There has been a spate of
articles about health care organizations partnering with on-demand
transportation services to improve access to appointments for office
visits and procedures, reducing no-shows and cancellations, improving
patients’ health and improving healthcare organizations’ operating
efficiency. (Exhibit A: Medical Providers Try Uber, Lyft For Patients With Few Transportation Options.)
While I do not mean to detract from the positive experiences that
result, rides to medical appointments have long been arranged through
other means — some better, some worse — and the on-demand economy offers
a mix compromises that merely supplement or supplant those of earlier
iterations (including those operated and/or funded by state and local
governments or their contractors, funded through Medicaid or otherwise).
Earlier models may have been less efficient (higher cost per ride — but
it’s covered by Medicaid!), and the perennial cost-cutting exercises at
the federal, state and local levels are often conducted without a good
understanding of the costs that will be created as a results of certain
costs being cut. (The age-old balloon problem: Poke a balloon on one
side, and it bulges out somewhere on the other side — or bursts.)
In an age when some visits are driven in part by the health care
system’s familiarity with, and reliance upon, fee for service
reimbursement, the focus on improving the experience of the in-person
visit is understandable. However, given the rise of value-based payment
systems for health care services, and the growing attention paid by
IDNs and other health care providers to increased quality and efficiency
— and by at least some to patient experience — the emphasis placed on
using on-demand ride services is ripe for reconsideration. We will
always need some in-person visits — but I’d like to see a broader focus
on eliminating those that are unnecessary rather than simply figuring
out how to get people to get themselves to those appointments in a way
that ensures more optimized utilization of health care system resources
within a pre-existing paradigm.
There are four modalities of telemedicine
— synchronous, asynchronous, remote monitoring and mobile health — and
each of them can reduce the pressure on the need for in-person
appointments, thus improving the quality and efficiency of the health
care system overall at the individual and population levels, and
improving the experiences of both patients and health care
professionals. (The Quadruple Aim.)
When most people think about telemedicine, they think of the
synchronous (real-time) video physician visit. That certainly has its
place, but intelligent uses of other modalities are likely to yield more
significant gains in terms of cost savings and quality improvements.
Just a couple of examples: Asynchronous video can help patients remember
and understand their clinicians’ instructions, given at an office
visit. (Some studies
have shown that many, if not most, patients forget those written or
oral instructions as soon as they’re out the door.) Remote monitoring of
CHF patients’ weight post-discharge can identify the need to titrate
diuretic prescriptions — which can be done by phone — thus preventing readmissions. Broader monitoring, combined with brief patient questionnaires administered via mobile device can combine into an FDA-approved chronic disease management app.
Looking beyond the traditional categories of telemedicine, it is
worth examining the opportunities presented by the application of
predictive analytics to the health care sector: artificial intelligence,
trained through deep learning on large data sets, can deliver precision
medicine to patients to meet their needs — before they or their
clinicians have even articulated what those needs might be.
At this watershed moment for digital health, ride-hailing apps are
surely not the best we can offer. I’m not looking for “The Uber of
healthcare.” I’m looking for the ability to predict and answer the next question out of the patient’s or clinician’s mouth — before it is asked. That’s progress. That saves time, eliminates hassles and unnecessary trips to the doctor’s office. That will help manage care in a way that meets or exceeds the expectations of payors, providers and patients.
Care to come along for the ride?
David Harlow
The Harlow Group LLC
Health Care Law and Consulting