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National rollout of 988 for mental health emergencies begins

By Jeff Levin-Scherz, MD | July 27, 2022

A new mental health hotline, a report on medical errors, an update on hospital mergers and the latest on COVID-19 in this week’s roundup.
Health and Benefits|Ευεξία
Risque de pandémie

This week’s healthcare roundup includes news about the rollout of a national mental health hotline, a decrease in hospital medical errors, regulatory approach to hospital consolidation and the latest on COVID-19.

Mental health emergencies are fundamentally different from crimes or fires, but until now, most people reporting a mental health crisis have called 911. A national suicide hotline (1-800-273-8255) was first established in 2004. But this number is 10 digits long and hard to remember.

In 2018 Congress passed a bipartisan bill to establish this hotline and the Federal Communications Commission chose 988. Just like 911, the new hotline is usually local, but other regions may handle overflow calls.

This new hotline will meet an important need. Anxiety and depression are up since the beginning of the pandemic, and there are over 3,500 suicides a month. Suicide is currently the tenth leading cause of death and the second leading cause of death among adolescents and young adults. The 988 line will focus on offering easy access to telephonic and in-person treatment for mental illness. Also police are less likely to become involved in calls to the line.

But this new hotline will likely have growing pains. Many states have yet to arrange sustainable financing for 988 call centers, and many of these call centers can’t connect people to the necessary in-person follow-up care because of provider shortages. Also technology used by 911 to pinpoint the caller’s location will not initially be available to 988 call centers, and the 911 and 988 call centers could compete for resources or staff in coming years. Also both services will have to learn to do “warm transfers” as a mental health call sometimes requires police (for instance when a weapon is involved), or an ambulance call sometimes requires mental health assistance.

I’m confident that a dedicated hotline for mental health crisis care can help address real community needs and decrease the suicide rate.

Implications for employers:

  • Supervisors should be aware of the new 988 hotline and should continue to refer employees as needed to employee assistance programs (EAP) or other resources.
  • Companies can help address the crisis of suicide by:
    • Providing robust behavioral health coverage with a network offering excellent access
    • Employing a comprehensive emotional wellbeing approach that integrates EAP and behavioral health with medical, pharmacy and disability
    • Communicating current resources in place throughout the organization to make people aware of what is currently available
    • Providing targeted manager training

FTC blocks hospital consolidation

The Federal Trade Commission (FTC) blocked four proposed hospital mergers or acquisitions over the last year. This is in line with a presidential executive order issued in July 2021 that ordered federal agencies to “promote competition in the American economy.”

High total healthcare costs in the U.S. are largely driven by high and increasing unit prices. There is overwhelming evidence that consolidation of hospitals leads to higher prices. Also there is some evidence that hospital mergers can lead to decreased quality of care.

Implication for employers:

  • More robust enforcement of antitrust laws is likely to help tamp down at least some cost increases.
  • Prior consolidation of health systems may raise costs in the coming years as multiyear contracts are renegotiated.
  • More competition generally helps keep prices lower, but most U.S. markets at this point have substantial concentration. Health plans also have consolidated, but in most markets they have less leverage than hospital systems.

Hospital medical errors down between 2010 and 2019

The Journal of the American Medical Association reported this month that the rate of medical errors in hospitals declined during the 2010s.

  • The rates of errors in the treatment of heart attacks, pneumonia, heart failure and major surgical procedures were down by about a third.
  • The rate of errors in treating heart failure went down by about a quarter.

The study focused on Medicare beneficiaries, since this data is readily available. Nonetheless, the benefit is likely to extend to those on employer-sponsored health plans, too.

Implications for employers

  • Decreased adverse events likely will help increase value of care delivered to members and could decrease overall cost for healthcare payers.
  • Each hospital adverse event means an individual stays in the hospital longer, doesn’t achieve their optimal health outcome or suffers more. Hospital adverse outcomes hurt patients and also have adverse impacts on their families.
  • We’ll have to see how this changed in 2020 with the pandemic, when many hospitals were short of staff, space and equipment. This might have increased hospital adverse events.

COVID-19 update

  • The Centers for Disease Control and Prevention (CDC) provided data on the efficacy of second booster shots for those over age 50. A second booster decreased the likelihood of hospitalization substantially. A third dose was 55% effective at preventing hospitalization after four months. A fourth dose was 80% effective after seven days – practically a two-fold reduction in the risk of a hospitalization. The limited follow-up time after the fourth dose makes comparison in efficacy more challenging. But this is still more evidence that employers should continue to encourage vaccination and boosters.
  • The CDC recommended the use of Novavax for primary vaccination (first two doses) this week. This is a protein-based vaccine and could be attractive to some who have resisted getting mRNA vaccines. The Novavax vaccine does not yet have emergency use authorization for booster shots.
  • The Department of Health and Human Services extended the COVID-19 pandemic emergency until at least October. This means that we will not see a large purge of Medicaid beneficiaries at least until mid-fall.
  • COVID-19 was the number one killer of adults age 45 to 55 for the first nine months of 2021 – surpassing deaths from heart disease, cancer and accidents.

The White House announced that President Joe Biden tested positive for COVID-19. He is displaying symptoms including fatigue, sore throat and congestion. He has had four vaccines (primary series and two boosters) and is taking Paxlovid. He is likely to recover quickly and fully. This helps demonstrate how common infection is. The President has many domestic and international exposures each week. In addition to vaccination, individuals can protect themselves by masking when indoors, especially in crowded spaces. Employers can reduce risks by increasing the quality of indoor air.

Suggested reading

  • WTW sponsored a client webinar on abortion in employer sponsored health plans after the Supreme Court Dobbs vs. Jackson Women’s Health recently, with over 1,200 attendees. For more, see a related article that I coauthored with Rachael McCann.
  • I coauthored an article on tips for digital and virtual vendors published in StatNews on July 20, 2022. For more on digital vendors, check out our podcast series the Cure for the Common Co.

Population Health Leader, Health and Benefits, North America

Jeff is an internal medicine physician and has led WTW’s clinical response to COVID-19 and other health-related topics. He has served in leadership roles in provider organizations and a health plan and is an Assistant Professor at Harvard Chan School of Public Health.

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