This Week Health

Today we explore the past and future of Telehealth. Do we agree on the opportunities and obstacles and are we ready to tackle them?

https://hbr.org/2022/05/the-telehealth-era-is-just-beginning

Transcript

Today in health. It tele-health the opportunities. This is part two of our series. My name is bill Russell. I'm a former CIO for a 16 hospital system and creator of this week health. Instead of channels, dedicated to keeping health it staff current and engaged. We want to thank our show sponsors for investing in developing the next generation of health leaders, Gordian dynamics, Quill health towel, site nuance, Canaan, medical, and current health. Check them out at this week. health.com/today.

Alright, before we get to today's story. , I wanted to make you aware of the fact that we have a webinar today at one o'clock Eastern time. And what we're going to talk about is the fact that your cybersecurity team isn't happy. At least that's what a recent, , study told us. And today I'm going to discuss that with industry leaders on a he Santiago with Christiana care.

And Gary Goodman with Seattle children's. And so I'd love for you to join us at one o'clock Eastern time. For this discussion on recruiting retaining. And once you have a great team optimizing their work through automation. So join us. You can just hit our website this week. health.com wait about three seconds and a pop-up will be there and just click on that and you can register for the webinar today. Love to see you there.

All right. So we're doing a deep dive on a single article from the Harvard business view. The tele-health era is just beginning. Is the name of the article. Worth a read. And I'm just breaking it down over a couple of days. It was written by Robert Pearl. Who was a former CEO of Kaiser Permanente medical group.

And as a faculty member at Stanford university, so forth and so on. Brian whaling is the executive director of telehealth services at Intermountain healthcare. And we did our first episode, we sort of set this up, right? So they talked about the fact that there's a lot of promise in telemedicine, 89% of us adults, 78% of adults globally, own a smartphone.

, so there's a way to reach a majority of the population. Literally around the world, which is , kind of amazing. They talk about the explosive growth of telehealth during the pandemic. And then it's a subsequent, , recession receding. I don't know how you say it. , but recession from those highs.

, to where it's at today. And then they throw out two models, obviously Kaiser Permanente and Intermountain healthcare. And talks about the fact. That, , they have treated more than 13 million patients. They are clearly the leaders in the industry with regard to this. And we're going to explore maybe in the next episode, which will be the final one on this.

, why I think that these two organizations thrive. , in this area.

And they set up their thesis and they say by reviewing their own organization's performance and the internal data data, that they're confident that full implementation. Of tele-health and the five opportunities that are available in telehealth, which is what we're going to talk about today. Would improve clinical quality nationwide by 20% increase access to care by 20% and reduce healthcare spending.

By 15 to 20%. So that's what we're going to take a look at today. We're going to take a look at the five opportunities that they have. And then, ,

Tomorrow, we will look at. how to overcome some of the obstacles.

That exists in the adoption of this. All right. So let's get to the opportunities. So the first opportunity they lay out here is reduce expensive and under. Necessarily trips to the ER. And essentially what they're saying is there's a long waits in the ER, it's expensive for people to go to the ER and that the work that these two organizations have done, not only these two organizations, but others.

, has reduced the load on the ER, in fact, we know that it does, we absolutely know that it does because we were trying to drive people out of the ER, early on in the pandemic. And what's the number one tool we threw at it. Tele-health right. So no one is really disputing this. This is one of the most.

Obvious ones , we can reduce the number of trips to the ER, or at least triage, those visits very effectively. , ahead of time. In fact, there are some EDRs. I remember talking to Daniel Barchie about this, , New York Presbyterian. They did a pilot where they set up tele-health you come in the front door and you could either wait in the emergency department. And there would be a significant wig because , it's in New York city or you can go through that. The door to the left will take you to the waiting room, the door to the right will take you to a tele-health. , triage kind of a scenario. So you could actually go to the right sit down in front of a kiosk, talk to.

, a clinician and be diagnosed and be told whether, Hey, you should go directly over to the ER or, Hey, here's what we can do for you. And, , . I don't remember the exact results, but it was pretty, pretty staggering in terms of the reduced reduction in costs. To those people who chose to go that route.

, probably the reduction in wait time and improve customer satisfaction across the board. It's an interesting same building. They still came in. Right door takes them to tele-health left door, takes them to the ed. It's still more effective. , imagine if they didn't even have to come in. , how effective it is. All right. Opportunity. Number two, reverse America's chronic disease crisis.

