For security reasons, Cigna.com no longer supports your browser version. Please update your browser, or use an alternative browser such as Google Chrome, Microsoft Edge, or Mozilla Firefox for the best Cigna.com experience.
A Wish List for Improving Care Access
Joe Nicholson, DO - Chief Medical Officer
With the first quarter ending, it is a good time to reflect on the start of 2023 and consider potential innovation opportunities on the horizon. As I think about what I would wish for in healthcare right now, a few themes come to mind.
First and foremost, I believe we have a duty to our patients to better share information about social determinants of health (SDoH).
As we all know, socioeconomic and environmental factors can significantly impact a patient’s health outcomes. Without a concerted effort to lessen the effects of SDoH, we cannot achieve optimal healthcare for our communities. Although we are beginning to make progress with this work, we still have a long way to go, especially in rural settings and urban medical deserts where access to healthcare is limited.
Fundamentally, we need to find ways to connect community-based organizations (CBOs) and healthcare entities to make sure we all have the same picture of the patient’s health needs and socioeconomic challenges. In an ideal world, there would be a federal program that gives all CBOs cost-free access to an SDoH platform. This technology could enable straightforward and HIPAA-compliant sharing of data between organizations that serve a community and would work similarly to a health information exchange. It could allow CBOs and healthcare organizations to communicate better and respond faster to patient health issues and the socioeconomic factors that affect them.
Next up on the “wish list” is the ability to integrate behavioral health and other specialty care more directly into primary care practice.
There are a few instances where physician groups have successfully integrated behavioral health. In my opinion, this is a winning combination, and I would like to see it gain traction. One thing standing in the way is there are not enough psychologists and psychiatrists to embed within primary care practices, resulting in access issues. As an industry, we need to figure out smart strategies to extend the reach of these critical providers. Although telehealth has helped, current certification rules limit the reach of virtual appointments. Right now, certification happens at the state level, making it difficult for providers to practice across state lines without penalty. However, if psychologists and psychiatrists could be certified at the federal level, they could practice in any state, making it easier for them to serve multiple practices across state lines either in person or via virtual appointments. This could be particularly beneficial when trying to reach patients in historically underserved areas. That is not to say that local certification and oversight are not important. However, once a physician is licensed in a single state, you could argue there should be auto-reciprocity for a national extension that happens automatically. This same approach could apply to other shortage-prone disciplines, including dermatology and ophthalmology.
Although some of the certification rules were lifted during the pandemic, and we expanded use of telemedicine, we are starting to revert to the old ways of doing things. Creating a federal certification body and using telehealth to its full potential could help get patients the clinical resources they need when and where they need them.
Those are just two of my many wishes for healthcare right now. Changes of this scope and scale are slow to come to fruition, however, thinking creatively about how to improve healthcare is a valuable exercise. As the industry works toward implementing big ideas like the ones described above, we can also take advantage of innovations that are already in progress, such as value-based care models. When providers participate in quality-driven reimbursement programs, they can transform the way they provide care, ensuring the best possible clinical health outcomes and patient experience while keeping the costs of care in check.
At CareAllies, we help providers as they advance their value-based care strategy. To learn more about how we are driving healthcare innovation, go to CareAllies.com.