Tag Archives: patients

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.

The Truth About Treating Low Back Pain

There is overwhelming medical evidence that many diagnostic tests, treatments and surgeries for low back pain are ineffective and waste many billions of dollars a year in the U.S. alone. Yet treatment appears not only to be continuing but seems to be growing and becoming more aggressive. The aggressive treatment of low back pain has become epidemic.

Medical studies on the problem of low back pain were widely reported in the mainstream media in 2007 and 2008. The Wall Street Journal, New York Times and other national publications like Time magazine reported on the Journal of the American Medical Association (JAMA) study that said Americans, “were spending more money than ever to treat spine problems, but their backs were not getting any better.”

The study documented common mistakes doctors make when treating back pain, including:

  • Ordering excessive X-rays , MRIs and CT scans
  • Performing invasive surgery too soon
  • Failing to educate patients about surgical alternatives
  • Failing to address underlying mental health issues

Also released in 2007 was The State of Health Care Quality report published by the National Committee for Quality Assurance (NCQA). It stated, “back injuries often undergo aggressive treatment when less costly and less complicated therapy may yield similar or better results.”

The NCQA report said that the vast majority of patients with low back pain have no identifiable cause of their symptoms and that less than 1% of X-rays provide useful information regarding the diagnosis of low back pain. Similarly, MRI and CT scanning usually fail to shed light on the causes of low back pain, except when there are red flags such as trauma or indicators for specific diseases. The authors stated that, “Needless tests and procedures that provide no real benefit to the patient can’t do anything but harm.”

The JAMA study also noted the widespread use of needless testing and found that 25% of the patients covered by private health insurance had an inappropriate imaging study, costing, in the aggregate, billions of dollars each year.

There is a wealth of medical evidence that most back and neck pain should be treated sparingly. An editorial in Spine Journal suggested that more than 200 treatments for chronic back pain are currently available in the clinical marketplace and that many of those “do not have a definitive track record in scientific studies.”

The authors of the JAMA study concluded: “If we keep our diagnostic and treatment efforts within well-proven limits, and emphasize the importance of activity and self-care, we suspect we would see better outcomes.”

Yet the total number of some spine treatments — e.g., spinal fusion surgery, spinal injections and the prescription of opiates — has skyrocketed in recent years, according to medical researchers.

There are many potential reasons for this spurt in back treatments, including the heavy commercialization and direct consumer marketing of treatments both old and new. It is hard to read a newspaper, watch TV or surf the Internet without seeing a commercial pop up for the latest treatment for low back pain.

Obviously, there is a lack of definitive evidence regarding many popular treatments, which allows them free rein in the marketplace before the risks and benefits can be scientifically studied and documented.

The JAMA study stated that 60% or more of initial back surgeries have successful outcomes. I am pretty good at math, so that means 40% DO NOT!  The study’s authors estimated that the 40% equates to 80,000 “failed back surgeries” a year.

The researchers also observed that the surgical success rate drops to 30% after the second surgery, 15% after a third and 5% after a fourth. The authors believed that many patients were under the care of physicians, “who are unfamiliar with the conditions leading to back surgery, the types of back surgery available and the best approaches to diagnosis and management.”

The annual medical cost to American businesses because of low back pain was estimated to be $90 billion in 2008.  This does not include the cost of related workers' comp or disability benefits, which also are in the billions, nor indirect costs such as lost productivity.

The medical studies have confirmed what I have known and studied for the past 33 years: Much of the money spent on healthcare — approximately one-third — is wasted on medically unnecessary and potentially harmful procedures.

What has changed in the treatment of low back pain since the release of the studies in 2008?

My bet: Not so much.

In fact, some medical researchers have stated the situation has gotten worse, not better, and that they have not been able to keep up with all the latest trends and back treatments available today.