I will get a few more excerpts out of this ones. All right. So chronic diseases are the leading cause of death and disability in the United States county for seven and 10 deaths. Many patients hospitalized with or killed by COVID 19 had conditions such as obesity, chronic. Obstructive pulmonary disease, hypertension, diabetes, cardiovascular disease, and chronic kidney disease.

All right. I don't think any of those stats really shock you. They go on to talk about high blood pressure and how it contributes to stroke and heart disease, kidney failure, and other things. And for members of large multi-specialty medical groups, such as Kaiser Permanente, high blood pressure is a much more manageable problem. KP consistently achieves.

A control rate above 90%. It's not that it's better doctors or medications than the other providers do. The biggest difference is frequency of disease, measurement, and timeliness of treatment factors facilitated by virtual care. All right. So , that's their case. For reversing America's chronic disease.

Crisis.

Virtual visits can be scheduled more frequently and they're less time consuming for both patients and physicians. Blood pressure can be checked at home with a device digitally connected to electronic health record systems. The combination of telemedicine and wearable devices allows for more frequent.

Medication adjustments resulting in faster and better disease control and fewer complications at a lower total costs with the combination of telemedicine and increased emphasis on primary care and prevention. Kaiser members in California and the Mid-Atlantic region are 14% less likely to die from stroke and 43% less likely to die from heart disease.

Then our people in the United States is a whole. All right. That's one of their biggest cases for reducing America's chronic. , disease and improving outcomes, so that's that's number two. This is a second opportunity. Third opportunity. Address disparities in healthcare.

All right. So this is a hot topic in healthcare today. , equity fairness. , distribution of care. And here's what they have to say here. Telemedicine is ability to address inequities. And access has been demonstrated during the pandemic, the ubiquitous smartphone capable of video interactions. Can be a lifeline for underserved populations in rural areas with few mental health professionals, for example.

Intermountain's ability to offer virtual visits gives patients prompt access to both emergency and routine care. When the pandemic forced the closure of in-person clinics and offices, psychologists, and psychiatrists across the United States quickly instituted virtual visits, Intermountain delivered 85% of its mental and behavioral health visits virtually, including those for drug and alcohol related programs, telemedicine visits remained popular even after restrictions, ease, Intermountain patients receiving their care virtually.

Reported high satisfaction and we're less likely to cancel appointments. Then were patients who had scheduled in-person visits. Okay. And they go on with the same typical case or the same kind of case. With Kaiser Permanente in the next paragraph. , You know, it's interesting when we talk about addressing disparities in healthcare, and this is really about access to high quality care.

Whether you're in, I, to be honest with you, this can be in an urban setting or a rural setting. , and it could be, , but generally the argument I get here and I, I got this when we were doing a lot of digital initiatives. At St. Joe's the sisters would say to me, what about the population that doesn't have cell phones? What about the population?

That, , you know, it doesn't download our app and those kinds of things. And the reality is I'd rather solve that problem. To be honest with you, then assume that people don't have cell phones. We already talked about this 89% of us adults and 78% of adults globally. Own a smartphone. Now. They may own a smartphone without a plan. They can't afford the plan. Those kinds of things let's solve that problem. Let's get these devices into the hands of people that it's going to help.

And let's determine. It's quite frankly, it's easier for us to go to them than for them to come to us in a lot of cases. So let's figure out how to go to them. And, you know, the case I always made with the, , with the sisters when we were having this conversation was let's solve the right problems.

Right. And the right problem. Isn't Hey, we can't serve that. 10 to 15% of the population. Therefore we shouldn't put this out there. The right problem to solve is how do we serve that 10 to 15% population more effectively. While improving what we're doing for the 80%. So, , I don't know, it might be cold and heartless. You can tell me if it is.

But essentially I want to solve the right problems in healthcare, which is, , upping the game for everybody across the board. Everybody has, , you know, better access to care, , more touch points. , More. , data coming in to the clinician so that we can care for them in the best possible way.

And, you know, having a lower cost model. For reaching that population and

having more touch points is going to give us better visibility. Into the care of that population. And it's going to give us the, a better chance of intervening when it's necessary. All right. Let's get to opportunity. Number four, make specialty care faster. And more efficient. So this gets into a different kind of tele-health this isn't the business to consumer. This is more the business of business. We did a lot of this. We did telestroke programs. We did, , , tell a psych for ramps and whatnot, where we had expertise within our system at certain hospitals, but not at other hospitals.

