The U.S. is facing a crisis in access to physical and mental healthcare. New thinking and approaches to leveraging the available resources to help more people is desperately needed. Accolade believes expanding pandemic-proven virtual care innovations provides one of the best options for helping more people.

The factors behind this crisis existed well before COVID-19 grabbed headlines. A growing population as well as an aging one, is putting increased demands on an already stretched healthcare system. In the past decade, the number of healthcare providers has not kept up with the needs of the growing population. Hospitals and clinics around the country, especially in rural areas, have closed due to lack of resources.[1] In the last 10 years, more than 120 hospitals have closed, and even more are struggling to remain open. 

This lack of resources has resulted in healthcare deserts that put millions of Americans at risk. It’s estimated that more than a third of the U.S. population now lives in a healthcare desert where they must travel at least 60 miles to the nearest provider.[2] People who live in these areas lack access to basic healthcare services, including pharmacies, primary care providers, hospitals, trauma centers, mental health resources and low-cost clinics. This disproportionately impacts people in lower income and rural areas who have limited internet access and lack insurance.

The pressures of the pandemic highlighted this problem across the nation. Primary care physicians (PCPs) and other healthcare professionals are experiencing record levels of burnout, and many are leaving the profession. According to the Association of American Medical Colleges (AAMC),[3] the U.S. could see an estimated shortage between 37,800 and 124,000 primary and specialty care doctors by 2034. This is especially true in rural areas where there are even fewer physicians available to care for those communities. 

It’s estimated that as many as 65 million people in the United States do not have easy access to a PCP. This deficit has the potential to increase risk factors and allow otherwise-treatable lingering conditions to fester for a significant portion of these isolated patients. The situation potentially creates needless stress on hospitals and other limited infrastructure when those conditions turn critical.

Employers will still have employees in these areas, whether it’s remote workers at home, service workers or rural outposts of distributed businesses such as agriculture or transportation. Enterprises still need to get their people the help they need no matter where they’re located. 

Virtual care brings water to the desert

Virtual care has the potential to ease the inequities in healthcare and provide people in healthcare deserts access to the care they need with virtual doctor visits. It can extend available resources into healthcare deserts, giving people access to a PCP for regular health screenings that may identify issues before they fester. 

It also makes specialists more accessible to those who need tailored care and increases their ability to seek out expert advice or second opinions. Specialists from urban centers can join video calls organized by a board-certified doctor to lend their expertise to a patient facing uncertainty. These second opinions are both diagnostic tools as well as sources of reassurance for patients.

Virtual care extends beyond traditional medical practice and can create collaborations between physicians and counselors. Many medical problems can bring on associated depression and anxiety or require some behavioral modifications to boost treatment success. The flexibility of the virtual care model can conduct basic screening tests and create tailored holistic approaches for patient care, like support groups, without the barrier of juggling lots of physical logistics for those in more remote areas. 

Mental health counselors can also help more people via virtual visits by alleviating geographic limitations and any stigma associated with seeking those services in-person. With the onset of COVID the number of people reporting symptoms of depression and/or anxiety  surged to 41.5%, up from 36.4%. The issues are bigger than the pandemic, but COVID gave us a reason to track the effectiveness of virtual mental health therapy. An American Psychological Association article from July 2020 summarized research that virtual interventions work for a variety of problems and populations and can be as effective as face-to-face psychotherapy when treating people with depression or other forms of mental illness.[4] Additionally, rates of patients using virtual mental health care are higher than those using in-person therapy.

A virtual-first model boosts healthcare access

Primary virtual and mental health care in various forms has been around for some time. The COVID pandemic accelerated the established trends as Accolade documented in this white paper. Regulations, reimbursement systems and the culture of patients and providers changed to embrace virtual care out of necessity.

In the process, all stakeholders discovered that it works for individual patients and at scale. We have the opportunity to take what we’ve learned from one crisis and use it to avoid another growing crisis in healthcare access.

[1] https://www.forbes.com/sites/claryestes/2020/02/24/1-4-rural-hospitals-are-at-risk-of-closure-and-the-problem-is-getting-worse/?sh=66a72281bc05

[2] https://www.goodrx.com/healthcare-access/research/healthcare-deserts-80-percent-of-country-lacks-adequate-healthcare-access

[3] https://www.aamc.org/news-insights/press-releases/aamc-report-reinforces-mounting-physician-shortage

[4] https://www.apa.org/monitor/2020/07/cover-telepsychology