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Publication Category: Delivery System

Telehealth for people with disabilities: here are the challenges and opportunities policymakers should consider

Portrait of a man in a wheelchair on a laptop

A man in a wheelchair accesses telehealth on laptopTelehealth was a lifeline for people with disabilities during the COVID-19 pandemic. Federal and state policy changes allowed clinics, health systems, and providers to expand telehealth services, which benefitted people with disabilities. 

People with disabilities, approximately one in every four Americans, are six times more likely to have ten or more physician visits and five times more likely to be admitted to a hospital. So there is a high need for accessible care.

Findings

Telehealth is known to:

  • Increase access to care by reducing transportation needs and wait times while increasing access to specialists in shortage areas.
  • Reduce costs by improving continuity of care, which lowers the likelihood of a high-cost care situation.
  • And promote independence by empowering people to manage their own conditions.

However, people with disabilities may find it difficult to access telehealth.

One Pew Research Center study found that people with disabilities were 20 percent less likely to own a computer, smartphone, or tablet compared to people without disabilities. And because 26 percent of people with disabilities live at or below the poverty line (2019) they can’t always afford high speed internet or advanced technology. 

In addition, telehealth isn’t well designed for people with disabilities.

Conclusions

Policy and decision leaders should consider the needs of people with disabilities as they review telehealth policies. 

In this new brief, CHRT describes telehealth opportunities and barriers for people with disabilities. CHRT offers national and state policy suggestions to make these services more accessible, functional, and supportive for people with disabilities.

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Cover Michigan Survey: Use of Health Care Benefits in Michigan

Data from the Center for Health and Research Transformation’s (CHRT) 2018 Cover Michigan Survey show health benefits that Michiganders with health insurance coverage have used in the past year (1)Survey participants were asked whether or not they or other family members covered by their plans used each health care benefit in the past 12 months.. Detail on the Cover Michigan Survey and analysis methodology can be found on CHRT’s website. In addition to findings on overall use of health care benefits, this brief focuses on three key areas: dental and vision, reproductive health, and mental health care.

Nearly all Michiganders used some kind of health benefit over the last year. To understand differences in the use of health care benefits, several variables were examined by demographics including gender, age, race, insurance type, income, and employment status.

  • Preventive care: The highest utilized benefit was routine, preventive primary care This was consistent across all groups.
  • Dental and vision care: There is high use of these benefits even though they are not generally core offerings of most insurance
  • Reproductive health care: Michigan women, especially younger women, use these health benefits at a significantly higher rate than men and older women. Reproductive health care represents 11 percent of younger women’s health care utilization.
  • Mental health care: Younger women and people who are unemployed reported significantly higher use of their mental health care or substance use treatment coverage.

Other findings include:

  • Aside from dental and inpatient care, women consistently utilized more health care benefits than men.
  • African Americans were the least likely to visit a doctor and use vision care benefits compared to other races, while white Michiganders were the most likely to use inpatient services.
  • Regardless of insurance type, respondents use doctor visits at similar rates, however those with employer-provided insurance were the most likely to use dental care health benefits.
  • Medicaid beneficiaries had the highest utilization of pediatric care, contraceptive/family planning, mental health/substance use, and maternity/newborn care benefits; and Medicare beneficiaries made the most use of the prescription drug benefit. These differences are likely due to the unique populations that make up membership in these plans.
  • Compared to those with lower household income, Michiganders with incomes of $50,000 or more per year were far more likely to use dental care, doctor visits, and vision benefits.
  • The unemployed population was more likely to use inpatient care, mental health/substance abuse services, and maternity/newborn care than those who are working or in school.

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References

References
↑1 Survey participants were asked whether or not they or other family members covered by their plans used each health care benefit in the past 12 months.

Learning health for Michigan: The path forward

A physician in blue scrubs points at a screen with tiles showing health symbols, a representation of a health learning system.

