Tag Archives: clinician

Untapped Opportunity in Healthcare

The U.S. spent $2.6 trillion on healthcare in 2010, with wages accounting for more than half of that sum, making healthcare one of the most labor intensive of all industries. For decades, healthcare leaders and policy makers have worked to reduce healthcare spending. Over that time, it has become increasingly evident that cost-reduction strategies focused on utilization and quality improvement will fall short if nothing is done to lower the cost of labor per unit of service. Unlike other industries in which technology has significantly boosted productivity, healthcare has experienced no such gains during the past 20 years.

At the same time, the U.S. is faced with health professional shortages. For example, there is a projected shortage of as many as 31,000 primary care physicians (PCPs) by 2025, according to the American Association of Medical Colleges.

Healthcare’s overlooked opportunity

How can the industry and individual health organizations bend the cost curve in a meaningful way, particularly at a time when chronically ill and aging patient populations are growing and more consumers have health insurance than ever before? A solution to balancing the demand/capacity equation is through virtual health approaches. In this way, healthcare can not only reach consumers who have been underserved, it can also serve in a better way those who already have routine care.

Virtual health can enable more clinical care work to get done without expanding the workforce, by streamlining work and redirecting clinician time to high-value tasks. Virtual healthcare models can expand clinician capacity in three critical ways: shift tasks and work to patients, replace labor with technology and automate tasks.

Combined, these three levers can streamline clinician work, decrease clinician demand and focus clinicians’ time where their training and experience have the greatest value.

More available time means greater coverage for more patients, without increasing workforce size. The optimal combination of traditional in-person and virtual interactions could also offer the best patient experience and has the potential to create a new standard of care across the entire range of clinical services.

What is virtual health?

Virtual health combines clinical care and professional collaboration through telemedicine, tele-health and collaboration-at-a-distance to connect clinicians, patients, care teams and health professionals to provide health services, support patient self-management and coordinate care across the care continuum.

Specific to physician-patient encounters, virtual health enables live and asynchronous clinical interactions, clinical practice and patient management supported by a wide range of communication, collaboration and cognitive computing technologies along with digital devices and data.

Scenarios to illustrate the opportunity

These three common primary and ambulatory care scenarios illustrate the opportunity of virtual health approaches and reveal both the potential time savings and economic value to healthcare. The industry faces clinician shortages in areas other than primary care, of course, but familiar primary care scenarios serve to highlight the possibilities of virtual health.

The need to palpate, auscultate or take samples for lab tests requires that most diagnostic encounters today remain in-person. However, in any “typical” office visit much of the physician’s time is spent gathering patient information, reviewing the information, considering potential treatment options and interacting with the patient. Often, the patient shares information in bits and pieces at different points in the exam, sending the physician back through the diagnosis and treatment option cycle.

Imagine, instead, if the patient provides information prior to the scheduled appointment. Common consumer devices, such as wearable sensors and digital weight scales, allow the patient to capture and share biometric information prior to the exam, which the patient can submit through a secure portal, with concerns or discussion items for the visit. The portal is also where a “virtual character”-a computer generated medical assistant-can guide the patient through the standard intake questions, such as family medical history and physical. Then, analyzing the combined information with a diagnostic engine, clinical options can be suggested to the physician prior to the in-person exam.

Reducing the amount of time gathering patient information and considering options prior to the exam can significantly streamline in-person encounters. Accenture analysis shows that applying virtual health to annual ambulatory patient encounters can save each U.S. PCP an average of five minutes per encounter. This is a time savings equivalent to as many as 37,000 PCPs-or 18% of the PCP workforce-with an economic value of more than $7 billion annually across the U.S. health system.

Equally important, after that initial exam, most of any follow-up visit can be conducted via video for greater patient access and both patient and physician convenience.

e-visits are becoming an increasingly common alternative to in-person office visits to manage patients’ continuing clinical needs. E-visits are asynchronous clinical exchanges completed via secure messaging in which patients submit information, questions and images for physician review and response. E-visits typically take fewer than 10 minutes of physician time. One example where e-visits can be applied is hypertension management. 26% of outpatient physician visits each year are related to hypertension. According to Accenture, if each patient has one in-person annual physical with half of the remaining hypertension-focused encounters converted to e-visits, the time savings could be the equivalent of around 1,500 PCPs-roughly 1% of the workforce- with an approximate annual value of $300 million.

Virtual health can support those with chronic conditions to self-manage their conditions to remain medically stable. As an example, adults with diabetes can use sophisticated mobile technology to effectively manage their lifestyles and conditions, and reduce the need for in-person encounters. Available technologies with sophisticated analytics can track, trend and assess data provided by patients-and medical devices-such as blood glucose levels. The same technology can also offer prompts and suggest a personalized self-management plan-and that plan can evolve as the patient’s health status changes. Further, the information can be made available to the clinical team when needed. The goal is to maximize patient self-care and allow physicians to practice “by exception.” In fact, such FDA-approved technology is available via physician prescription today.

Accenture analysis reveals that a care model composed of an annual physician exam and technology-enabled self-management the rest of the year can save time equivalent to approximately 24,000 PCPs-representing 11% of the workforce-for a value of almost $2 billion annually.

The enterprise-level impact of these scenarios is just as compelling as the industry-level view already described. Consider a large regional health system or independent practice association with approximately 1,800 affiliated or employed PCPs. Accenture analysis shows that an average of five minutes saved across all ambulatory annual encounters can release almost $63 million in physician capacity per year, the equivalent of about 320 practicing PCPs. For a smaller system or clinically integrated network, a staff of about 800 PCPs is more the norm. A five-minute savings across all annual encounters for that organization can release the equivalent of roughly 140 physicians’ time with a value of almost $28 million annually.

