Hello everyone,
 
Hope you’ve had a great week. Here’s a look at some new expectations and new developments in health and wellness.

 

Submitted by Jamie
How Health Care In The U.S. May Change After COVID: An Optimist's Outlook
The pandemic has created medicine's greatest generation. By shepherding this country through the crisis, an entire generation of doctors, nurses, pharmacists and administrators learned an entirely new set of skills: public communication, front-line innovation, data-driven decision-making. An outside force — a new virus — accelerated much-needed change in health care, but the work is just beginning. The future of care is now on us.

 

Submitted by Jamie

Meet the Nun Who Wants You to Remember You Will Die

“It’s actually in facing the darkest realities of life that we find light in them,” punk-rock fan, Sister Theresa Aletheia Noble explains.  She’s made it her mission to revive the practice of memento mori, intentionally thinking about your own death as a means of appreciating the present.

 

Submitted by Melissa
Huntington's Disease Awareness Day is May 15^th
Tomorrow marks International Huntington’s Disease Awareness Day. The Huntington’s Disease Society of America(HDSA) this year is focusing on educating the world through social media about the impact of the disease on families. “Each May, Huntington’s Disease Awareness Month gives the HD community a platform to turn up the global volume and educate more people about this devastating and rare brain disease,” said Louise Vetter, HDSA’s CEO. The society’s #LetsTalkAboutHD campaign is designed to help families share their stories, videos, and photos on social media.
 
Huntington’s disease is a neurodegenerative disorder characterized by uncontrolled jerking and writhing movements known as chorea, loss of thinking ability, and psychiatric problems. It was first documented in 1872 by a 22-year-old American doctor named George Huntington. It is thought to affect three to seven per every 100,000 people of European ancestry.
 
Submitted by Skyler
Fixing the Children’s Mental Health Crisis: It Takes a Community
Sobering statistics from the National Alliance on Mental Illness show that 1 in every 5 teens has or will develop a serious mental illness and that 50% of all lifetime cases of mental illness begin in children by age 14. If left untreated, these disorders can wreak havoc on families and communities. The COVID-19 pandemic has only made the situation worse. 
 
Submitted by Pete
Let’s banish the term ‘patient’ from the health care lexicon
With the rise of consumer centricity, multiple industries have made a conscious decision to choose language that better reflects the desired experience for their customers, er…I mean guests, members, passengers. Can you imagine referring to the people we serve each day as clients? How might that change the way we think about their experience and how we interact with them? Read how one physician transformed his practice by doing just that.
 
New Data from the National Alliance for Caregiving
Two reports were released looking at trends in caregiving in 2020. A few highlights:

• The number of Americans providing unpaid care has increased 22% since 2015
• 26% of Americans are caring for someone with Alzheimer’s or dementia (up from 22% in 2015)
• 21% of caregivers report their own health as fair to poor
• Caregivers of adults ages 50 or older are a diverse group
• 61% are non-Hispanic White
• 17% are Hispanic/Latinx
• 14% are African American
• 5% are Asian American and Pacific Islander
• 3% are some other race/ethnicity
• 61% of caregivers of those ages 50 or older are women
• 62% of caregivers of older adults also work while providing care
• Caregivers of older adults are themselves 50.1 years old, on average.

Let’s Learn to Reject Ageism During Older Americans Month

Older Americans Month highlights our responsibility to ensure that everyone has the opportunity to live a fulfilling life, with dignity and purpose. One way we can all improve seniors’ lives is to recognize and combat ageism, actively promote a positive depiction of aging, and ensure our communities are built upon age-friendly public policies. This editorial from Serving Seniors in San Diego highlights the efforts they are making to combat ageism.

 
Bose Launches First FDA-Cleared DTC Hearing Aids
In a clinical study with researchers at Northwestern University, Bose CustomTune technology yielded results that were as good if not better than those achieved by traditional prescription-fitting methods used by audiologists. They will be sold directly from Bose for $849.95 starting May 18th in five states: Massachusetts, Montana, North Carolina, South Carolina, and Texas — with nationwide availability to follow.
 
The pandemic made digital healthcare real and people aren’t going back
My colleague Andy Ross recently shared some data from Cedar’s 2020 Healthcare Consumer Experience Studyand “The Great Awakening” from The Harris Poll that reinforce rising expectations when it comes to digital healthcare.

