The Telehealth Era is Just Beginning

“Having analyzed health outcomes data from the independent National Committee for Quality Assurance, health plan member satisfaction surveys from J.D. Power, and internal data from our own organizations, we are confident that full implementation of five opportunities would improve clinical quality nationwide by 20%, increase access to care by 20%, and reduce health care spending by 15% to 20%.

  • Reduce expensive and unnecessary trips to the ER – [..] Kaiser Permanente members in Virginia, Maryland, and Washington, DC [..] can access a 24/7 video health center that connects them with a doctor who can quickly assess the problem and offer guidance. If the doctor determines that the problem is life-threatening, she tells the patient to go immediately to the ER, sending the relevant medical information ahead to reduce the risk of complications. But telehealth physicians can solve the problem some 60% of the time. And when a patient needs follow-up care, they can schedule an appointment with his personal physician and communicate relevant details ahead of the visit. This application of virtual care not only addresses medical problems immediately and around the clock; it also prevents unnecessary ER visits that can lead to inappropriate hospital admissions and thousands of dollars in unnecessary expenses per patient. [..]
  • Reverse America’s chronic-disease crisis – [..] For members of large multispecialty medical groups such as Kaiser Permanente, high blood pressure is a much more manageable problem. KP consistently achieves a control rate above 90%. It’s not that it has better doctors or medications than other providers do; the biggest difference is frequency of disease measurement and timeliness of treatment—factors facilitated by virtual care.The traditional approach to managing chronic disease is intermittent and episodic. Once a doctor makes a diagnosis, he schedules follow-up office visits on a routine basis, usually every four to six months. Most Americans are used to this cadence, but it makes no sense. Some patients with well-controlled chronic diseases might not need to see their doctor for a year, while others would benefit from monthly evaluations. But traveling to the doctor’s office once a month, often for nothing more than a blood-pressure check, is time-consuming, inconvenient, and for many people expensive.Virtual visits can be scheduled more frequently, and they’re less time-consuming for both patients and physicians. Blood pressure can be checked at home with a device digitally connected to the electronic health record system. The combination of telemedicine and wearable devices allows for more-frequent medication adjustments, resulting in faster and better disease control and fewer complications at a lower total cost. [..]
  • Address disparities in health care [..]
  • Make specialty care faster and more efficient – When treating patients who require specialty referrals, primary care doctors have a common complaint: They have 95% of the expertise needed to accurately diagnose and treat but no easy way to obtain the other 5%. Sometimes all they seek is assurance that their diagnosis or plan is appropriate. But without that missing 5%, their only option is to make a referral for an in-person specialty consultation, leading to treatment delays and higher costs. [..]
    Across the most common medical and surgical specialties, KP’s remote-specialist model resolves patients’ problems 40% of the time, with no specialist visits needed. Patient satisfaction is 10% higher than for in-person consultations. When a patient does need to visit a specialist for a procedure, the appointment is scheduled after the virtual consultation; no in-person consult is required. If 30% to 40% of in-person specialist visits in the United States were replaced with this type of telehealth consult, patients would miss fewer workdays and receive faster and more-effective care, and tens of billions of dollars annually would be saved. [..]
  • Provide access to the best doctors – [..] Virtual technology can connect patients with the most experienced and knowledgeable doctors regardless of where they practice. This scenario is already playing out in Kaiser Permanente’s Northern California region. A nationally renowned expert in kidney cancer is located in a remote corner of Marin County, nearly 200 miles from some KP members. Newly diagnosed patients can meet with him virtually. During video consultations he educates them about their condition, using visual aids on a shared screen. He walks them through the relevant clinical information, their radiological scans, and treatment options. He shares videos of the anatomy and the anticipated surgical procedure. Given the rapport thus established, nearly all patients choose to have him perform their surgery, despite the distance many must travel; the day of the operation is often the first time both parties are in the same room. The doctor’s patient-satisfaction scores are universally excellent. [..]By eliminating the barriers of time and distance, telemedicine can help address two serious problems for patients with difficult diagnoses and rare diseases. The first is misdiagnosis. The second is long waits for a proper diagnosis and effective treatment plan. [..]

[..] Kaiser Permanente and Intermountain Healthcare have adopted many of these elements, including a significant degree of capitation, sophisticated technology, and right-sized staffing ratios. But barriers remain for both, limiting their ability to achieve full-fledged tele-driven systems. KP still draws heavily on brick-and-mortar facilities, which require large capital investments. Intermountain depends on doctors, particularly in rural areas, who are paid on a fee-for-service basis and care for people insured through a variety of plans. Still, both organizations could move rapidly toward full-fledged tele-delivered systems if the businesses buying health insurance demanded it.”
Full article, R Pearl and B Wayling, Harvard Business Review, May-June 2022