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Readers Write: Moving Beyond the App: How to Improve Healthcare Through Technology Partnerships

August 24, 2016 Readers Write 1 Comment

Moving Beyond the App: How to Improve Healthcare Through Technology Partnerships
By Ralph C. Derrickson


As the pace of change in the US healthcare system increases, we are seeing inspiring progress in access and care delivery driven in part by the adoption of telemedicine and other technology-enabled care models. Health systems are embracing virtual medicine as a way to serve their patients and communities by meeting their budget and lifestyle needs. Health systems are trying to match the consumer experience of other Internet services by delivering new care models that give patients better care, save them time, are easier on their wallets, and keep them within the health systems they already know and trust.

While the prospects for technology are enormous, there are downsides that have to be avoided.

Healthcare isn’t an app. We all use apps to conduct business, purchase products, and get our entertainment fix from our favorite mobile games and streaming media services. The idea that we could put an app in a patient’s hand to diagnose or treat them is very appealing. When that app is offered as part of a comprehensive set of integrated treatment options, there are reasons to be very hopeful. But when it’s offered outside a local health system, it leads to fragmentation, excessive prescribing, and even worse, inappropriate treatment.

Simply aggregating providers using the Internet is bad medicine. App developers and their networks of doctors – who are paid on a per-visit basis – have used technology to bring out the worst of fee-for-service care. The data on telemedicine prescribing rates, visit durations, and management rates is in and it isn’t pretty. If the expectation is that the patient’s needs will be met with a telemedicine visit, it becomes a failure when the patient doesn’t get treatment or a prescription.

There’s no doubt the provider is doing their best to serve the patient, but without a place to send the patient for in-person care, they’re stuck trying their best to meet the patient’s needs. In fact, a study in JAMA Internal Medicine shows that the quality of urgent care treatment varies widely among commercial, direct-to-consumer virtual care companies. Their transactional models for medicine also offer no integrated next step for the patient and no connection to a broader spectrum of care.

Health systems need an approach that runs counter to telemedicine/app developer trends. An integrated virtual clinic enables health systems to extend the service offering in clinically appropriate situations and build on the trust they have earned from patients in years of service to their community. Payment models can come and go, but the patient’s reliance on a doctor in a time of need should never be compromised by the method of access or their payment system.

Health care is challenging. I’ve referred to it as the Three Hopes: I hope it’s not serious, I hope I can see my doctor, and I hope it’s paid for. Countless studies have shown that the proven, most cost-effective health care model is to have access to primary care doctors and great doctor-patient relationships, two qualities that are part and parcel of a strong health system. However, most app-centered telemedicine companies have no connection to a patient’s primary care provider, leading to care fragmentation instead of care continuity.

Through all of this, the greatest institutions of clinical excellence – our health systems – are losing the arms race for patients, especially as the healthcare market continues to consolidate and health systems face fierce competition from their peers to attract and retain patients. Health systems simply don’t have the marketing engines of app-centered telemedicine providers and pharmacies who are fighting tooth and nail for patient acquisition.

Many health systems have yet to figure out how to adapt to a consumer-directed model while continuing to provide quality care. The same patients who want convenience first and foremost are often unable to accurately judge the quality of care received through most telemedicine methods. For health systems and patients to succeed, virtual care must be part of a broader care continuum and tightly integrated within health systems.

Keeping patients within the systems they already know and trust provides an invaluable convenience and allows opportunities to refer patients to appropriate care when an ailment cannot be treated virtually. Those referrals offer a chance to reconnect patients to health systems rather than their using a high-cost option like an emergency department or a quick fix like an app-centered retail clinic.

This is especially important as the industry shifts to fee-for-value reimbursement.

An approach that integrates virtual care within health systems ensures patients get the same quality of care that they would receive from an in-person visit. Patients have a better chance of understanding their own health, as trusted physicians give patients the information they need to become educated healthcare consumers. For health systems, integrated virtual care puts them in the driver’s seat on how care is delivered and managed, whereas an app-centered approach might not meet metrics of quality nor the needs of the patients they already serve.

App-centered telemedicine has no place in our health care system. This approach to addressing the changes in healthcare is robbing patients of the type of care they deserve.

There is no reason for the Three Hopes of healthcare to be points of uncertainty or stress for patients. I see great promise among leading hospitals and health systems who are alleviating this uncertainty with integrated virtual care. They realize they know how best to treat a patient – apps do not. Virtual care that’s integrated into a provider network is best equipped to put quality at the center of care now and in the future.

Ralph C. Derrickson is president and CEO of Carena, Inc.

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Currently there is "1 comment" on this Article:

  1. I must be more cynical. My 3 hopes are that it’s not serious, that my Dr has enough time to spend more than 5 minutes evaluating if it’s serious, and that my bill won’t be outrageously expensive.

    The central issue I see with achieving these 3 hopes is that while health care is heavily regulated the regulations actually make everything more difficult. Let’s review. If it is #1 and serious, the treatment will be outrageously expensive and with insurance it might be covered, but due to all of the lower cost or money losing requirements of Medicare / Medicaid if I were to unfortunately be on those plans like it or not the care I would receive would be much worse. If it is #2 and my Dr barely has enough time to see me, I can’t really as a patient get a refund or any guarantee about the quality of the care I’m going to receive. All I can do as a patient is go see someone else. If it is #3 and turns out to be outrageously expensive I can join the ranks of the many people that went bankrupt over medical bills. The regulations don’t exist to improve, but protect the current system. Regulatory reform is a critical piece to change going forward. I’d advocate for some basic rules of thumb like the regulations cannot be more than say 2 pages and a half page bulleted summary of the rules to enforce complexity reduction and put more trust in Doctors hands.

    I know there is a lot of talk about fee-for-value. And in a rational world where every Doctor is a good person (most are, but I know we all know a few bad apples) fee-for-value sounds great if everyone is a good person. Pay based on treating a whole population and it’s immensely valuable. The problem with this is that it’s the very definition of socialism. Socialism is defined as ” any of various economic and political theories advocating collective or governmental ownership and administration of the means of production and distribution of goods”. Fee-for-value isn’t government ownership of private property, but it is “collective ownership and administration […] and distribution of goods”. In this case, the distribution of goods is the service of medical care. Fee-for-value will be a complete and total disaster just like socialism. Fee-for-value sounds great, but in practice it will be a mess. Personally, I’d advocate for a focus on the supply side of health care by dramatically increasing the number of medical schools and education while providing a true career path for Doctors. We can fill the seats with qualified people without any problem so it’s time to build these schools and make the path to a US citizenship the easiest for anyone who graduates to stay and practice medicine. The pay of Doctor’s will decline which unfortunately is a requirement for the cost of health care to decline. Creating a real career path for Doctor’s and compensating them for experience not just credentials could offset this.

    One nice change to health care is that we’re seeing talented entrepreneurs go after critical opportunities in health care. The likes of yourself, Johnathan Bush at Athena, and allbeit controversial Elizabeth Holmes of Theranos will dramatically improve health care in the US if we let them. I also hope that Steve Jobs sketches and journal of ideas for improvements to medical devices finds its way into an organizations hands that could help make them a reality some day.

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