 

 

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May 14, 2021 | 3.14

A compendium of articles detailing the impact of COVID-19 on behavioral health and potential strategies for improvement

I came across an article that led me on a bit of a deeper dive into the current status of behavioral health in America. It’s not new news that the pandemic has exacerbated existing trends in depression, anxiety and substance misuse. But until I spent some time exploring the topic, the scale of it wasn’t clear to me. According to the National Institute of Mental Health Disorders an estimated 26% of Americans ages 18 and older -- about 1 in 4 adults -- suffers from a diagnosable mental disorder in a given year. Yet, estimates suggest that only half of people with mental illnesses receive treatment. What’s more, a recent analysis from McKinsey suggests the number of people with a behavioral health need may have increased by as much as 50% during the pandemic. Yet total utilization of behavioral health services has decreased by roughly 8%.

It’s a complex issue with varying effects on different populations. What’s clear is that there’s virtually no segment of the American population that is not dealing with behavioral health in some way. For some additional perspective, following are a number of recent articles and studies examining the situation, beginning with one that’s been pretty prevalent in the news the last few days.

 
Meghan's candor on race and mental health hits home for Black women, experts say
Meghan revealed that she struggled with thoughts of self-harm and sought help. "Look, I was really ashamed to say it at the time and ashamed to have to admit it to Harry especially, because I know how much loss he has suffered, but I knew that if I didn't say it, then I would do it," Meghan told Winfrey. "I just didn't want to be alive anymore."

Dr. Joy Harden Bradford, a licensed psychologist and host of podcast Therapy for Black Girls, said Monday that she was particularly struck by the reaction from Black women. “There was something particularly resonant about the whole conversation around the worries around how dark the baby would be, because I think that is another conversation in the Black community, the idea of colorism,” Bradford said. “So the closer you are to white, the better you are treated, and I think that's what we saw highlighted.”
 
It is important for women of color to see that even those who appear strong, successful and happy on the surface can be emotionally drained and feel that their mental health is unsupported, said Dr. Christine Crawford, associate medical director at NAMI.

Exploring the Mental Health Stigma in Black Communities
The lack of culturally sensitive treatment by providers may play a role in the way the Black community views mental illness and treatment. It is not normalized in the way that it should be. People often view it as a personal and/or moral defect. As a result, the mental health field is viewed along the same lines as the other systems that have caused substantial harm to Black people.
 
Black people are far less likely to seek care. Statistics tell us that about 25% of African Americans seek mental health care, compared to 40% of whites. Unequal access to health care is one major contributor to this disparity. Dr. Crawford added that other factors include “the lack of cultural sensitivity by health care professionals, African Americans feeling marginalized, and the reliance on family, community, and spiritual support instead of medical or psychiatric treatment—even when it is critically necessary.”


Teens' mental health claims skyrocket in pandemic
A Fair Health report found that mental health claims for patients aged 13 to 18 skyrocketed 97.0% in March and 103.5% in April 2020. In contrast, medical claims fell 53.3% in March and 53.4% in April. The pattern of increased mental health claims and lower medical claims held though November 2020, but to a lesser degree. Mental health claims remained at least 19% higher in 2020 than in 2019.
 
Young people have proven especially vulnerable to mental health issues related to the COVID-19 pandemic. School closures, having to learn remotely and isolating from friends due to social distancing have been sources of stress and loneliness. A review of the international literature identified high rates of anxiety, depression and post-traumatic symptoms among children during the pandemic. A CDC report showed that, starting in April 2020, the proportion of mental health-related emergency room (ER) visits for children under 18 among all pediatric ER visits increased and stayed elevated through October. Students surveyed at seven American universities reported largely negative impacts of COVID-19 on their psychological health and lifestyle behaviors.

The state of mental health in aging America
According to the CDC it is estimated that 20% of people age 55 years or older experience some type of mental health concern. The most common conditions include anxiety, severe cognitive impairment, and mood disorders (such as depression or bipolar disorder). Mental health issues are often implicated as a factor in cases of suicide. Older men have the highest suicide rate of any age group. Men aged 85 years or older have a suicide rate of 45.23 per 100,000, compared to an overall rate of 11.01 per 100,000 for all ages (7). 

