Macro Perspectives
Insights
Healthcare access, underserved populations, and improving social outcomes — by Matthew Sexton, LCSW.
The Attrition Death Spiral: Why Recruiting More Clinicians Won't Fix Behavioral Health's Workforce Crisis
HRSA projects a 114,000 behavioral health counselor shortage by 2037. The real story isn't the pipeline — it's the hole in the bucket. Attrition is outpacing new entrants, and training more clinicians without fixing the conditions that burn them out is a policy prescription that can't work.
AI Is Replacing Licensed Clinicians in Mental Health Triage — And Nobody Is Asking If Patients Are Safer
Kaiser Permanente recently moved licensed clinical social workers out of behavioral health triage, replacing them with unlicensed operators following an AI script. The cost savings are immediate and visible. The liability is invisible — until it isn't.
Screening Without Handoffs: Why CMS's SDOH Rollback Creates a Dangerous Gap for High-Risk Patients
CMS has removed SDOH reporting from inpatient quality programs while expanding outpatient screening mandates. For ESRD and transplant patients — who move across both settings — this creates a structural gap that clinical social workers are now expected to bridge alone.
Your VA Rating Isn't Safe Just Because You're Getting Better
A 2026 VA interim rule allows medication effectiveness to reduce disability ratings — meaning veterans who manage their symptoms through treatment are now at financial risk for doing so. This is a documentation crisis, not a clinical success story.
When the Hospital Closes, the Neighborhood Pays: Urban Demand Concentration and the Hidden Equity Crisis
Urban hospital closures disproportionately hit low-income and minority neighborhoods, driving patients toward ERs as primary care. This is not a supply problem. It is a structural failure that compounds every other social determinant of health.
The IOTA Model Is Here — But Dialysis Centers Are Still Missing the Patients Who Need It Most
CMS's new IOTA Model incentivizes transplant centers to improve kidney access. It's a meaningful policy move. But it starts at the wrong end of the pipeline — and the 80% of ESRD patients who never make it to evaluation are still being left behind.
The Urban-Rural Healthcare Divide: Why More Supply Doesn't Mean More Access
Urban areas have more providers but longer wait times. Rural areas have fewer providers and longer drives. Neither population is well-served by the current model.
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