April 2022: What’s Next for Healthcare
By Eileen Kenna
If the lessons the pandemic has taught us about America’s health system over the last two years could be distilled into a simple slogan, it might be: “Collaborate and then collaborate some more.”
Oh, while we're at it, we might also want to address the nursing shortage, health insurance complications, care disparities and gun violence.
The collaboration theme was a main thread of a wide-ranging discussion by the panel of healthcare professionals convened April 6 at the Fitler Club to tackle the weighty question: “Now What … for Healthcare?” The three experts dug into the issues in front of an audience of about 45 Sunday Breakfast Club members and guests.
David Rubin, a pediatrician, and director of Policy Lab at CHOP, has been on the COVID front lines since Day One, gathering data, analyzing it and making recommendations at the federal, state and local levels. He elicited nods of agreement from his fellow panelists, Betty Long and Patricia Wellenbach (both of whom are registered nurses) when he said teamwork is really what gets the job done.
“A lot of forces have led us to this moment,” Rubin said. “We know the integrated model works. It’s not just the doctors and nurses, it’s the unit clerks, the social workers and everyone else who comes in contact with the patient.”
Rubin lives the teamwork philosophy as the leader of 35 faculty and instructors and more than 60 staff in conducting population health research at Policy Lab. In his work with both the Trump and Biden administrations, Rubin said, “Teal problems with the Centers for Disease Control” were exposed. He cited a lack of COVID tests for the Omicron strain when they were desperately needed late last year as one instance of that.
“It’s literally about many actors coming together and trying to do a coordinated response,” he said.
Betty Long, president and CEO of Guardian Nurses Healthcare Advocates, has been a registered nurse since 1986. As a recognized national expert on patient advocacy, she said her agency’s mission has never been more important than it is today.
“We have plenty of stories that show care coordination is cheaper and more effective than people going it alone,” said Long, whose agency referrals went up 22 percent over two years. “Give me the team and I can help patients access care.” She referred to “physician extenders” such as nurses and social workers who reside in the community, not a distant hospital office, y as key to a healthier population and more equitable care.
Patricia Wellenbach, chair of the Thomas Jefferson University board of trustees, which oversees Jefferson Health, said problems with health insurance continue to spill over into emergency rooms, using up precious resources that would be better put to use dealing with, well, emergencies.
“We’ve seen a real shift in our cases with a lot of people without any insurance or with inadequate insurance,” she said. “Also, people are coming in (to the hospital) sicker because they didn’t get any care during the pandemic. We’re an ‘eds and meds” city. What’s our responsibility regarding healthcare in one of the poorest cities in the country? We need to use these issues to come together.”
Long noted the frustrating dilemma faced by many insured people who skimp on medications or eschew them altogether due to out-of-pocket costs: “All of our patients actually have good insurance. But when someone has a $1,500 deductible for a diabetes medication, he’s not going to get that. And maybe his other meds, he’ll take only every other month. And overall, people don’t have the wherewithal to figure out the health care system.”
Wellenbach, who is also CEO of the Please Touch Museum in Philadelphia, agreed that COVID revealed some glaring fault lines in our health care system.
“Globally, you couldn’t look away any more from the disparities in health from one ZIP code to another,” she said.
All agreed that health care workers, particularly hospital staffs have been under “tremendous stress” for a decade or more. “The pandemic brought it to the fore,” Wellenbach said.
While nurses were celebrated early in the pandemic with clanging pots and pans and handmade signs, that support has faded, Long said. It seems everyone now is weary, especially the nurses who have been leaving the profession entirely or turning to “travel nursing” which pays (literally) huge dividends, measured in the thousands of dollars.
“Nurses have become the scapegoats of the healthcare system,” Long said. “We do it because we love it. But now there’s compassion fatigue felt by nurses, doctors, and everyone else in the system.”
What can be done?
The panel noted that insurance companies should continue to support telehealth. Ironically, they’re apparently moving away from that, despite its effectiveness, Rubin said. Nursing education needs more scholarship money, particularly to encourage diversity in the applicant pool, Long and Wellenbach noted.
Billing is so complicated that it “distracts us away” from taking care of patients, Rubin said. He did note that he is not necessarily in favor of “Medicare for All.” He stressed that the Affordable Care Act was never intended to stand as is; revisions were intended and are needed but opposition to the law has blocked many attempts to improve it.
Long said she is a bit taken aback when she sees Blue Cross-Blue Shield advertising at Phillies games: “Is that really the best use of their money?”
And then there’s the gun violence that has, by all accounts, ratcheted up in virtually every major U.S. city since the pandemic began.
“We can’t turn away from this,” Wellenbach said. “We’d like to see a public-private partnership to address this issue. I don’t think the solution is coming from City Hall. We need leadership to ask: How do you want to come together to save our city?”
Rubin said he has been recommending for years that Philadelphia put together a “children’s cabinet” such as the one that exists in New York City to address the many issues from violence prevention to mental and physical health care that affect the lives of children. Rubin said in New York each member of the children’s cabinet submits a budget outlining what services they’ll be delivering. This avoids duplication of services and highlights what’s truly needed, he said.
Now that the federal government is giving cities billions to help pandemic recovery, Wellenbach asked: “What are we going to do with $1.4 billion from the feds? Let’s not put it in a war chest for down the road. The crisis is now.”