One in Four Older Adults Report Anxiety or Depression Amid the COVID-19 Pandemic
Overall, one in four (24%) adults ages 65 and older reported anxiety or depression in August 2020, a rate which has been relatively constant since the pandemic started in March. This rate is substantially higher than the one in 10 (11%) older adults with Medicare who reported depression or anxiety in 2018 (based on the 2018 Medicare Current Beneficiary Survey) (Figure 1). However, consistent with other KFF analysis, our analysis finds that older adults reported anxiety or depression in August 2020 at a lower rate than younger adults under the age of 65 (24% vs. 40%).


COVID-19 takes heavy toll on farmers’ mental health
According to a national survey of 2,000 individuals, conducted in December by the American Farm Bureau poll, a majority of rural adults and farmers/farm workers said the pandemic has impacted their mental health and more than half said they are personally experiencing more mental health challenges than they were since the farm advocacy organization conducted its first rural mental health survey in 2019. Half of rural adults (53%) say the pandemic has impacted their mental health at least some, while 44% say it has not impacted their mental health much or at all. Younger rural adults were more likely than older rural adults to say the pandemic has significantly impacted their mental health.

Lack of Mental Health Care in Rural America
This is a situation made more challenging by the fact that accessing in-person care, and even virtual care, is much more difficult in rural communities.
 
Compared with their urban counterparts, rural Americans have higher depression and suicide rates, but are less likely to access mental health care services; specifically, 19.1% of residents aged 18 or older had a mental illness. In addition to having a mental illness, 4.9% of rural adults experienced suicidal ideation during the year.
 
According to Lycette et al, for every 30,000 rural Americans, there is 1 psychiatrist. Rural Americans are also less likely to seek mental health services because of a prevailing sense of shame and stigma surrounding mental illness. In addition, rural residents are less likely to be able to afford mental health services because of financial constraints and lack of health insurance.
 
And according to the CDC, children in rural areas also face challenges. A recent CDC study finds that children in rural areas with mental, behavioral, and developmental disorders face more community and family challenges than children in urban areas with the same disorders.
 
The recently approved COVID-19 relief bill includes $500 million in grant funding for rural healthcare, which providers can use to increase telehealth capabilities, including underlying healthcare information systems. It also includes $50 million of appropriation for community-based local behavioral health needs, including providing services via telehealth.


Health care workers facing a mental health crisis
Care providers are not immune to mental health issues. In fact, the stress and unprecedented conditions brought about by the pandemic have resulted in a rise in healthcare workers feeling depressed, and considering therapy.
 
From June-September 2020, MHA hosted a survey on mhascreening.org to listen to the experiences of healthcare workers during COVID-19 and to create better resources to help support their mental health as they continue to provide care.
 
The responses collected from the 1,119 healthcare workers surveyed indicated that they are:

• Stressed out and stretched too thin: 93% of health care workers were experiencing stress, 86% reported experiencing anxiety, 77% reported frustration, 76% reported exhaustion and burnout, and 75% said they were overwhelmed.

• Worried about exposing loved ones: 76% of healthcare workers with children reported that they were worried about exposing their child to COVID-19, nearly half were worried about exposing their spouse or partner, and 47% were worried that they would expose their older adult family member(s).

• Emotionally and physically exhausted: Emotional exhaustion was the most common answer for changes in how healthcare workers were feeling over the previous three months (82%), followed by trouble with sleep (70%), physical exhaustion (68%) and work-related dread (63%). Over half selected changes in appetite (57%), physical symptoms like headache or stomachache (56%), questioning career path (55%), compassion fatigue (52%) and heightened awareness or attention to being exposed (52%). Nurses reported having a higher exposure to COVID-19 (41%) and they were more likely to feel too tired (67%) compared to other healthcare workers (63%).

• Not getting enough emotional support: 39% of healthcare workers said that they did not feel like they had adequate emotional support. Nurses were even less likely to have emotional support (45%).

• Struggling with parenting: Among people with children, half reported they are lacking quality time or are unable to support their children or be a present parent.

 
 
 
 
Well, if you’ve read this far, you may be asking “what can be done?”
Here are two perspectives among many. The first from Deloitte on the operational and structural changes that can improve behavioral health. The second from McKinsey on the importance of “whole person care.”
 
