Workforce of the Future - Ben Frasier

I. Technological solutions
Telemedicine and Virtual hospitals

Background and benefits:
• 2 in 3 clinicians reported that they prefer virtual-only or hybrid
treatment settings. This is a big jump from before the pandemic.
• Patients are onboard as well with 88% of Americans stating that they
would prefer to keep telehealth as an option even after the pandemic
is over.
• Virtual hospitals can stem the doctor shortage, particularly in rural
and underserved areas, allowing for physician-led treatment in areas
where many patients often don’t get to see a general practitioner.

• 76% of clinicians think virtual care should be taught in medical school
and advanced nursing programs.
• 63% of clinicians believe that virtual primary care will surpass in-
person care within five years (2027).

• Inconvenient or unreliable transportation can interfere with
consistent access to health care, potentially contributing to negative
health outcomes. Studies have shown that lack of transportation can
lead to patients, especially those from vulnerable populations,
delaying or skipping medication, rescheduling or missing
appointments, and postponing care. Transportation barriers and
residential segregation are also associated with late-stage
presentation of certain medical conditions (e.g., breast cancer).

Implementation challenges and models:
• Virtual hospitals are a great solution in theory, but in reality, there are
a number of potential downsides and challenges to implementation
such as:
oPatient access to and ability to use the necessary technology (wifi,
messaging platforms, video platforms and apps)
oThe need to have on-site technical support and training for health
care staff.
oPatients relying on virtual care when a personal visit is needed.

• In a survey of 400 doctors and nurses, 46% said they felt inadequately
trained in virtual care.
• A study by University of Texas MD Anderson Cancer Center (MDACC)
and Texas A&M University’s Mays Business School lays out a
comprehensive blueprint on how to successfully implement virtual
care practices through DIBS (Documentation, Integration, Best
Practices and Support).

Robotics

Robotics
• A number of studies reveal that robotics reduce surgeon fatigue,
preventing burnout among surgeons and reducing risk to patients.
• In 2019, 60% of non-metropolitan counties in the US were without an
active general surgeon.
• Teleoperated robotics could fill in the gap and increase healthcare
equity in underserved populations.

Robotics
• The majority of nursing home and assisted living communities in the
U.S. are short-staffed and unable to successfully recruit needed staff
to fill their ranks. Robotic work aides can perform tasks such as
fetching equipment, transporting medication and specimens,
transferring patients between beds, chairs, toilets and showers.
• Robots can also be effective in providing conversation and
companionship to stem the effects of loneliness and isolation and
promote well-being.

Robotics
• Studies have shown how robotic assistants in nursing homes in Japan,
the nation with the largest percentage of elderly population in the
world, have filled in gaps in the healthcare workforce, and increased
the ability of nursing home administrators to offer flexible contracts
to nursing staff, reducing burnout and increasing retention overall.

Robotics
• The challenges of adopting robotics lie primarily with the cost. They
are still an expensive solution.
• In Japan, legislators implemented policies to stimulate innovation in
the area of medical robotics and incentives to hospitals and care
facilities who adopted them.

Robotics
• Christine Bishof, MD, said using teleneurology and telenephrology
services has worked out well at the two Central Illinois facilities where
she practices emergency medicine: OSF Heart of Mary Medical Center
in Urbana, and OSF Sacred Heart Medical Center in Danville. “It’s
really been fantastic,” said Dr. Bishof, an AMA member and speaker of
the Illinois State Medical Society. “It has really improved our ability to
manage patients who need those consultive services,” she added.
“It’s as easy as rolling the robot in the room and the specialists log on,
do their assessments, and they’re able to give us feedback in real
time. I think it’s very viable.”

II. Administrative solutions
Increase staff diversity at all levels

• Diversity, Equity and Inclusion (DEI) has become a buzzword for
employers and DEI-related job postings increased from May to
September 2020 by 123%.
• However, there’s distance to go from a buzzword to an integrated
approach to staffing:
oMales comprise only 9.4% of registered nurses, but 49% of U.S.
population.
oWhites comprise 80.6% of nurses, but only 60% of the U.S.
population.