A physician in blue scrubs points at a screen with tiles showing health symbols, a representation of a health learning system.In the United States, health care purchasers, consumers, and policymakers are demanding improvements in the quality and efficiency of medical care. A promising approach to meet this demand is the development of what is known as a learning health system (LHS). A learning health system has the capability to continuously study and improve itself. Among many types of benefits it can bring about, the learning health system makes it possible for providers to make faster and better decisions about which treatment options would produce the best outcomes for patients.

Today, the Michigan-based stakeholder initiative, Learning Health for Michigan (LH4M), is proposing the use of a learning health system approach to address persistent health care problems in Michigan. Unwarranted and costly hospital readmissions—which are discussed in this paper—are one example of a problem that could benefit from a learning health system approach.

In 2013, the Center for Healthcare Research and Transformation (CHRT) convened a group of patients, clinicians, researchers, public health professionals, and payers to discuss ways to apply the idea of the learning health system at a state level: to turn Michigan into what might be called a “learning health state.” The initiative was named “Learning Health for Michigan,” or LH4M. Later convenings of the LH4M stakeholder group were organized by the Michigan Health Information Network (MiHIN) Shared Services and the Department of Learning Health Sciences at the University of Michigan Medical School.

Michigan has many resources that are key ingredients for a state-wide learning health system.

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Publicly Reported Hospital Quality Rankings

Five wooden stars arranged on wooden blocks.Publicly-reported hospital rankings are released annually and are widely publicized by both the sponsors of the rankings and hospitals that are highly ranked as indicators of hospital quality or safety. Meant to be a useful way for consumers to assess hospital quality, these ranking systems produce inconsistent, contradictory, and confusing results, as some hospitals are highly ranked in some systems but not in others.

The use of a unique set of criteria by each ranking system contributes to these inconsistent results. For example, a 2015 Health Affairs study compared hospital rankings from four prominent ranking systems and found that no hospital was ranked as a “top performer” by all four systems and only 10 percent were ranked highly by more than one ranking system, suggesting a lack of agreement regarding what constitutes high-quality hospital performance.

Federal ranking systems are no exception. For example, the Centers for Medicare & Medicaid Services (CMS) star ranking system was recently criticized for purportedly giving a disproportionate amount of low rankings to teaching hospitals and hospitals that serve low-income populations.

Moreover, there is some evidence that consumers do not utilize hospital rankings to make healthcare decisions, calling into question the value of these rankings from a consumer perspective.

This brief builds on previous findings by examining hospital rankings in Michigan and nationwide from nine well-known hospital ranking systems. This brief also examines the measures and methods used to assess hospital quality, and the extent to which hospital rankings address consumer needs regarding hospital choice. It includes summarized information from a 2014 systematic review of hospital quality rankings, an analysis of 2015 Michigan hospital rankings, and results from three consumer focus groups that were convened in 2016 to understand how consumers interpret and understand these rankings (see Methodology for more information regarding the analyses and focus groups).

Key findings include:

  • In 2012, more than one-third (37 percent) of U.S. hospitals were highly ranked(1)Hospitals were counted as “highly ranked” according to the methodology used by each individual ranking system. Because Leapfrog Safety Grade assigns a grade (“A” through “F”) to all hospitals, we counted hospitals that received an “A” as “highly ranked.” on one of nine hospital ranking systems;
  • In 2015, over half of Michigan acute care hospitals (52.7 percent) received a high rank on at least one of nine hospital ranking systems but less than one-fourth (22.5 percent) received a high rank on at least two ranking systems;
  • Each ranking system’s unique approach to evaluating hospital performance, including different goals, measures, and data sources, contributes to inconsistent results; and
  • Consumers report that they are not using rankings to choose a hospital because the rankings do not always include information that consumers are interested in and are not presented in a consumer-friendly manner.

Editor’s Note: This brief was based on a CHRT-funded unpublished manuscript by Kim, BoRin; Hu, Hsou-Mei; Bahl, Vinita: An Analysis of Publicly Reported Hospital Rankings of Hospital Quality.

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References

References
↑1 Hospitals were counted as “highly ranked” according to the methodology used by each individual ranking system. Because Leapfrog Safety Grade assigns a grade (“A” through “F”) to all hospitals, we counted hospitals that received an “A” as “highly ranked.”