IHP600CS3

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3-1 Case Study 3-1 Case Study: Approaches to Healthcare Delivery Faizan Malik Southern New Hampshire University March 14 th , 2021

3-1 Case Study 1. What are the cultural beliefs and values presented in the video? In the video, What if Dr. House used Twitter, the cultural beliefs and values covered relate to the use of social media in terms of medicine and healthcare. Dr. Mekso highlights his company, Webicina, which manages the medical resources of social media for medical professionals and “e-patients” or those patients who use participate in their medical care through the internet. Dr. Mesko points out the benefits of social media in healthcare, citing an example of a difficult illness that was subsequently diagnoses through social media. This trend of industries moving online and utilizing social media is not use and has been shown to improve treatment received by patients. In a study performed by Ventola, it was found that “social media can also improve patients’ access to health care information and other educational resources. In the U.S., eight in 10 Internet users search for health information online, and 74% of these people use social media. Through social media, patients can join virtual communities, participate in research, receive financial or moral support, set goals, and track personal progress.” I believe the underlying cultural beliefs and values that were highlighted here, albeit not directly mentioned, is a hesitancy amongst some in healthcare to embrace the digital era and social media. Ventola went on to mention that, “in a survey of approximately 480 practicing and student physicians, 68% felt it was ethically problematic to interact with patients on social networks for either personal or professional reason.” Dr. Mekso attempted to show that, although not completely without some drawbacks, social media and e-patients are likely the future of healthcare, and those in the industry should anticipate and embrace the eventual transition to help improve the outcomes for their patients. In the video, Training More Country Doctors, the cultural beliefs and values covered related to the pros and cons physicians practicing in rural communities. It highlights Dr.

3-1 Case Study Hartman, a physician who has been serving a rural community in California for over two decades, who discusses the nuances of healthcare in rural areas and the difficulties it often presents. However, these difficulties are not isolated to California and occur in many rural areas across the country. As stated by Jaret, “Of the more than 7,200 federally designated health professional shortage areas, 3 out of 5 are in rural regions. And while 20% of the U.S. population lives in rural communities, only 11% of physicians practice in such areas.” The cultural beliefs and values presented are primarily related to the difficulties of attracting healthcare providers to rural communities and the subsequent health issues faced by residents of these communities as a result of a lack of access to care. Jared goes on to explain that “in part, because rural residents are more likely to die from health issues like cardiovascular disease, unintentional injury, and chronic lung disease than city-dwellers. Rural residents also tend to be diagnosed with cancer at later stages and have worse outcomes.” The video goes on to explain how some medical schools are addressing these difficulties by establishing a subset of students to learn and practice medicine in such rural areas. 2. What is the value to the patient of incorporating cultural awareness in the education of healthcare professionals? What is the value of the medical facility? Explain. For e-healthcare, I believe there will value in incorporating cultural awareness in the education of both healthcare professionals and their patients. Although countless studies show the benefits of online healthcare, many healthcare providers and patients remain hesitant of embracing this new digital era. Reasons behind these hesitancies include:  “Bad health information used improperly can be highly detrimental. Patients might trust misleading information or might make important health decisions based on sensationalized or emotionally charged stories that are not relevant to their health context.

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3-1 Case Study  The Internet can also be used as a platform for the promotion of esoteric and unscientifically founded health practices. Patients are often in a vulnerable position, and many are willing to accept information that provides a sense of hope and control.  Owing to a lack of technical knowledge, some patients are also unable to critically assess or might misinterpret health information. These factors can lead to a false sense of knowledge and security, and potentially non-compliance if the patient adopts beliefs that conflict with appropriate medical practices” (Tonsaker, 2014). For their medical facilities, by incorporating cultural awareness regarding the education and benefits of e-healthcare, the stigma around healthcare and technology can be removed, which will ultimately improve the care patients at the facility receive. Improved care can result in patient retention and recommendation, funding and grants, and the ability to expand their service beyond their respective campuses. It will also benefit patients during situations such as the Covid-19 pandemic, wherein in certain circumstances, it is better to avoid public places such as medical facilities. For rural healthcare, the value to the patient of incorporating cultural awareness in the education would be more so for the healthcare professionals. By providing education on the nuances of rural medicine, healthcare providers can have a better understanding of the issues faced by those in such communities. For example, and as stated by the Georgetown University Health Policy Institute, “the rural population is more likely to engage in risky health-related behaviors and to experience higher rates of chronic conditions and activity limitations. Rural residents are also more likely to be uninsured for longer periods and are less likely than urban residents to receive some types of health care, including tests for various chronic conditions.” In terms of medical facilities, if these issues are appreciated by healthcare providers, some may be