• According to the Association of American Medical Colleges:
oFemales comprise only 36% of physicians, but 51% of U.S
population.
oBlacks comprise only 5% of physicians, but 13% of U.S. population.
oHispanics comprise only 6% of physicians, but 19% of U.S.
population.
oWhites comprise 75% of Nurse Practitioners, Physical Therapists
and Occupational Therapists, but only 60% of U.S. population.

• Disparities in healthcare outcomes by ethnicity are unfortunately a real
problem. For examples, studies have shown that:
oAfrican-American women with breast cancer are 67% more likely to die
from the disease than are Caucasian women.
oThe mortality rate for African-American infants is almost 5 times
greater than it is for white children.
oHispanic and African American youth are substantially more likely to die
from diabetes than white populations.
oEven when controlling for access-related factors, such as patients’
insurance status and income, some racial and ethnic minority groups
are still more likely to receive lower-quality health care.

• It can be inferred that one of several reasons for these disparities may be tied
to a lack of diversity in healthcare. According to a report by the U.S.
Department of Health and Human Services:
oHispanic populations are significantly underrepresented in all of the
occupations in Health Diagnosing and Treating Practitioners occupations.
oAmong Non-Hispanics, Blacks are underrepresented in all occupations,
except among Dieticians and Nutritionists (15%), and Respiratory
Therapists (12.8%).
oAsians are underrepresented Speech–Language Pathologists (2.2%), and
Advanced Practice Registered Nurses (APRN) (4.1%).
oAmerican Indians and Alaska Natives are underrepresented in all
occupations except Physician Assistants, and have the lowest
representation among Physicians and Dentists (0.1% in each occupation).

• Harvard T.H. Chan School of Public Health published an article that
encourages health care centers to consider the following factors
around integrating a more diverse work culture:
oUnderstand the mission and purpose of the organization, and the
mission and purpose of the office within that framework. Make sure to
ask: Why are we doing this work? And how does it actually impact our
organization?
oConsider the metaphorical “seat at the table” of this person or group.
How do they integrate into the rest of the leadership structure? Is there
an identified place for them? Do they have a voice and authority? Are
they able to make policy changes? How much autonomy do they have?

• Cont’d:
oThink about how organizational infrastructure can support these changes.
What does the rest of the organization look like? How are changes
implemented? Is there a long-term plan (and financial resources) to sustain
DEI work? Is there a culture change that should occur as a part of this work to
be multiculturally supportive?
oDefine what success looks like. What are the easy, short-term wins that can
help demonstrate that this work is worth doing—and what are the medium-
to-long-term goals? If these efforts are not working, what changes need to be
made and how?
oWhat resources are available? How much is the organization investing in DEI
initiatives?

• Provo College’s diversity piece offers proof that wherever diversity is
encouraged and cultivated, businesses (hospitals included) perform
significantly better:
oA study by the firm McKinsey and Company entitled “Why Diversity
Matters” found that gender-diverse companies are 15% more likely to
outperform those non-gender-diverse companies, and ethnically
diverse companies are 35% more likely to outperform companies with
minimal diversity.
oDiversity even has an effect before a medical worker enters the field.
Studies have shown that students who study within a diverse student
body and faculty make better doctors.

• Cont’d:
o“We argue that student diversity in medical education is a key
component in creating a physician workforce that can best meet the
needs of an increasingly diverse population and could be a tool in
helping to end disparities in health and healthcare,” said coauthor Paul
Wimmers, an assistant professor at the David Geffen School of
Medicine at UCLA.
oThere are also findings that support the position that racial diversity in
higher education is associated with measurable, positive educational
benefits.