The future of behavioral health
This analysis from Deloitte lays out some of the barriers to improving behavioral health and offers strategies for improving the delivery of care. 
Barriers include:
1.     Gaps in clinical and scientific knowledge
2.     Stigma and drivers of health 
3.     Ineffectual and sub-scale care systems
4.     Siloed health care data management 
 
And six potential opportunities to drive change (detailed review of each found in the article):
1.     Cultural and behavioral change
2.     Scientific and technological advancement
3.     Increased access to care
4.     Data sharing
5.     Interoperable data
6.     Empowered consumers
 
The article further assesses the opportunities for insurers, care providers, employers and government policy makers.
 
A concluding thought from the article:
“We believe consumers will have better access to high-quality treatment, increased control over treatment modalities, and a higher quality overall experience. They will increasingly choose to use highly personalized health tools for self-care and to sustain health independently, while fair pricing and increased access to high-quality services will promote equity in care. They will also be able to choose services that break down the walls of traditional services, leveraging on-demand virtual engagement to manage their health.
 
What’s more, these changes mean consumers will be empowered to critically evaluate care providers prior to treatment. And consumer data ownership will also mean that consumers are able to monetize that data if they so choose. As a result, care providers will put increased emphasis on operating in a more consumer-centric way. In a step indicative of this direction, US Medicare reimbursement rules are being updated to be linked to patient satisfaction scores.” 
 
Unlocking whole person care through behavioral health
This article from McKinsey is part of a broader series on behavioral health. 
 
They advocate that investing in prevention and early intervention programs is key to mitigating the movement from lower needs to high needs. Changes such as: including behavioral health screenings in preventative physical health appointments, providing school-based mental well-being and substance use education, and preventing social isolation though peer support can help create an environment that provides benefits to both behavioral and physical health.
 
Establishing the groundwork for whole person care will require addressing supply-demand inequities in behavioral health services, expanding equitable access to evidence-based models of care, and investing in behavioral health at parity with other health conditions. The six strategies McKinsey has identified include:
 
1.     Expand equitable access to evidence-based behavioral health services
2.     Invest in behavioral health at parity with other health conditions
3.     Strengthen community prevention
4.     Integrate behavioral and physical health
5.     Leverage data and analytics
6.     Address unmet health-related basic needs
 
Furthermore, they estimate taking these actions could reduce total US healthcare spending annually by $185 billion. This figure represents around 6 percent of total healthcare spend in the United States.

Potential Effects of $15 Min. Wage

(Adapted from an internal memo prepared by Mike Ensroth shared with our team 2/26/2021)

I’ve spent time researching the economic and business impact of a potential increase to a $15 minimum wage. This is a conversation that many of us have been having recently as a result of the COVID relief package. But it's not a new topic, with the ‘Fight For $15’ efforts dating back to 2014. The major difference is that it's now proposed in legislature with many advocates behind it.

I have researched the topic across 6-8 sources, trying to find the most bi-partisan facts to share with everyone. I am sharing these notes as a means to help inform all on the topic, so that we are prepared for further conversations. I put no political leaning on the notes and please do note, I have tried to incorporate as many research findings and forecasts to look at this through a broad lens. I say that acknowledging that there are a myriad of benefits that could come from a raise in min. wage, but they may not be overtly noted in the below, which is concentrated on impact to small business owners. 

 

Situation

• Federal minimum wage currently sits at $7.25 and has not changed in over a decade. A proposal, as part of the latest COVID stimulus package, is to increase to $15/hour.
• If an increase to a $15 min wage is passed, the current proposal has stairstep increases marked over the next five years to reach $15/hour in 2025.
• Tipped wages will be phased out with this plan. Tip wages (think servers, bartenders, etc) currently make at least $2.13/hour, $3.67/hour in Michigan for perspective.
• Roughly 2-4MM workers (or 2.5% of the hourly pay workforce) earn the federal min. wage or below.
• 52% of min. wage workers are in the food preparation or service-related industries.
• Min. wage workers are disproportionately young; over 50% are 16-24 years old. 24% of min. wage workers are teens.
• Most restaurants/retailers already need to pay above min. wage to attract and/or keep talent.
• Beyond the 2-4MM at min. wage, an additional 35-40MM earn just over min. wage and would also need an hourly pay increase. 