Toward a new gold standard of care

Virtual care and in-person care are equally important and complementary, the best mix depending upon the nature of the encounter. The ratio of virtual to in-person will shift over time as technologies evolve to enable more patient self-testing and caring.

The scenarios described are only some of the many ways that virtual approaches can unlock the time and capacity of the highly valuable clinical workforce. The gold standard of care will become the best combination of in-person and virtual approaches that support sound clinical practice, continuity of care and episodic clinical needs as well as continuing care for those with chronic conditions.

This is not a far and distant opportunity; technologies exist now that can help deliver quality care in a more affordable way by optimizing clinicians’ time. The industry as a whole, as well as individual organizations, must act now to integrate virtual care models into everyday clinical practice. Only then will healthcare begin to address the looming cost and labor crises affecting the industry at national and organization levels.

It's Not Cost, Stupid – It's Care Transparency!

In my article last month — Care Transparency: What Employers Are Missing! — I wrote about how employers are missing an understanding of how employees are making health care decisions, and how that crucial factor impacts health care costs.

Employers need to meet employees where they are — online. Employers need to provide them with tools that can help their research and decision-making process with robust, accurate, unbiased and evidence-based information. Employers can significantly improve the quality of care consumed by their employees and reduce health care costs by focusing on creating care transparency.

In this article, we have explained the types of tools that will be effective in supporting employee decisions and that employees will really use in making care and treatment decisions. WiserTogether's research of patient decisions across the top 200 health conditions shows that of the 22 unique factors that patients typically use in evaluating treatments, quality of care tops the list. Cost does not even make the top five. In other words, cost is not the primary decision driver for patients, and consumers do not seek out cost tools when they begin making decisions. This explains the low utilization that organizations see when they offer cost transparency tools as a stand-alone service.

Health Affairs1 recently published an article that found that patients object both to discussing health care costs with clinicians and to considering costs in deciding among comparable clinical options. It is also well-known that despite the payer's best efforts, patients do not factor in payer and employer cost burdens when making health and care decisions, despite the fact that payers cover a majority of the costs. Economists have a term for this phenomenon that patients exhibit, called the “Tragedy of the Commons.” This concept means individual decision making is driven by personal benefit and ignores the implications of those decisions on third parties and the common good.2

Studies show that patients faced with a treatment decision can only process a limited number of factors. In its 2012 research that showed quality of care is the most important factor patients consider when making health care decisions, WiserTogether found that only seven of the 22 factors carry enough weight to qualify as first-tier factors for patients. Those seven factors are explained below.

Importantly, patients also indicated differences in how open they were to information about a factor coming as an expert opinion versus information coming in the form of experiences of other patients.

WiserTogether found that for the following four factors, patients want accurate information about the experiences of other patients. For each treatment, patients wanted to know the following:

  • Treatment Effectiveness — How effective did other patients say the treatment was for them?
  • Treatment Popularity — What percentage of patients in a situation like mine use the treatment?
  • Treatment Speed — How fast did other patients start to see a difference, and how long was the recovery?
  • Treatment Side Effects — What side effects have other patients experienced, and how severe were they?

For the remaining three factors, patients wanted expert opinion:

  • Scientific Evidence — Which treatments are best supported by medical evidence?
  • Consequences of Delay — What might happen if I wait to have the treatment or decide not to have it?
  • Treatment Duration — How long will the treatment last?

The results seen were independent of whether the information was available. Patients ranked out-of-pocket costs as a second-tier factor they are willing to consider when making a health care decision. Patients also report that finding information about any of the seven top-tier factors is extremely hard, and the current tools/support systems provided are inadequate.

Research has shown that patients seek out such information prior to making a health care decision, and the information gathered influences their commitment to follow through on a treatment.

Employees repeatedly state that they are overwhelmed with health information and need help finding content that is relevant to their situation. Tools that help them understand their options, evaluate those options based on personal preferences and constraints, and succinctly communicate their questions and concerns to their providers can supply the missing link. Treatment selection and shared decision support tools — whether used by the patients directly or in consultation with a provider — help support patient decisions and effective interactions with providers.

Effective and engaging tools need to offer the following:

  • Personalized treatment selection based on the patient's demographics, co-morbidities, personal preferences, and financial constraints.
  • Need to provide (at least) the seven top-tier decision-making factors to assist employees' evaluation of options along with cost and plan coverage.
  • Be easily accessible online anywhere, including at point of care set-ups.

Employees are adopting these tools at very high rates, as these tools are aligned with the natural behavioral process people follow in making health care decisions. Such tools are helping employees become informed health care consumers who understand choices and are able to make wiser choices based on their values. These tools also are helping to reduce the knowledge gap between the providers and patients and to create more confident health care consumers who can start engaging with providers in making shared and effective health care decisions.

Having said that, WiserTogether's Patient-Centered Care Index (PCCI) shows that the provider community is a long way from treating patients as an equal partner. In my next article, I will write about specific areas where providers are underperforming in delivering patient-centered care and how they often treat themselves differently than they treat their patients.

This article is co-authored with Gregg Rosenberg, Ph.D., Chief Product Officer at WiserTogether, Inc. and author of A Place for Consciousness (Oxford University Press).

1 “Focus Groups Highlight That Many Patients Object To Clinicians' Focusing On Costs,” Sommers, Goold, McGlynn et al.; Health Affairs, 32, no.2 (2013): Pgs 338-346.

2 “The Tragedy of the Commons Revisited,” Rafid Fadul; New England Journal of Medicine, no. 10 (2009): Pg 361.