As the CEO of AMC Health, a leading provider of virtual care technologies and services, I am fortunate for the macro-level view that few healthcare executives enjoy. What is exceptional about my corner of healthcare is that it touches all aspects of healthcare delivery, and so I’ve been granted a unique vantage point from the perspective of insurers (government and commercial), providers, vendors, and patient consumers simultaneously. What I can report is that we are at a nexus of deep pain across the entire healthcare ecosystem right now, but the emerging solutions are no less exciting than the challenges are formidable.
The pain is unequivocal. This dreaded COVID-19 has not only resulted in a precipitous drop in an ambulatory (i.e. non-emergent) care traffic – the true bread and butter of healthcare provider systems – but it has resulted in a precipitous drop in the services designed to treat and manage costly conditions (such as cardiovascular, pulmonary, and psychiatric disorders, as well as cancers, renal diseases and high-risk pregnancies that represent nearly $1.2 trillion in the U.S. alone) and prevent the catastrophic exacerbations they lead to. These conditions have not disappeared during the pandemic but represent a ticking time bomb of hundreds of millions of dollars in preventable and unplanned care that will go off not now, but 6, 15, or 24 months from now. In short, we are in a crisis of care access.
So, what do we do? We have no choice but to seek out a new framework for care access. This means virtualization, or what has been colloquially come to be called ‘Telehealth’. Telehealth is far broader than a live interaction between patient and health care provider via video-conference for the purpose of remote evaluation, treatment, and peer-to-peer consultation. Telehealth also encompasses the entire spectrum of automation and analytics as applied to remote care delivery. This can include daily and real-time, automated collection and analysis of patient biometrics and data on symptoms and behavior, as well as automated and focused health coaching and education.
Indeed, COVID has forced our hand to incorporate telehealth and real-time data from patients’ homes into clinical best practice. But this is a good thing, and it’s unfortunate that it took this pandemic for us to finally reach for these transformative tools. It’s also inevitable; it makes absolutely no sense that healthcare, which represents a fifth of our economy, hasn’t yet embraced virtual technologies, IoT (Internet of Things), and real-time data that have transformed many other industries such as retail and banking.
At our backs is an unprecedented alignment of incentives occurring simultaneously that are pushing payers and providers toward these virtual care innovations. The truth is, COVID-19 only accelerated the healthcare paradigm shifts already gaining momentum. First, of course, are the obvious demographic realities of an exploding chronic disease problem in the U.S. This isn’t just a result of the graying of our nation, but also the price we pay for the sedentary and unhealthy lifestyles we’ve been living for decades. At the same time, we are seeing a major paradigm shift in healthcare away from the reimbursement for each service provided to reimbursement based on the outcome of the care (Accountable Care). We are also witnessing a major paradigm shift from getting patients to clinical expertise, and instead of getting expertise to the patients (put another way, making home and workplace effective loci of care). Lastly, we are (finally) seeing momentum on effective reimbursement for employing these tools. Never before have these incentives aligned so dramatically, and entrepreneurial vendors are uniquely poised to take advantage of these opportunities. COVID-19 did not create these opportunities. COVID-19 was just the cold water thrown in our faces to wake us up.
But does telehealth work? It does. And it works not just because of the care access it affords when patients cannot be physically in front of a clinician, but because it addresses those pre-emergent situations identified far enough upstream of a tipping point that you can steer that patient to a timelier, less intense intervention, either by addressing a gap in care, changing medical management at home or altering the toxic trajectory by having the patient come into the office (even virtually so). Equally important, these virtual tools compensate for what realistically cannot be done in the physician’s office or outpatient clinic, namely take the necessary time to thoroughly evaluate root causes (including psycho-social causes) based on real-time data wherever the patients may be and effectively educate patients. It is a time-consuming process that physicians cannot accommodate (it has long been estimated that doctors would have to spend an additional 7 hours of their day just to ensure that patients receive all recommended preventive services and counseling).
We find ourselves at an unprecedented convergence of need and real-time technological capability. Hopefully, when this terrible pandemic is a bad memory, we will be reaping the fruits of our embrace of these tools, creating an opportunity for these exciting innovations that will remain unsated.
Yarnall, K. et. al. 2003 Is there enough time for prevention in primary care? American Journal of Public Health 93, No. 4 (April): 635-641.
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