Offer Flexible Scheduling

• 50% of clinicians said the number one thing they would change about their jobs
was the administrative burden The second most cited change was flexible work
schedules (29%) Both of these complaints reflect a high valuation on time as a
factor in job satisfaction.
• A study on clinician burnout published in ScienceDirect stated that the majority
of health care workers who report feelings of burnout are in the early stages of
their careers (ages 30-39) and women are twice as likely to report burnout as
men.
• The pandemic response has been gender-regressive with many women
shouldering the burden of at-home childcare and household care duties. Flexible
scheduling contributes to attracting and keeping female workers who may be
juggling childcare and work.
• Flexible scheduling empowers healthcare workers to find better work/life
balance, contributing to higher job satisfaction and retention.

• A comparison study for flexible and standard scheduling published by
ScienceDirect revealed that 55.4% of care providers who were given
flexible scheduling reported greater work satisfaction, 50% reported
experiencing better quality of life and significant improvement in
perception of control over workload and work-related stress as
compared to those with standard scheduling.

• In the UK, the NHS People Plan for 2020/21 included flexible work
scheduling as imperitive to retaining staff, with dozens of studies cited
to the benefit of flexible scheduling for several categories of
healthcare workers: “To become a modern and model employer, we
must build on the flexible working changes that are emerging through
COVID-19. This is crucial for retaining the talent that we have across
the NHS. Between 2011 and 2018 more than 56,000 people left NHS
employment citing work-life balance as the reason. We cannot afford
to lose any more of our people.”

Address burnout and PTSD in health
care worker wellness programs

Address burnout and PTSD in health care worker
wellness programs
• Hospitals and healthcare centers are way ahead of the curve as
compared to other industries in terms of adopting wellness and
stress-resilience programs for staff members including practices like
mindfulness, yoga, meditation and other stress-reducing practices
and this was true before the pandemic.

wellness programs
• Here are stats from a 2017 Workplace Health in America Survey conducted
by the Center for Disease Control:
o83% of hospitals in the United States provide workplace wellness
programs, compared to 46% of all employers.
o63% of the hospitals offer health screenings, also known as biometrics,
compared to 27% of all employers.
o31% of the hospitals provide health coaches, compared to 5% of all
employers.
o56% of the hospitals have stress-management programs, compared to
20% of all employers.
o55% of the hospitals offer counseling to help employees stop smoking,
compared to 16% of all employers.

wellness programs
• The pandemic created exponential stress levels among healthcare workers
that needs to be addressed in kind to retain staff and stem the drain.
Factors such as handling empathy fatigue, managing covid misinformation,
and combating patient mistrust as well as witnessing high rates of
mortality and being continually understaffed have caused thousands of
healthcare workers to leave their jobs.
• 33% of clinicians see burnout as the most significant threat to healthcare
organizations, more so than financial issues (28%) or staffing shortages
(20%).
• In order to get health care workers that left the field to come back and to
retain those who stayed, hospitals need to dedicate resources to giving
them the support they need including wellness programs that focus on
preventing burnout and addressing PTSD.

wellness programs
• In response to the elevated stress on healthcare workers of the Covid-
19 pandemic, Mount Sinai opened a Center for Stress, Resilience and
Personal Growth. Dennis S. Charney, MD, the Anne and Joel
Ehrenkranz Dean of the Icahn School of Medicine at Mount Sinai and
President for Academic Affairs for the Mount Sinai Health System had
this to say about the program’s goals:

wellness programs
• “…We estimate 25 to 40 percent of first responders and health care
workers will experience PTSD as a result of COVID-19. The success of this
program in understanding and addressing PTSD among Mount Sinai’s
health workers will inform future efforts to refine, scale up, and adapt to
care for our patients and their families in the communities we serve but
also to better support health professionals at institutions throughout our
nation and the world,” Dr. Charney says.
• “Ultimately, we hope it becomes a model for enhancing psychological
resilience in frontline health care workers exposed to COVID-19, thus
ensuring that health care systems nationally and internationally continue
to deliver outstanding patient-centered care whatever challenges the
future may bring.”

Establish and adhere to nurse staffing
minimums

Establish and adhere to nurse staffing minimums
• There is a direct correlation between nurse staffing and patient
mortality. Each one patient added to a nurse's workload is associated
with a 7% increase in risk-adjusted mortality following general
surgery.

