Health Professional Shortage Areas and How Telehealth Can Help

The COVID-19 pandemic has shed light on a problem that has been present for years: an overburdened healthcare system in the U.S. As COVID-19 patients became more numerous, concern surfaced over the potential for overflowing hospitals and emergency rooms, overworked and underprotected healthcare workers, and a potential inability to get routine or other care for conditions unrelated to COVID-19. However, access to healthcare has been inadequate for years.

One way to define populations that may have trouble getting the care they need is by Health Professional Shortage Areas (HPSA) in primary care. By definition, an HPSA has a low ratio of doctors to patients residing in the area, and results can be devastating for patient health afvnd for healthcare costs. For example, while a simple lifestyle change program can lower risk for type 2 diabetes among patients with prediabetes, patients who have prediabetes but inadequate basic care are likely to develop type 2 diabetes within years.

Telehealth solutions can deliver care to these and other underserved populations and relieve the burden on the healthcare system through reducing the shortage of providers, improving population health, and keeping costs down. Lark Diabetes Prevention Program (DPP) is a telehealth lifestyle change program that serves HPSA’s, is infinitely scalable, and is effective.

What Are Health Professional Shortage Areas?

The Bureau of Health Workforce of the Health Resources and Services Administration (HRSA) defines an HPSA by its ratio of patients in a population group to providers in a geographic area. A Primary Care HPSA has a population-to-provider ratio of at least 3,500 to 1, or at least 3,000 to 1 in lower-income areas[1]. Physicians that are counted in this ratio include those who practice mainly in family practice, internal medicine, OB/GYN, pediatrics, and internal medicine. 

A “population group” can include all patients within the geographic area. It could alternatively include a specific community, within that area, such as migrant workers, homeless individuals, low-income households, or prison inmates. In 2019, nearly 80 million people lived in an HPSA. That means that nearly 1 in 4 people living in the U.S. lived in an area with a shortage of primary care providers. 

Having a Primary Care HPSA designation makes the area eligible for a variety of grants and other support, including bonuses for physicians who serve Medicare beneficiaries in HPSAs. Other programs can include training and educational support for faculty, nurses, and doctors. Despite these incentives, though, HPSAs and a shortage of primary care persist. With COVID-19 in the picture, shortages can be even greater, and consequences being even more severe. 

What Are the Consequences of Living in a Health Professional Shortage Area?

Healthcare provider shortages are a growing problem throughout the country. The Association of American Medical Colleges (AAMC) predicts a shortage of physicians that could grow to 46,900 to 121,900 by 2032 [2].

What happens when patients have less access to primary care doctors? The AAMC lists several areas that directly involve primary care providers.

• Better population health, with an emphasis on preventive care and modifying lifestyle factors such as obesity, hypertension, high blood sugar, and smoking.
• Managed care to shift incentives to outcomes rather than services provided.
• Behavior management to support mental health.
• Coordinating care, including providing basic care that can prevent emergency room admissions.
• Services that specialists could also provide.

Living in an HPSA, which lacks sufficient primary care providers, can lead to poorer outcomes in each of these areas. For example, without being able to provide support for patients to change lifestyle behaviors causing obesity, hypertension, high blood sugar, and other risk factors, populations may have a higher prevalence of prediabetes, diabetes, heart disease, and other chronic conditions with lifestyle choices as underlying causes. 

Challenges of Diabetes and Prediabetes

Diabetes provides an example of challenges that can be present in HPSAs. In 2018, this chronic condition affected 34 million, or 1 in 8, Americans, with 90 to 95% of these cases being type 2 diabetes [3]. Another 88 million, or 1 in 3, Americans had prediabetes. 

Without proper treatment, prediabetes is likely to progress to diabetes within 5 to 10 years, leading to excess per-person medical costs of $9,601. Diabetes is a risk factor for conditions such as hypertension and heart disease, and complications linked to uncontrolled blood sugar include kidney disease, diabetic neuropathy, and blindness. 

COVID-19 appears to be another health concern for patients with diabetes. Diabetes weakens the immune system and increases susceptibility to infections. In addition, patients with diabetes appear to be at higher risk for developing more serious cases of COVID-19, such as hospitalizations and requiring ventilators.

However, type 2 diabetes and prediabetes are largely considered preventable. Obesity and physical inactivity are among the greatest risk factors for developing insulin resistance, prediabetes, and diabetes. Even after the development of prediabetes, healthy behavior changes such as losing weight and increasing physical activity can lower the risk of being diagnosed with diabetes soon.

Losing weight and increasing physical activity among overweight individuals with prediabetes lowers risk for type 2 diabetes by over 50% over the next 3 years [4], and by 27% over the next 15 years [5]. Preventing or delaying type 2 diabetes lowers complications and reduces healthcare costs.

Barriers to Diabetes Prevention and Prediabetes Management in HPSAs

Patients in HPSAs and with less access to primary care and preventive services are at a disadvantage when it comes to preventing and managing chronic conditions. Losing excess weight and increasing physical activity can manage prediabetes and lower risk for developing type 2 diabetes, but inadequate access to primary care can lead to a lack of sufficient support for these and other behavior to lower risk, such as quitting smoking and choosing more nutritious foods.

The National Diabetes Prevention Program (DPP) is a lifestyle intervention program with goals of losing weight and increasing physical activity, but fewer than 3% of those who may be eligible are actually participating in a DPP. A traditional DPP has in-person sessions for weigh-ins and discussion of a curriculum approved by the Centers for Disease Control and Prevention (CDC). Barriers to participation can include cost, not enough programs, scheduling conflicts, and lack of time or transportation. Social distancing measures and avoidance of voluntary trips to medical facilities due to COVID-19 can be additional barriers to participating in preventive, in-person programs, such as a traditional DPP.

