For the past year a parade of news has crossed my desk on the wonders of telehealth. If you’re someone who sees a doctor on a periodic basis only, it’s been a fantastic option for saving time, money, even hassle.
Yet it’s also exposed how far medicine lags behind the rest of the business world in serving its customers. Technologically speaking, we’ve essentially just mastered the basic art of video conferencing for episodic care and how to bill for it. But we’ve come nowhere near tech’s promise in serving patients beyond episodic care or shifting from fee-for-service to value-based health. Just because something is digital doesn’t automatically mean it’s better. We can — and should — expect these tools to serve patients and families better.
Complex patients with comorbidities must still largely be seen in-person, though they’re at the highest risk from Covid-19 and its variants. We’ve made little movement in areas that should be among the easiest to solve, such as compassionate care or treatment for loneliness. And even after a half-million Covid deaths, patients on their deathbeds must still resort to borrowing a nurse’s phone for their last conversations with loved ones.
Wrong tech, wrong approach
The problem, of course, is that we’re approaching technology from a clinical and billing perspective, with little input from patients. Hard-to-navigate and counterintuitive websites remain. Customized and comprehensive care is rarer still. And we’re amplifying the same disparities that already existed — all at the risk of losing engagement.
No one needs reminding that healthcare is an intensely local offering. If we don’t provide patients with the customization that acknowledges their unique issues, they’re going to assume telehealth isn’t for them. It’s a lost opportunity to provide better outcomes and behaviors — and motive to drive them to a more considerate provider.
Gaps in treatment
Of course, telehealth offerings have improved exponentially in the past 12 months. But it’s not enough. Banks, insurers, and a host of online consumer services have vastly superior offerings and patients know it.
For example, consider the user-friendliness of weight-loss apps that already exist in the marketplace. They don’t merely count calories and chart movement. They also have an element of personal communication. These personalized messages reassure the user that if they’ve had a bad week, don’t worry, tomorrow is a new day.
By contrast, medicine largely makes the patient hunt and peck their way to meaningful access or insight. We’ve barely scratched the surface of using tech to provide mental health insights, coaching, or the kind of monitoring that makes patients feel empowered.
And huge gaps in treatment remain. Take the cancer patient who’s undergoing regular chemotherapy treatment. Unexpectedly she becomes neutropenic in the middle of the night. Yet most cancer centers don’t offer 24-hour telehealth. There’s no chance for a professional to put eyes on this person and say, “You don’t need to go to the ER. It looks like this and this.” Instead, a call to the doctor usually results in a directive to head to emergency care, sending a high-risk patient into an expensive, high-risk environment that may not be necessary.
Current technology really fails elderly people with comorbidities. When caregivers are unable to attend doctors’ appointments with their loved ones, for example, those caregivers must later reconstruct medical instructions second-hand from very sick people. There is still no way to remotely sit in on visits. That leaves caregivers dangerously guessing at how to manage care between appointments.
Why haven’t we made more progress on what seems to be some very basic solutions? Tech companies rely on shockingly scant feedback from real-life patients in developing products. And most tend to be built from a clinical and reimbursement viewpoint. The result is programs built for everyone — except those they’re supposed to help.
If the past year has highlighted anything, it’s shown how much we must adjust to a diverse population of patients — and the imperative of creating a reimbursement model that doesn’t disincentivize value-based care.
Resistance — and return on investment
The pandemic has made our regulators realize that their constituents are not only willing to access medicine in a different way, but that patients are often homebound for good reasons. It’s encouraging to see new codes for remote monitoring and chronic condition management. If we acknowledge that telehealth is here to stay, it also presents the opportunity to put real payment models in place — and provide something more meaningful to populations who are not fee-for-service or dual-eligible.
Demonstrating this need is not as hard as one might think. We’ve made strides building and adapting technology for the sickest patients and overburdened practices. For those worried about the administrative burden, or demonstrating a return on investment, there’s no need to rebuild infrastructure from the ground up. But it’s also not plug-and-play. That’s because most tech has been engineered with healthy patients in mind — not the sickest ones. We must demand and implement technology that is designed for the population you are serving.
Yes, there will be resistance from those who don’t believe they have the infrastructure or the capital to get a return on investment. But this can be countered by delivering savings in systems and staffing, creating wealth for stakeholders, and revising compensation models to make it all worthwhile.
More importantly, it allows providers to stave off the risk of being left behind. As medicine shifts to value-based care, video conferencing will soon be seen as the mere beginning, the opening launch of a full field of services. The leaders will see an influx of patients drawn to convenience and safety. The reluctant will one day find that today’s obstacles are trifling by comparison.
Photo: ipopba, Getty Images