• In addition to compromised patient care, when nurses’ patient load is
too high, it causes undue stress on them as they have to make critical
decisions about which patients to attend to and in what order where
an error in judgement or inability to get to a patient on time can
result in patient death.
• Zo Schmidt, a registered nurse in a medical-surgical unit at Kansas
City’s Research Medical Center, said the hospital increased the ratio of
patients to nurses from 4-to-1 to 6-to-1 early in the pandemic, which
has had dire consequences for some patients. “I know there are
patients who are alive now because I had four patients that day, who I
don’t think would be alive if I had six.”

• The logic that hospitals use for creating high nurse/patient ratios is to
cut costs. In fact, understaffing increases hospital costs. When patient
care is insufficient, it may result in extended patient stay, additional
treatments or surgeries, readmissions and other complications that
end up adding more costs and compromising both staff and patient
well-being.

• Hospital administrators need to win back the trust of patients and
health care workers by establishing and honoring minimal
nurse/patient staffing requirements. A study by JAMA Surgery
showed that hospitals who establish and adhere to ideal minimal
nurse/patient ratios produce better patient outcomes for the same or
less than hospitals with high nurse/patient ratios with 40% less
patients being admitted to costly intensive care units.

• As of March 2022, 16 states currently address nurse staffing in
hospitals through either laws or regulations:
oHospital-based: Eight states with committees comprised of at least
50% direct care nurses: CT, IL, NV, NY, OH, OR, TX, WA. One state
where a Chief Nursing Officer develops a core staffing plan: MN.
oNurse to patient ratios/standards. Two states: CA, MA
oDisclosure and/or reporting requirements. Five states: IL, NJ, NY,
RI, VT

III. Credentialing solutions
Micro-credentials

Micro-credentials
• The shelf life of current skill sets is about 5 years or less.
• We have been overly focused on top-of-license issues, and now we
have lost critical help at the LPN & lower technician levels.
• The pandemic curbed nursing school enrollments.
• There are not enough instructors for nursing programs.

Micro-credentials
• Micro-credentialing can address many of these issues:
oMicro-credentialing addresses critical skills gaps for health care
workers.
oIt also takes the onus off health care organizations to invest in training
for employees who may then leave to join another organization.
oIt creates a culture of continuous learning that can prevent
organizations from perpetually struggling to fill in shortages of workers
with relevant skills.
oIt empowers health care workers to have more flexibility in their career
paths, increasing job satisfaction and retention.
oThe programs are short (a few weeks or sometimes less), affordable and
workers can learn in their own time.

Micro-credentials
A Forbes article titled “Why Microcredentials are Huge for the
Future of Work” explains that:
• Within the healthcare ecosystem, as jobs become “hybridized and require
multiple skill sets” it is increasingly important for workers to possess varied
skillsets.
• Previously individuals could find success in the workplace as “specialists,”
possessing deep knowledge on only a narrow scope of topics, or
“generalists,” with a more shallow understanding of a wide variety of
topics.
• The workplace of the future demands individuals become “versatilists,”
possessing deep knowledge of a wide breadth of topics.
• Micro-credentials allow individuals to demonstrate competence in a variety
of areas, and to update existing or obtain new skills or knowledge.

Micro-credentials
• An example of how micro-credentialing can fill in critical skills gaps at
a low cost to the healthcare worker and can be gained in a short time
period:
In late 2020, The American Association of Critical-Care Nurses
(AACN) launched a micro-credential for nurses and healthcare
workers providing direct care for critically ill patients with COVID-
19, making it the first professional nursing organization to offer a
micro-credential…

Micro-credentials
• Cont’d…“Since the onset of COVID-19, nurses have looked to AACN
for best practice recommendations, clinical guidelines, staffing
models and emotional support. This micro-credential responds to the
need to validate the knowledge required to care for patients with
COVID-19,” said Connie Barden, AACN’s chief clinical officer.
• “As the coronavirus continues to have a significant impact, hospitals
need well-educated staff they can trust to provide safe care to
critically ill patients with COVID-19. This micro-credential will help to
substantiate that knowledge base.”

