Health 2.0: Providers must reinvent themselves to achieve quadruple aim

SANTA CLARA – At the Health 2.0 Provider Symposium on Monday, one physician leader opened the morning by taking a trip back in time, to 1999.

It was a year of red pills (The Matrix, where Neo gulped down a tablet that showed him the true nature of reality) and blue pills (Viagra, which earned Pfizer $281 million that year, boosting its profits by 14 percent).

It was a year of a technology panic that wasn’t (Y2K) and of the first major warnings about a different sort of emergency: the Institute of Medicine’s landmark ’99 report, “To Err is Human: Building a Safer Health System,” which shocked the world by showing 44,000-98,000 people die each year as a result of avoidable medical errors.

In the two decades since, a lot has changed in healthcare as the industry has worked in earnest to achieve the Triple Aim: improving quality and safety while also lowering costs and boosting patient experience, according to Dr. Albert Chan, chief of digital patient experience at Sutter Health.

But too much has also stayed the same, he said. The digital revolution put into motion by widespread adoption of electronic health records has been a major innovation, and has helped improve patient safety when the technology is effectively deployed. (Chan, who graduated from medical school in 1999, said he decided to specialize in clinical informatics for that very reason.)

But today, too many physicians feel like technology is “part of the problem,” he said. No wonder, given that docs have to spend three hours of “desktop medicine” for every hour spent with patients.

That’s why the Triple Aim has since become the Quadruple Aim, with the key component of provider experience now added to the equation, something Chan said is invaluable to the effective and efficient care delivery.

That sort of willingness to innovate and rethink existing care processes will be essential if healthcare wants to make good on its promise to patients and physicians alike.

Interpreting data in new and novel ways will be key for shaping our solutions going forward. Twenty years after that agenda-setting IOM report, the marching orders for the years ahead are to think more creatively and humanely about how information and technology are put to work, said Chan.

“Interpreting data in new and novel ways will be key for shaping our solutions going forward,” said Chan.

Crucially, he added, “we can’t do it alone. We have to have partnerships.”

There’s “tremendous interest, investment and opportunity” in digital health funding, he said. But it’s imperative to stay focused on the big goal.

“It’s the patients who matter in this case,” said Chan. “They access data much more than us.”

He offered a success story from Sutter Health by way of example. “We have 2.2 million patients enrolled in our portal,” he said. Every year more than a million of them book appointments and make payments online.

Building from that deep patient engagement, then, Sutter launched a new program of text intervention – reaching out to their patients to remind them of their appointments.

The result? No-shows dropped by as much as 19 percent. Even better, with the opportunity to more efficiently fill cancelled appointment slots with patients from a waitlist, Sutter patients were able to see their primary care docs 14 days sooner, on average, and specialists 22 days sooner.

It was a simple innovation, scaled quickly, said Chan. And it had big results.

At Sutter, he said, “if we can’t scale it we won’t do it.”

Innovation pilots are all well and good, he explained, but unless they’re scalable to the wider enterprise, they’re just a waste of resources.

“We have tremendous work to do,” said Chan. “Prioritization is key. Scale is key.”

 
 

Global Edition

Telehealth

How should your organization assess telehealth ROI?

A new report from Manatt Health Strategies points to big differences in how return on investment should be gauged, depending most importantly on provider type – but also on acuity mix, IT infrastructure, staffing and other considerations.

By Mike Miliard

As more health systems avail themselves of the quality, cost and access benefits that come with telehealth, IT leaders naturally have big questions about how those major investments in technology infrastructure, reshaped clinical strategy and staffing changes should be paying off.

A new study from Manatt Health Strategies offers perspective, drawn largely from two case studies of different care providers, about how the return on investment should be assessed for nascent telehealth deployments.

WHY IT MATTERS
The report shows that conceptions of comprehensive telehealth ROI will vary widely across organizations and depends on an array of factors unique to each provider: size, type, clinical capacity, payment model to name just a few.

Given that virtual care investments are “highly dependent on the institution’s objectives, as well as the estimated financial impact of the telehealth program,” Manatt Health’s new framework is meant to help healthcare organizations calculate predicted financial impact of specific deployments.

“Provider organizations should assess a potential telehealth program’s impact on value by evaluating the program’s impact on improving revenue, health outcomes and patient experience relative to cost,” according to the report, authored by Mannat’s Jacqueline Marks, Jared Augenstein, Anthony Brown and Sol Lee.

“In addition to the direct economic drivers, telehealth programs can generate value in a number of ways that may be difficult to measure,” they wrote. “These include increasing access to care, allowing patients to receive care in more convenient settings, and improving patient and provider satisfaction.”

THE LARGER TREND
The most fundamental variable in how a virtual care program should be judged is the kind of provider that’s implementing it.

Academic medical centers, for example, “typically have a highly specialized workforce that treats high-acuity patients across a wide range of clinical domains,” said the Manatt researchers. “In contrast, many community hospitals are smaller, have a more generalized workforce and may not provide comprehensive services at all hours of the day.”

The reports authors listed some key questions that C-suites at each type of organization should be asking themselves:

• Academic medical centers (“Can we extend specialty and subspecialty expertise beyond our four walls via telehealth? Can we employ telehealth tools to improve care coordination, patient engagement and ongoing health management?”)
• Integrated health systems (“Can we utilize telehealth services to reduce per-member health expenditures? Can we leverage AI-driven triage tools to navigate patients to the most appropriate site or method of care?”)
• Community hospitals (“Can we offer additional specialty services and reduce avoidable transfers by partnering with local tertiary or quaternary hospitals for virtual consults? Can we increase patient retention by offering direct-to-consumer telehealth services for low-acuity conditions?”)
• Primary care clinics (“Can we extend primary and preventive care to remote and vulnerable populations through telehealth services?• Can we better connect our patients to behavioral health and specialty care through virtual visits while they are in rural clinics?”)

Other essential considerations that affect the lens through which telehealth ROI should be viewed, according to the report: patient acuity mix, potential for cost savings, new-patient volume and patient retention levels, hardware and software costs, program management requirements and staffing levels.

ON THE RECORD
“Providers are leveraging telehealth to optimize delivery of care, reach patients in remote locations, and improve care quality and overall patient satisfaction,” said Manatt researchers. “Healthcare institutions should anticipate that for the time being the most significant financial benefits from telehealth programs are likely to be the result of changes to patient acuity levels and increases in new or retained patient volume, rather than the result of increases in reimbursement.

“Telehealth adoption is still in its nascent stages in the United States, and the overall evidence base is still limited,” they added. “However, healthcare leaders can use the framework detailed here to reasonably estimate the ROI of telehealth programs to evaluate the merits of implementing and scaling telehealth activities.”

Twitter: @MikeMiliardHITN
Email the writer: [email protected]

Healthcare IT News is a publication of HIMSS Media.

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