3-1 Case Study inclined to provide in these areas, such as the medical students highlighted in the Training More Country Doctors video. If the available care is expanded in such communities, the providers at these medical facilities can then expand their knowledge to the residents to avoid such high-risk behavior, managing their care, and ultimately improving their outcomes. 3. Do you think the insurance companies would cover these treatment approaches? If not, how could the cost of time and services be recovered? Whether insurance companies cover e-healthcare is dependent on the type of care being provided. Healthcare providers are encouraged and reimbursed for providing their patients some forms of e-healthcare, such as patient portals which allow patients access to their healthcare records, a means to schedule appointments and payments and communicate directly with their healthcare providers. As stated by Heier, “patient portals were developed to improve how patients and healthcare providers interact. A product of meaningful use requirements, they were mandated as a way to provide patients with timely access to their healthcare.” Furthermore, in light of the Covid-19 pandemic, many states, and insurance companies have expanded their coverage to include telehealth services, in which patients receive care via electronic information and telecommunication technologies. As stated by Martin, “some states have parity laws that require insurance companies to reimburse [telehealth services] at the same rate as in-person care for services provided. However, this is not nationwide. For this to become a standard across the country, the government needs to sit down with the major insurance firms to work out an agreement for telehealth hardware and services as well as for payments to medical professionals.” As such, I believe insurance companies would only cover such approaches to treatment if they are required to do so or if they stand to benefit from it. In the case of telehealth related to the Covid-19 pandemic, many insurance companies have already begun to roll back

3-1 Case Study the coverage they initially provided. As stated by Mallow, “several big private insurers are pulling back some of their coverage of telehealth for non-COVID issues. Companies including UnitedHealthcare have already rolled back policies that waived co-pays and other fees for non- COVID-related appointments. Other plans such as Anthem BlueCross BlueShield have extended their coverage through the end of the year, but only the first two sessions are free for the consumer.” I believe insurance companies would cover the approach to improving access to healthcare to those in rural communities, as they would ultimately stand to have monetary benefits from doing so. According to the Kaiser Commission, “among the 41 million uninsureds in the United States, nearly one in five live in rural areas. However, in states like Montana and Maine, over 70% of the uninsured are from rural areas.” As stated earlier, those in rural communities tend to be older and less healthy than those in more urban areas. If access to healthcare is expanded to rural communities (and if those in the communities become insured), the insurance companies stand to have a significant increase in revenue and profits from healthcare services provided to the sick and elderly. Ultimately, health insurance companies are just that, companies who need to generate profits to keep their doors open. As a result, they will only cover new treatment approaches when it is in their best interest (or are required to by law). 4. Would either of these care delivery approaches cause more or less competition among healthcare organizations and practitioners? Explain When comparing e-healthcare and rural medicine, I believe e- healthcare would be more likely to cause increased competition amongst healthcare organizations and practitioners. With a clear movement towards healthcare technology, it is more likely that healthcare organizations and providers would compete to both produce and have the latest in healthcare technology as

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3-1 Case Study compared to competing over who can provide healthcare to underserved rural communities. As stated by Dr. Dash, “in a normal market, competition drives relentless improvements in quality and cost. Rapid innovation leads to the rapid diffusion of new technologies and better ways of doing things. Excellent competitors prosper and grow, while weaker rivals are restructured or go out of business. Quality-adjusted prices fall, value improves, and the market expands to meet the needs of more consumers.” Vendors will compete to provide the latest and best technologies available, which medical facilities will have to compete in their respective industries and communities to attract more patients. Although rural medicine would not make healthcare organizations and providers more competitive, I don’t necessarily believe it would make them less competitive. Prospective medical students from rural areas may be inclined to go to medical schools that offer rural medicine programs such as the one demonstrated in the Training More Country Doctors video. If such programs are deemed successful, additional medical schools may develop similar programs and the demand for rural healthcare providers may eventually increase. However, this would be a slow process when compared to e- healthcare and healthcare technologies. 5. Do you agree with providing services with these two approaches? Explain. I fully agree with providing both rural medicine and e- healthcare services. As someone who grew up in a rural area and currently works in the health information technology sector, I have seen both the limitations of rural medicine and the benefits of healthcare technology or e- healthcare services. In the small town I grew up in, the availability of healthcare services was not as limited as those highlighted in the Training More Country Doctors video, but to this day, many residents have to travel 2 to 3 hours to receive more specialized care. Having seen my parents plan all-day trips just to see a specialized healthcare provider, it becomes clear why many

