertinent issues in recent years. It is estimated that six out of every ten Americans need behavioral health services either for themselves or their loved ones.
Despite the increasing number of people who need the service, there are many barriers like the fragmented care between mental health and physical health. A report by the New England Journal of Medicine showed that fragmented care results in two separate and unequal systems of care which cause suboptimal treatment of patients at a very high cost.
The Surprise Medical Bill Problem
Related to the cost issue has been the problem of surprise medical bills. The term “surprise medical bill” describes charges when an insured person inadvertently receives care from an out-of-network provider. Many factors can facilitate surprise medical bills, such as medical emergencies where the patients cannot select the hospital for emergency room (ER) care, the medical team, or the ambulance services. Patients with emergent or urgent health problems require stabilization, provision of necessary treatments, and prompt transfer to the appropriate settings as priorities of emergency care. Although treatment is initiated during emergency services, ongoing definitive treatment of the underlying problem is provided in other settings. Amidst all that, they end up incurring surprise medical bills.
It can also happen when the patients go to a facility where some health providers providing care are outside their health plan network. Different states have laws to protect patients with surprise medical bills, but these state laws generally do not apply to people with large employer coverage, whose employers self-insure. So, many individuals still face the problem of dealing with a potential surprise medical bill. This requires a systematic approach to establishing and treating health priorities.
Case Managers, Care Coordinators, Population Health Operations Process
Within a strategically planned population health operations process, case managers and care coordinators also play a vital role in the health care continuum. The focus of case management has traditionally been on delivering personalized services to the patients through care coordination.
Care coordination services are essential for ensuring optimal health outcomes, especially for patients with complex or chronic medical conditions who see multiple health care providers. The Affordable Care Act (ACA) of 2010 helped transform the role of care coordination to include other members of the healthcare team, like physicians, to take part in care coordination. However, that is yet to solve the problem of coordination.
To deliver personalized services, case managers need to know the patients, and understand their needs, including non-medical ones. For example, a case manager scheduling medical appointments needs to coordinate transportation services, both to and from, if the patient is challenged to get to the clinic location.
The case manager/care coordinator must ensure that the patient has the required medication and timely refills and coordinate pick-up or delivery. However, faced with the complexity of health services and poor coordination among different health systems, some case managers/care coordinators may lack information about the patients’ other services.
It is widespread for case managers to encounter loads of medical appeals for some insurance claims denied just because of insufficient information or inability to call to get prior authorization for some procedures. This lack of information is because some of the case managers or the patients lack a proper database for all the procedures done.
Health Policymakers and Healthcare Challenges
When thinking about solutions, policymakers have a crucial role in addressing most challenges. Healthcare policies, rules, and regulations have a powerful effect on the quality of health care delivered and individuals’ health. The passing of policies by governments happens after a dynamic policy-making process.
However, just the passage of laws and the presence of policies do not guarantee their implementation. This was seen with the COVID 19 pandemic. There were many policies put in place to protect the patients, but there are still many cases of patients who have issues with the insurers on what can be covered or not in the case of an admission.
The health care system consists of multiple players and stakeholders, including employees, insurance companies, managed care companies, health service professionals, health service organizations, and the government. All members perform specific tasks but work in collaboration to meet the patient health care needs.
Solutions to healthcare problems should focus on making the collaboration seamless. The individual and public health needs can only be met with a complete and appropriate continuum of care.
Technology Platforms for the Continuum of Care
Julota (Just Love on Them Always) has a platform that can serve as a solution to the continuum of care in public health. Faced with the complex nature of public health, lack of coordination can only skyrocket the costs while not necessarily increasing the quality of care.
A great benefit of Julota lives with its interoperability platform. Due to the sensitive nature of health data, many healthcare organizations are unable to exchange health data with one another, emergency medical services (EMS), or other community agencies.
Julota’s care continuum solution bridges that gap by using HIPAA, CFR-42, and CJIS compliant cloud computing technology to offer software as a service, or SaaS, to communities to help them connect better and make their systems interoperable. Consequently, this helps with linkage-to-care, improving the coordination of different organizations, and solving the barriers of security, privacy, consent management, and differing interagency policies.
Linkages between outpatient support and inpatient services that are often unevenly distributed and operate in silos rather than in collaboration are vital in ensuring a continuum of care. During an emergency, something as simple as ambulance services can be the difference between life and death.
However, it beats logic fighting to stabilize a patient, only to be informed that admission is not possible because of a lack of specialized services for that particular patient in the facility or insufficient intensive care unit (ICU) beds. In addition, the Julota platform can connect the “helper community” by automating complex workflows, referrals, data aggregation, and reporting while managing consent and securing bi-directional sharing of PII and PHI, all powered by Julota’s patented TouchPhrase Interface.
In summary, the proliferation of the use of health technology holds promise for promoting more precise, timely, and effective management of patients. Solutions that help create and expand programs and incentivize and reward the use of technology to advance care delivery help promote appropriate information sharing and maximize continuity of care. Therefore the value that organizations like Julota offer cannot be overstated in the healthcare industry.