Micro-credentials
• Cont’d…“COVID-19 Pulmonary and Ventilator Care” micro-credential
is a 38-question exam that is designed to validate the entry-level
knowledge of direct care clinicians who provide pulmonary and
ventilator care to patients with COVID-19. The test plan for the exam
is based on content from AACN’s free course “COVID-19 Pulmonary,
ARDS and Ventilator Resources.”

Micro-credentials
Cont’d…
• All medical professionals are eligible to take the online exam in order to
receive the “COVID-19 Pulmonary and Ventilator Care” micro-credential,
which includes:
oValidation by AACN, a trusted provider and resource.
oNo distinct eligibility requirements.
oAn online verification tool for current and potential employers.
oIndividuals can purchase and complete the exam online, on their own
schedule, conveniently from a home computer or mobile device.
• “COVID-19 Pulmonary and Ventilator Care” micro-credential exam fees:
oAACN Member - $30
oAACN Nonmember - $45

Facilitate international medical
graduates to practice in the U.S.

Facilitate international medical graduates to practice in
the U.S.
• There are ~270,000 foreign-trained immigrant healthcare
professionals in the U.S.
• 25% of all doctors in the U.S. are foreign-trained.
• Foreign-trained doctors are more likely to serve in impoverished and
minority communities, areas that typically lack sufficient physician
staff.
• U.S. immigration policies impede foreign-trained doctors from legally
living and practicing in the U.S., cutting off a workforce that could
stem hospital shortages.

the U.S.
• Even when living legally in the U.S., foreign-trained clinicians have to
overcome many obstacles to obtain licensing to practice in the U.S.
Many have to repeat years of coursework and spend tens of
thousands of dollars or more studying at American institutions in
order to meet the licensing requirements.

the U.S.
• An article titled “Doctors Trained Abroad Want to See You Now”
published in Pew explored how facing healthcare worker shortages
during the pandemic led to a change in attitude towards allowing
foreign-trained health care workers to practice in U.S. hospitals.

the U.S.
• “A handful of states are easing certain licensing requirements,
creating programs for foreign-trained doctors to work alongside U.S.-
trained ones, reserving residency spots for immigrant health workers
and providing help, sometimes including financial aid, for those
working to get a U.S. license. States hope the efforts can not only get
medical providers to more places where they are needed—
particularly underserved rural and urban areas—but also lead to
more professionals who speak the same language as and are
culturally attuned to those they treat in an ever more diverse
America.”

the U.S.
• An example of adapting policy towards foreigners through state
legislature is Indiana’s recently passed HEA 1003, whose main
objective is to curb the state’s projected nursing shortage of 5,000
nurses by 2031.
• The law will stimulate enrollment in nursing courses by allowing for
more flexibility for students to complete nursing courses, including
allowing foreign students to complete nursing courses in the state.

Addressing the physician shortage

• In 2019, the United States had nearly 20,000 fewer doctors than required
to meet the country’s health care needs, according to an estimate by the
Association of American Medical Colleges, which analyzes the physician
workforce.
• At the current rate, the group said, that gap could grow as high as 124,000
by 2034, including a shortage of as many as 48,000 primary care doctors.
• “Within the next 10 years, two of every five physicians in the workforce will
be 65 or older,” said Michael Dill, the group’s workforce studies director.
Meanwhile, the population also is aging and requiring more health care.
“Just when we need physicians more, we will have a large cohort of
physicians reaching retirement age,” he said.
• There aren’t enough physicians in training to replace them.

• A popular solution to the physician shortage has been to utilize
physician’s assistants and nurses. According to the AMA, using nurses
rather than physicians leads to more tests and consultations than if
the patient had been seen by a physician. This ends up being more
costly, rather than saving money and compromises patient care.