 

Realities

• Wage increases of this magnitude would lift many out of the poverty level, moving them out of qualifying for public assistance programs (SNAP/food stamps, child tax credits, etc). It is estimated that over 1MM would elevate out of the current poverty threshold.
• Some will try to reduce their hours to try and keep housing subsidies and/or other federal benefits.

• Min. wage increase would reduce income and gender inequality.
• Women represent 63% of min. wage workers.

• African Americans represent 18% of the min. wage workforce.
• Hispanics are 22% of the min. wage workforce.  

• Brands will be forced to pass price hikes to consumers to offset labor costs (along with rising food costs, utilities and other hard cost increases). Research suggests that many QSR’s and other industries will pass along 100% of increased labor costs to consumers. The net result, as modeled, is +5% or higher product pricing or -15% in product/portion-sizing to offset. 
• Raised min. wage will increase tax payments for individuals and could decrease employee benefits.
• 40% of surveyed CFO’s would reduce employee benefits to offset increased labor costs.

 

Assumptions

• Basic assumption: The higher wages are, the higher costs of production are. The higher costs of production are, the higher prices are. The higher prices are, the lower the demand for your product (and in turn, the less number of workers you need to produce your product).
• The Congressional Budget Office believes a jump to $15 min. wage could lead to job losses of 1.4MM+. 
• An increase in min. wage will likely cause lay-off and/or decreased hiring levels for many small businesses.
• Employers have a hard time justifying higher wages to those with low skill levels, resulting in job cuts. A 10% increase in min. wage has led to a 1-3% decrease in employment of low-skilled workers. 
• The cost of childcare is said to increase +21% on average, negating wage gains for many.
• Some fast food brand CFO’s have modeled the effect of a $15 min. wage, saying that it would force the closure of roughly half of their locations. 
• Reports from within the hospitality industry suggest that min. wage increases will adversely decrease upward job mobility in the industry, keeping people locked into roles for extended periods.
• An increase in min. wage would lead to less employee turnover (from those jumping to another company for a minimal increase) and possibly increase productivity. 
• Raising min. wage will advance automated processes to replace service employees. Automated processes have already been fast-tracked due to the pandemic, so many brands/industries are well in motion on this objective.
• A min. wage hike will increase housing costs. Areas with limited housing supply will especially see boosted rental prices as more are now able to compete for available units. It is estimated that a $15 min. wage will cause a jump in monthly rent of +$200 due to supply and demand.
• A JAMA analysis concludes a broad look at the impact of increasing the minimum wage on health suggests that it can positively improve health outcomes for the entire population—but not without trade-offs. Depending on the state, increasing incomes could make people ineligible for public benefits assistance, including Medicaid, and ultimately harm instead of improve health.

 

Real World Examples

• Minimum wage hikes have occurred in parts of the U.S., so there are real examples of the outcome to draw on.
• The assumption was that workers would work at least the same or more to earn even more money with the increased hourly rate. In many examples the opposite occurred, with employees opting for less hours, as it now required less hours to cover their expenses. 
• This created an added hurdle for companies, especially in a tight job market, to replace the now uncovered hours.
• A hike in min. wage will cause many teens to lose jobs, as firms struggle to justify paying young workers with no skill or experience a higher wage. 
• The teen unemployment index fell 8% in just three months after Chicago increased min. wage.
• Recent increases in min. wage in areas has led to the closure of several Wal-marts and cancelled other expansion plans for the brand.
• As a barometer, the price of a cup of coffee (QSR/C-store/other) jumped +10-20% in California after min. wage moved to $12. Coffee prices rose +7% in Chicago when min. wage hit $10/hr.

 

Discussion

• Many believe that min. wage should be discussed locally/regionally, as there is too much regionality to the cost of living and labor market needs.
• Increased min. wage disproportionately harms the poorest areas. Employers in lower income areas would need to spend more than those in higher cost areas for staff, but would be unable to cover the costs by raising prices to levels their customers could not afford. 
• Min. wage has not kept up with inflation. With min. wage not increasing since 2009, the stagnant wage has lost over 10% of its purchasing power to inflation. Min. wage should at least keep up with inflation to not create such an imbalance in wages.
• If min. wage had kept pace with rising productivity and incomes, it would have been nearly $22/hr in 2012.

 

Hopefully this helps alleviate too many of us from doing added homework on the topic, but rest assured more studies will be released in the coming weeks on the topic.