Telehealth and Prediabetes in Health Professional Shortage Areas

Telehealth allows for the remote delivery of healthcare services. Online health portals, video chats, emails, and phone calls can be part of telehealth as patients can get care without being in the physical presence of a provider. Live providers can be behind telehealth interventions, but telehealth can also be powered by artificial intelligence (AI). Medicare and other payers now cover a wide range of telehealth services, including some preventive services.

A major benefit of telehealth, especially in HPSAs, is its potential for improved health outcomes through increased access. Each provider can see more patients, which in effect reduces the provider shortage in an HPSA. Getting primary care can lower the risk for developing many chronic conditions, such as diabetes and hypertension, or help patients better manage conditions they already have. The result can be better health and fewer complications.

Virtual visits and online interactions have other advantages. Patients who may not be able to take off several hours from work to drive far or take public transportation to a clinic for an in-person appointment or pharmacy visit can get services in far less time. Having appointments via video calls, accessing online portals, and ordering prescriptions online can be more feasible by requiring little or no childcare to complete the transaction.

Telehealth can have economic benefits as well. A greater number of patients per provider increases revenue. Patients may be more likely to access preventive care, such as a DPP or tobacco cessation program, via telehealth, thus staying well and preventing more costly emergency room visits and hospitalizations later. Keeping patients out of offices takes fewer resources. Since Lark DPP is powered by AI, it can serve infinite patients while retaining its personalization for each patient.

Telehealth and Care for Prediabetes During COVID-19

Telehealth is an important strategy within the healthcare system, especially during the COVID-19 pandemic. To avoid getting infected with the novel coronavirus, many patients are staying away from hospitals and clinics for services that are considered non-essential, such as weight counseling and blood sugar management, for example. Consequences of skipping these services can include higher risk for chronic conditions and , such as type 2 diabetes, and related complications. Telehealth offers a way for patients to get care without exposing themselves to the virus. For example, Lark DPP is available over the phone for patients with prediabetes.

COVID-19 threatens to push an already overburdened healthcare system over the edge, but telehealth can help relieve the burden. Providing basic care outside of healthcare facilities takes fewer resources, including personnel, space, and equipment, all of which are in high demand during the pandemic. Since it is powered by AI, patient interactions with Lark DPP do not take any live providers away from other duties.

In summary, telehealth can offer:

• Better health outcomes by continuing preventing healthcare during the pandemic.
• Less risk for patients to get COVID-19, leading to better health for them and fewer COVID-19 patients to care for in hospitals.
• Less chance for patients to expose healthcare providers to COVID-19.

With Lark DPP, patients can get preventive services, such as weight loss counseling and health education, anytime via their smartphones.

Lark DPP and HSPAs

Lark DPP is fully recognized in the Diabetes Recognition Prevention Program (DPRP) by the Centers for Disease Control and Prevention (CDC). As required for CDC recognition, Lark delivers a CDC-approved curriculum for preventing diabetes and helps patients set and work towards weight loss and physical activity goals. In addition, Lark provides coaching on healthy eating, sleep, stress management, and other topics relevant to lowering blood sugar. 

Lark is delivered via a smartphone app and it is powered by AI. Unlike with in-person DPPs, Lark patients have unlimited access to their Lark coach at any time and from anywhere they can connect to the internet. This can especially benefit patients in HPSAs who may be less able to attend in-person DPP sessions or who need extra support in making healthy lifestyle choices. Furthermore, AI allows patients to receive personalized coaching every time, and for the personalization to increase as patients use Lark more.

Because Lark does not depend on live providers for patient-coach interactions, the program is infinitely scalable, including in HPSAs that are in need of primary and preventive care services and providers.

Preventing Diabetes and COVID-19 at in HPSAs with Lark

Lark’s DPP has been shown to be effective, including in underprivileged areas. In one analysis of over 25,000 Lark DPP participants, over half were in HPSAs. Among these participants, the average amount of weight loss was 4.3% of initial weight, or about 2 kg. Weight loss is important not only as a sign that the program is achieving its goals, but because it is closely tied to diabetes risk. A loss of 1 kg has been linked to a 16% reduction in risk of diabetes diagnosis.

As patients continue to receive preventive care to lower diabetes risk, there is another set of benefits to getting the care at home with Lark DPP. By staying home rather than risking trips to hospitals or other facilities for in-person educational DPP sessions, patients with prediabetes are practicing social distancing and avoiding unnecessary exposure to possible COVID-19 patients.

With proven results, Lark DPP is a proven telehealth service that can make a difference. Patients in HPSAs can use Lark to prevent or delay type 2 diabetes, all while staying home and safe from COVID-19, thus reducing the burden on the healthcare system. Seamless startup and administration make the program easy to introduce and run.

References

1.  Bureau of Health Workforce, Health Resources and Services Administration (HRSA), U.S. Department of Health & Human Services, Designated Health Professional Shortage Areas Statistics: Designated HPSA Quarterly Summary, as of September 30, 2019 available at https://data.hrsa.gov/topics/health-workforce/shortage-areas.
2. Association of American Medical Colleges. The 2019 Update: The complexities of physician supply and demand: Projections from 2017 to 2032. 2019. Washington, D.C. 
3. Centers for Disease Control and Prevention. National diabetes statistics report 2020: Estimates of diabetes and its burden on the United States. https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf
4. Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. February 7, 2002. N Engl J Med. 2002; 346:393-403. DOI: 10.1056/NEJMoa012512
5. Diabetes Prevention Program Research Group. Long-term effects of lifestyle intervention or metformin on diabetes development and microvascular complications over 15-year follow-up: the Diabetes Prevention Program Outcomes Study. Lancet Diabetes Endocrinol. 2015;3(11):866–875. doi:10.1016/S2213-8587(15)00291-0