• “The AMA is deeply concerned with the notion that patients in rural
and underserved areas, often a vulnerable and medically complex
population, should settle for care from a health care provider with a
fraction of the education and clinical training of physicians,” says an
AMA Advocacy Resource Center issue brief, “Access to Care” (PDF,
members only). “All patients, regardless of ZIP code, deserve care led
by a physician,” the brief adds, noting that “physician-led care is
equitable care.”

• In addition to facilitating the legalization and licensing of foreign-
trained doctors as discussed in the box above, there are other
measures that can be taken to expand the number of practicing
physicians in areas where there are shortages according to a
publication by the AMA:
oExpand GME slots.
oOffer loan forgiveness for practicing in shortage areas
oInitiate programs that encourage students from shortage areas to
pursue medical careers.
oExpand the use of telehealth.

Implement licensing that’s valid
country-wide

Implement licensing that’s valid country-wide
• Flexible state licensing combined with telehealth and virtual hospitals
allows hospitals to redistribute healthcare practitioners to areas
where they are needed.
• 58% of health care workers want to be licensed in more states.

Implement licensing that’s valid country-wide
• Many states relaxed licensing requirements during the pandemic to enable
out-of-staters to practice within their borders.
• This not only made it easier for hospitals in need to fill their ranks with
clinicians from areas that weren’t as severely impacted, but it also allowed
clinicians more flexibility and mobility.
• Republican Gov. Kristi Noem of South Dakota wants to make those changes
permanent to attract more providers.
• Vermont Republican Gov. Phil Scott signed a law allowing medical providers
licensed in other states to continue telemedicine services for Vermont
patients.
• Democratic Gov. Jared Polis of Colorado has considered eliminating
licensing fees for health care workers.

IV. Legislative solutions
Preventive measures through public
health campaigns

Preventive measures through public health campaigns
• As seen with the Covid-19 pandemic, the need for consistent and
humanized information is paramount to gaining public trust and allow
health care workers to do their jobs, effectively preventing the spread
of infectious disease.
• The same is true for public health messages in general. While the
Covid-19 pandemic pushed public health authorities to utilize non-
traditional tools such as AI, apps and social media to track the
disease, answer questions and spread information, the same efforts
can be made to address public health issues in non-crisis mode.

• The worst of the workforce resignations have been in the acute-care
setting. Many hospitals are overwhelmed due in part to ineffective public
health outreach that would prevent patients from needing acute care.
• In terms of the culture of our health system as a whole, there is no reward
for creating the absence of disease. Much of our health system can be
summed up as “wait until you get sick, then we care for you.” If we can
figure out the wellness side of equation, this may help with the shortage
side of the equation.
• By eliminating behavior-related risk factors, ~ 40% of all cancer-related
cases and ~80% of all heart diseases, diabetes and stroke could be
prevented.

• The authors of the study “The Role of Incentives in Health – Closing
the Gap” emphasize that making wellness incentives and programs
part of company cultures on a broader scale can help to improve
employee health and stimulate healthy lifestyle practices that prevent
disease.

• Expanding wellness and health campaigns in schools, educating
children and families on healthy lifestyle choices, including diet,
exercise, mental health and wellness are important measures in
preventing disease.
• Example: The state of Georgia implemented a program called Growing
Fit which offered comprehensive health education toolkits and staff
trainings to 302 schools to combat child obesity and promote early
childhood health and wellness.

• Billboards are great, AI is better. A Deloitte study on public health
campaigns emphasizes that dollars spent on public health outreach
campaigns can optimize their effectiveness through the strategic use
of AI and personalized messaging, engaging cultural influencers, and
utilizing behavioral theories.

Increase state funding of nursing
programs

Increase state funding of nursing programs
• “The average age of employed registered nurses climbed from nearly
43 to nearly 48 between 2000 and 2018, and nearly half are now over
50, according to the University of St. Augustine for Health Sciences in
Florida.
• The U.S. Bureau of Labor Statistics estimates that each year through
2030, there will be nearly 195,000 vacancies for registered nurses.
The St. Augustine report says that the profession isn’t producing
registered nurses fast enough to meet the demand.”

