Moving From Crisis To Lasting Change
The COVID-19 pandemic has forced the healthcare system to evolve quickly to meet the urgent needs of patients. One of the most immediate changes has been in the implementation of telemedicine — accessing healthcare professionals remotely, via phone or internet. While these changes have come about due to tragic circumstances, this modernization of the healthcare delivery system should endure beyond COVID-19. Our industry has an opportunity — an obligation really — to harness and improve upon the efforts made over the last few months to formalize a new operating model utilizing all of the clinical, digital, and pharmacological tools at our disposal to raise the standard of care for people well into the future.
We are all aware of patients choosing to forego care rather than place themselves in a potentially high-risk setting by visiting their doctor’s office or a hospital. Physical distancing and shelter-in-place measures are preventing many from accessing care, or the loss of employment has made the cost of basic treatment unaffordable. These circumstances have magnified the access and quality issues that so many people have always faced. In particular, those in rural areas, those with conditions that leave them vulnerable and in fear leaving their homes, and those affected by addiction and serious mental illness are often directly affected by the primary and secondary effects of the pandemic.
In the wake of COVID-19 we can expect another wave: a surge of mental health and addiction crises in a post-pandemic world. Before COVID-19, in the U.S. in 2018, 14.4 million adults struggled with alcohol use disorder (AUD), more than two million people lived with opioid use disorder (OUD), and 11.4 millionadults experienced serious mental illness. These diagnoses are challenging to treat but become even more complicated when paired with the exacerbating conditions of a pandemic: fear, social isolation, and economic hardship.
I share the concern of many about the impact of these conditions on people living with substance use disorders and serious mental illness. It is too early to discern long-term trends at this point, but already a study of 3,000 workers in the U.S. showed that 1 in 3 people said they’re more likely to drink in isolation, while another report found that 47 percent of adults who are sheltering in place say the pandemic has negatively affected their mental health and 21 percent say it has had a “major negative impact,” and a federal emergency hotline for people in emotional distress registered a more than 1,000 percent increase in April compared with the same period last year.
At Alkermes, we are focused on meeting the needs of these populations, specifically those suffering from schizophrenia and opioid and alcohol addiction, through the development of long-acting medicines — therapeutics uniquely suited for a time when physically distant care is needed. But we know from first-hand experience that prescription medication is only one aspect of patient need. True patient-centered care takes a comprehensive/holistic approach, including consideration of the appropriate medicine for the patient and accounting for the psychological, environmental, and behavioral factors that affect outcomes. This is where telemedicine, specifically telepsychiatry, can play a role.
Within the crisis we see evidence of beneficial change.
Prior to the pandemic, according to Ipsos, only 10 percent of healthcare providers saw patients via telemedicine, likely due to regulatory and reimbursement challenges, as well as inertia in practice. As the impact of the crisis set in, and the disruption to needed care became increasingly apparent, policymakers, payers, and other stakeholders moved quickly to enact important changes in our healthcare landscape, enabling much broader adoption of telemedicine. Now, according to the same Ipsos study, 80 percent of healthcare providers report over the last few months that they are seeing patients via telemedicine.
While in-person care should always remain a critical component of psychiatric care, in the instances where there are barriers to access, the option of telepsychiatry is a welcome addition and may broaden the pool of people able to seek care. But regardless of the circumstances, the necessary regulatory and statutory changes prompted by COVID-19 need to be made permanent. And there are challenges to this form of healthcare delivery that require attention. Individuals need to have access to a computer or other internet-connected device that allows for remote interaction. They need to have an ability to find a secure, private setting to ensure they are comfortable speaking openly across an unfamiliar medium. They need to be able to acquire their prescribed medication, which can be difficult if it requires administration by a licensed healthcare professional. And it goes without saying that no aspect of care should be diminished due to the introduction of telehealth — quality, compassionate, patient-centric care should always include the appropriate pharmacological approach tailored for the individual patient, along with the appropriate behavioral and social supports.
Despite some of these challenges, telepsychiatry can open a world of possibilities for patients; saving time, enabling people to access medical professionals outside of their immediate geographic area, and removing the need for transportation. While we at Alkermes are committed to doing our part to ensure that impediments to healthcare delivery are reduced through our patient access and prescriber network programs, we are also doing what we can to address current systemic and social barriers. We are looking closely at what we can do to evolve, including investing in our digital capabilities, incorporating telemedicine into our clinical trials, and identifying ways to help patients and their care network to access prescribed therapies as part of this broader move to less frequent in-person office visits.
Real change requires shared thinking among a wide range of healthcare stakeholders. Now is the time to come together and put forth a concerted effort to comprehensively rethink the way we care for patients, utilizing the digital, clinical, and pharmacological advances of the past few years and engaging all aspects of the healthcare system. We must work together with policymakers to ensure that the state and federal licensing requirements can accommodate this shift, insurers need to enable the right models for reimbursement, and regulators need to examine the digital platforms and HIPAA concerns to institute the right form of the currently-relaxed regulations.
As Andy Warhol said, “They always say time changes things, but you actually have to change them yourself.” Now is the time for us as an industry to unite as a positive force for change to forge purposeful advancements that will outlast this crisis and meaningfully impact our healthcare system for the long-term.