And we were able to essentially expand that those capabilities to additional hospitals by putting the right technology in place. Let's see what they have here. When treating patients who require specialty referrals, primary care doctors have a common complaint. They have 95% of the expertise needed to accurately diagnose and treat, but no easy way to obtain the other 5%. Sometimes all they seek is.

Assurance that their diagnosis or plan is appropriate. But without that missing 5%, their only option is to make a referral. Waiting list for specialist is high. For example, even before the pandemic patients in the United States often have to wait weeks to see a dermatologist at Kaiser Permanente, primary care physicians routinely use telemedicine to consult dermatologist. Right?

So it's essentially reaching out, finding that specialty, bringing it in very quickly and getting the diagnosis that you need. So we reduce a number of steps that happened in the process. Which, you know, quite frankly, is. One of the primary things that leads to a bad experience within healthcare because we deliver good outcomes.

It's it's the number of steps and the number of meetings and the number and the amount of time off work and so forth. And so on. , they go on across the most common medical and surgical specialties, Kaiser Permanente's remote specialist model resolves patients' problems. 40% of the time. With no specialist visit needed. Patient satisfaction is 10% higher.

Then for in-person consultations. When a patient does need to visit the specialist for a procedure, the appointment is scheduled after the virtual consultation. No one person console there's fart. All right. So that's the kind of workflow that just makes sense. , across the board, across all of healthcare.

Opportunity number five and the last one for today provide access to the best doctors. Patients with obscure or complex medical problems often find themselves living. A two-pronged nightmare. There's the pain and fear of having a rare disease and the frustration of trying to find the right specialist.

Patients may bounce from one local physician to the next wasting weeks and months sitting through useless appointments and enduring sleepless nights. Telemedicine offers a far better solution. Virtual technology can connect patients with the most experienced and knowledgeable doctors, regardless of where they practice.

This scenario is already. Playing out and Kaiser Permanente, Northern California region. A nationally renowned expert in kidney cancer is located in a remote corner of Marine county, nearly 200 miles from some KP members, newly diagnosed patients can meet with him virtually during video consultations. He educates them.

About their condition using visual aids. On the shared screen, he walks them through relevant clinical information, so forth and so on. You get the picture. We take these, the specialists. And we give them access. This is by the way, I believe the opportunity for the brands for the academic medical centers.

, for the Mayo's was the, Clevelands the, , the Cedars, the, , the UCLAs the, , , the MD Anderson's, , so forth and so on. This is the biggest opportunity that I believe that they have, they could use this brand and telemedicine.

To expand their reach significantly. If I have cancer. I would much rather see a physician from one of those facilities. Then my local physician. , not that I won't need to see my local physician, but I'd still rather be talking to somebody who's an expert. In the field. , with a health system that I know has phenomenal processes, then just, you know, seeing, , what I can get down the street. Is it good enough? I mean, we're talking about.

A life-threatening. , illness, I would like to talk to the best doctor possible. So those are the five opportunities. Let me go through them again real quick for you. Opportunity one. Reduced expensive at. Unnecessary trips to the ER, and I think we all know that to be true. Reverse America's chronic disease crisis is opportunity.

Number two. Opportunity number three, address disparities in health care, giving people more access. , number four, make specialty care faster and more efficient. And number five, provide access to the best doctors. In the world. So those are the five opportunities that exist. I don't think people argue the opportunities, to be honest with you.

The question becomes if we know the opportunities and we know the potential, why aren't we able to make it happen? And I think the reason it's good to start with these opportunities is because. , in a lot of cases, this is about changing an entire organization's culture and moving it forward and getting it to think differently and to address the delivery of care.

Differently. And there's a lot of different constituents within an IDN or a health system, no matter what the size, there's a lot of constituents. That need to understand. The value, and how it's going to play out. , in the last episode here. Tomorrow, we're going to talk about. , some of the challenges with making this happen. And then I'm going to tell you the number one thing.

That makes these two organizations successful

while other organizations struggle to make progress in this area. All right. That's all for today. If you know, someone that might benefit from our channel, please forward them a note. They can subscribe on our website this week, health.com or wherever you listen to podcasts, apple, Google, overcast, Spotify, Stitcher, you get the picture. We are everywhere.

We want to thank our channel sponsors who are investing in our mission to develop the next generation of health leaders, Gordian dynamics, Quill health Taos site nuance. Canon medical and 📍 current health. Check them out at this week. health.com/today. Thanks for listening. That's all for now.

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