Highlights of Outreach and Collaborative Efforts of the
Beneficiary and Family Centered Care - Quality Improvement Organization (BFCC-QIO)
|
|
Breaking Down Barriers: Access to Healthcare |
|
Depending on a person's location, a quick internet search for “doctors near me” can generate a lengthy list of healthcare providers, practitioners, and facilities. Although locating a healthcare provider may be simple enough, the ability to get a needed appointment at a desired location may not be simple. In fact, for some people, getting timely appointments can present significant barriers to receiving necessary health care, contributing to poor health outcomes and other adverse effects. This issue of The Livanta Compass examines some of the challenges that individuals may experience regarding access to health care.
|
|
Access to health care was defined over 30 years ago in the landmark publication Access to Health Care in America, published by the National Academies of Science, Engineering, and Medicine (NASEM). Access is defined as “the timely use of personal health services to achieve the best health outcomes.” This definition goes beyond services simply being available by including the notion of timeliness. Healthy People 2030, a federal initiative, provides an even more detailed explanation of what constitutes healthcare access.
As part of Healthy People 2030, the U.S. Department of Health and Human Services (HHS) defines four main components of access to health care. These components are described below.
-
Coverage. Insurance coverage helps people access the medical services they need by paying for a portion of the rendered care. People who do not have health insurance are less likely to get the care they need and frequently have poorer health outcomes than their insured peers.
-
Services. According to the Administration for Healthcare Research and Quality (AHRQ), patients with a regular healthcare provider, i.e., a primary care physician, are more likely to receive preventative care, which can lead to better overall health. The services component acknowledges the need for regular sources of care.
-
Timeliness. For many, not receiving needed care at the time it is needed can be the equivalent of going without care. Timeliness is a critical component of healthcare access.
-
Workforce. The availability of capable, qualified, and culturally competent healthcare professionals is a critical component in the healthcare continuum. Providers who are poorly trained, and/or staff who lack cultural competence will be unable to connect with those they are seeking to serve. This could be a significant barrier to quality health care.
Access to quality health care is also a key component in CMS’ Framework for Health Equity. To learn more about this important initiative, visit CMS website here:
Healthy People 2030
NASEM, “Access to Health Care in America”
|
|
For those who live in large cities and major metropolitan areas, the list of available healthcare providers can be overwhelming when trying to locate a new physician or specialist, especially when several large hospital systems exist in the same community. However, the growing problem of workforce shortages can make it hard to access timely healthcare services, particularly for individuals who live in rural communities or sparsely populated areas.
The Health Resource and Services Administration (HRSA) classifies many rural jurisdictions as Health Professional Shortage Areas (HPSAs). In these areas, an acute shortage of licensed health professionals can constitute a barrier to receiving care. This shortage affects two significant components of access: workforce and services. With a shortage of qualified workers, facilities such as hospitals may be understaffed and unable to address the daily influx of patients seeking care. Similarly, HRSA reports that 65 percent of primary care shortage areas are in rural communities.
HRSA, “Designated Health Professional Shortage Areas Statistics”
|
|
Transportation and Access |
|
In addition to experiencing shortages of qualified healthcare professionals, people who reside in rural areas also frequently experience transportation challenges. Because of the low population density, lack of public transportation and rideshare services, and relative poverty compared to urban areas, residents in rural jurisdictions frequently have few transportation options if they rely on others for transportation. Additionally, many individuals who live in rural communities must travel long distances to seek care, especially for medically complex heath issues or specialty care. In the U.S., the population is aging more rapidly in rural areas than in urban areas. This presents unique challenges for older adults in these communities.
RHIHub, “Health Care Access”
AHA, “Social Determinants of Health Series: Transportation and the Role of Hospitals”
Health Affairs, “Public Transportation In The US: A Driver Of Health And Equity”
American Journal of Public Health,” Transportation Barriers to Health Care in the United States: Findings From the National Health Interview Survey, 1997–2017”
JAMA Network, “Disparities in Travel-Related Barriers to Accessing Health Care From the 2017 National Household Travel Survey”
|
|
Self-perceptions of Aging as a Barrier to Care |
|
Reducing and removing perceived barriers to care is one of the most challenging complications in improving access to care. According to a 2017 study published in The Gerontologist, one of the more significant perceived barriers to seeking medical care was older adults’ views of the aging process. This study showed that those who have a negative view of the aging process are less likely to seek care. Stemming from multiple factors, including a negative view or dislike of visiting a doctor or a healthcare facility, these perceptions often prevented individuals from seeking care, leading to artificial barriers to accessing care. Delaying or skipping care can lead to adverse health outcomes and poorer overall health.
The Gerontologist, “Self-Perceptions of Aging and Perceived Barriers to Care: Reasons for Health Care Delay”
|
|
Telemedicine: Improving Access |
|
Medicare has recognized the need to include telehealth services as a covered benefit, especially in rural communities. During the COVID-19 pandemic, Medicare extended telehealth coverage regardless of location. However, those coverages are scheduled to end in December 2024. After December 2024, in most cases, only rural residents will qualify for Medicare covered telehealth services. Exceptions include home visits for dialysis, services for evaluating and treating strokes, substance abuse or mental health treatments, and in-home behavioral health services. To learn more about what may be covered and what may not be covered, review this page from Medicare here: https://www.medicare.gov/coverage/telehealth
|
|
Removing Barriers for Medicare Beneficiaries, Families and Caregivers |
|
When Medicare beneficiaries have concerns related to healthcare access, Livanta’s immediate advocacy service can be an extra layer of support. Livanta’s dedicated nurses and advocates can address concerns directly with the healthcare provider or work with the provider to identify the beneficiary’s needs for additional resources. Understanding and addressing real and perceived barriers for Medicare patients, their families, and caregivers is imperative to Livanta’s work as a Beneficiary and Family Centered Care - Quality Improvement Organization (BFCC-QIO).
As a Medicare contractor, Livanta takes several steps to ensure equitable access to its programs and services. These steps include ensuring Livanta’s website and electronic content meet federal accessibility standards and providing support for those who speak languages other than English. Did you know that Livanta’s BFCC-QIO website is also fully coded in Spanish? https://www.livantaqio.cms.gov/es
Livanta also provides real-time interpreters for over 200 languages, from Arabic and Bengali to Urdu and Vietnamese, and dozens of other languages, Livanta’s language support is available to all callers to its Medicare helpline. Additionally, beneficiary letters and other materials can be translated to other languages by request.
|
|
This material was prepared by Livanta LLC, the Medicare Beneficiary and Family Centered Care - Quality Improvement Organization (BFCC-QIO) that provides claims review services nationwide and case review services for Medicare Regions 2, 3, 5, 7, and 9, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy.
Livanta does not provide medical advice, diagnosis, or treatment. The content of this article is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.12-SOW-MD-2024-QIOBFCC-CP326
|
|
|
|
|
|
|