• An article in Pew titled “Health Worker Shortages Forces States to
Scramble” sought to tackle this issue:
o“Several governors, including those in Alabama, Colorado, Maine, New
York and Wisconsin, have pushed for higher compensation for health
care workers.
oIn her state of the state address, Democratic Gov. Janet Mills in Maine
cited the state’s investment of $600 million in state and federal funds to
raise Medicaid reimbursement rates, which would increase payment to
doctors who see low-income patients. She proposed spending $50
million more.

• Cont’d:
oNew York Gov. Kathy Hochul, another Democrat, proposed making a $10
billion, multiyear investment in the health care workforce to raise the
Medicaid reimbursement rate, provide retention bonuses to frontline medical
providers and increase the pipeline of those going into health care. The New
York legislature is discussing an even higher financial commitment.
oGovernors in Alaska, Georgia, Hawaii, Maine, New Mexico and Oklahoma
proposed expanding education programs to train more nurses and other
medical providers. Georgia Republican Gov. Brian Kemp, for example, said he
was including millions of dollars in his budget proposal to train more nurses
and add medical residency slots. Over time, he said, the goal is to increase the
health care workforce by 1,300.

• Cont’d:
oAlaska Republican Gov. Mike Dunleavy cited a state grant of $2.1 million
to train and retain nursing faculty.
oIn Iowa, Republican Gov. Kim Reynolds announced a new
apprenticeship program for high school students that would enable
them to become certified nursing assistants before they graduated.
oReynolds, Hochul and Democrats J.B. Pritzker of Illinois and Daniel
McKee of Rhode Island pledged additional scholarships, tuition
reimbursement or loan forgiveness for students training in health care,
particularly for those who stay to practice in those states.”

Expand affordable health care

• The Affordable Care Act (Obamacare), Medicaid, Medicare depend on
preventive care to lower costs.
• Hospital care accounts for 1/3 of health care costs in the U.S.
• Affordable healthcare allows more people to access health care
providers for non-acute problems, giving an opportunity for
healthcare providers to catch conditions early and provide solutions
to prevent the condition from reaching a critical point that would
require more extensive treatment and hospitalization.

• Affordable access to these and other services can significantly impact
long-term health care and prevent the onset of acute diseases:
-Annual physicals
-Gynecological visits
-Allergy medications
-Insulin
-Colonoscopies and mammograms
-Screenings for high blood pressure and high cholesterol

• Expanding affordable health services like Medicaid and Medicare
works.
• A Health Affairs study conducted in 2018 found a 40% increase in
diabetes prescriptions being filled in states that had expanded
Medicaid with no increase found in states that had not expanded
Medicaid.
• According to a 2019 study, Medicaid expansion was associated with
19,200 fewer deaths among older low-income adults from 2013 to
2017; 15,600 preventable deaths occurred in states that did not
expand Medicaid.

• Essential health benefits help disabled people access necessary
services. Prior to the ACA, 45 percent of individual market plans did
not cover SUD services and 38 percent did not cover mental health
care. Following ACA implementation, people with mental health
conditions became significantly less likely to report unmet need due
to cost of mental health care.
• About one-quarter to one-third of new enrollees under Medicaid
expansion are children.
• 20 million fewer Americans are uninsured since the Affordable Care
Act was implemented.

Make the increase in public health
budgets permanent

Make the increase in public health budgets permanent
• 77% of clinicians believe policymakers should make the current
reimbursement changes that were created in response to the
pandemic permanent.

Make the increase in public health budgets permanent
• We’re already there, it’s just maintaining the current cap.
• According to a National Library of Medicine article: “The pandemic has
persuaded and forced the governments to inject much-needed funds into
the health system. The health system has seen the allocation of
unprecedented amounts of finances that have the potential to change the
whole outlook of the health system, making it stronger and more
responsive to the needs of populations. However, the government needs to
create a permanent budget cap exemption mechanism for public health
functions that are critical to prevent, detect, and respond to infectious
diseases. This mechanism is a potential road for stable and increased
funding for public health for the long term.”

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