3-1 Case Study of those who are uninsured in rural communities avoid treatment or management of their care. If healthcare is expanded to rural communities, not only do patient outcomes improve, I believe the quality of life in such areas improves as well. For healthcare technology and e- healthcare, as mentioned, I have been in the industry for over a decade and have seen the plethora of benefits they can provide. From the EHRs that allow healthcare workers to get rid of countless sheets of paper, or the apps that allow patients to see their test results in real-time, there are a plethora of benefits from such an approach. The two approaches can ultimately intertwine, with the use of telehealth and other similar services in areas in which there are limited healthcare services. The possibilities are essentially endless with healthcare technology and e-healthcare. 6. Would embracing cultural beliefs, values, and these care delivery approaches within our medical organizations make the U.S. more or less competitive than other countries? Explain. Just as it would for healthcare organizations, embracing the cultural beliefs, values, and these care delivery approaches within our medical organizations make the U.S. more competitive when compared to other countries. In terms of healthcare technology and e-healthcare, America ranks near the top as is. As stated by Girvan, “the United States ranks 4th in the World Index of Healthcare Innovation, with an overall score of 54.96, behind only Switzerland, Germany, and the Netherlands. Americans are usually the first to gain access to major new medical advances, advances often discovered at American universities and developed by American companies. As a result, the U.S. ranked first for both Choice (57.65) and Science & Technology (75.14).” As such, it can be concluded a majority of the nation has already embraced the cultural beliefs, values, and care delivery approaches associated with healthcare technology and e-healthcare. If the remaining subset of the population who are hesitant to embrace such changes could be

3-1 Case Study convinced to do, I believe America would be the leader in such metrics and would be the standard for healthcare technology and e-healthcare. Unfortunately, the same cannot be said for rural healthcare. According to Dr. Carome, “The Commonwealth Fund in June issued a report examining that troubling fact. The report, “Mirror, Mirror on the Wall: How the Performance of the U.S. Health Care System Compares Internationally, ” ranked the U.S. last overall among 11 major industrialized countries as of 2013 (see table below). This continues a trend that the Commonwealth Fund has documented in prior reports published in 2004, 2006, 2007, and 2010. The report also revealed that the U.S. had worse health outcomes than the other countries.” Although many in urban areas have plentiful access to healthcare, the same cannot be said for the rural areas across the country, which ultimately makes us less competitive when compared to other nations. If the healthcare community embraced the cultural beliefs, values, and care delivery approaches needed in rural parts of the country (and there is a significant overhaul of legislation and healthcare insurance practices), America could mitigate its poor standing of its healthcare system and become more competitive when compared to other countries.

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3-1 Case Study Works Cited Carome, M. 2014, November 1 st . “Dead Last: U.S. Health Care System Continues to Rank Behind Other Industrialized Countries.” Retrieved from https://www.citizen.org/article/dead-last-u-s-health-care-system-continues-to-rank- behind-other-industrialized-countries/ Dash, Penelope. 2010, November 1 st . “When and how provider competition can improve health care delivery.” Retrieved from https://www.mckinsey.com/industries/healthcare-systems- and-services/our-insights/when-and-how-provider-competition-can-improve-health-care- delivery# Georgetown University, Health Policy Institute. N.D. “Rural and Urban Health.” Retrieved from https://hpi.georgetown.edu/rural/ Girvan, G. 2020, September 4 th . “United States: #4 in the World Index of Healthcare Innovation.” Retrieved from https://freopp.org/united-states-health-system-profile-4-in- the-world-index-of-healthcare-innovation-b593ba15a96 Heier, E. 2018. “What is a Patient Portal and How Does it Help Medical Practices?” Retrieved from https://www.selecthub.com/medical-software/what-is-patient-portal-how-help- medical-practices/ Jaret, P. 2020, February 3 rd . “Attracting the next generation of physicians to rural medicine.” Retrieved from https://www.aamc.org/news-insights/attracting-next-generation- physicians-rural-medicine Kaiser Commission. 2003, April. “The Uninsured in Rural America.” Retrieved from https://www.kff.org/wp-content/uploads/2013/01/the-uninsured-in-rural-america-update- pdf.pdf

3-1 Case Study Mallow, J. 2020, October 27 th . “Health insurers are starting to roll back coverage for telehealth – even though demand is way up due to COVID-19.” Retrieved from https://theconversation.com/health-insurers-are-starting-to-roll-back-coverage-for- telehealth-even-though-demand-is-way-up-due-to-covid-19-147648 Martin, E. 2020, August 19 th . “Does Health Insurance Cover Telehealth?” Retrieved from https://www.insurance.com/health-insurance/health-insurance-telehealth Tonsaker, T. 2014, May. “Health information on the Internet.” Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4020634/ Ventola, L. 2014, July. “Social Media and Health Care Professionals: Benefits, Risks, and Best Practices.” Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4103576/

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