Earlier this year, the Harvard Business Review (HBR) conducted an analysis of the way Kaiser Permanente and Intermountain Healthcare have utilized telemedicine to help reduce expensive and unnecessary trips to the emergency room, reduce chronic diseases, address care disparities, make specialty care quicker and more efficient, and provide patients access to top-level physicians.
The HBR article was written by Robert Pearl, CEO of Kaiser Permanente, and Brian Wayling, executive director of telehealth services at Intermountain Healthcare. Both health systems have been using “virtual care platforms” for more than a decade to “improve preventive medicine, care coordination, chronic disease management, and affordability for more than 13 million patients.”
According to the article, telemedicine makes healthcare accessible to adults who own a smartphone (which is 89% of adults in the U.S. and 78% of adults globally), including those who live in medically underserved communities. HBR notes that telemedicine can benefit patients around the country and that “providers around the world should aggressively strive to tap its full potential even after the pandemic abates.”
Pearl and Wayling outline five specific opportunities, that if implemented, would reduce healthcare spending between 15-20%, improve clinical quality by 20%, and increase access to care by 20%.
Reducing ER Visits
Pearl and Wayling point out that many patients struggle with deciding whether their care is emergent enough to warrant a trip to the emergency room, and even if it is, they will often have to endure a lengthy wait in the waiting room and inflated prices for medical care. Once seen, the physicians often are at a disadvantage because they cannot access patients’ electronic health records and do not offer follow-up care.
Kaiser Permanente in Virginia, Maryland, and Washington, DC, came up with a potential solution to this problem: a 24/7 video health center that allows patients the ability to connect them with a physician who can assess the problem and provide guidance. In life-threatening situations, the physician would advise the patient to head to the ER and send relevant medical information ahead, to reduce the risk of complications.
Intermountain Healthcare created a remote patient-monitoring COVID program, combining telemedicine and home monitoring, which helped to free up resources and hospital beds in the thick of the COVID-19 pandemic. Upon evaluation by a physician, if a patient tested positive for COVID-19 but did not have life-threatening symptoms, they would be given a Bluetooth pulse oximeter and told to go home. The oximeter would be paired with their smartphone and used to measure blood oxygen levels daily, for two weeks. If the levels were low, the center would contact the patient and conduct a phone or video consultation – if the patient continues to present as low-risk, they could remain at home. Those whose condition was severe or deteriorating would be sent to the ER.
Pearl and Wayling believe that if similar programs were instituted across the country, billions of dollars could be saved annually.
Chronic Disease
Pearl and Wayling also note that even before COVID-19, the United States spent $214 billion per year on medical interventions for “preventable complications” from certain events, such as heart attacks and strokes.
One of the leading causes of strokes and a major contributor to heart disease, is high blood pressure. High blood pressure is a chronic condition that is poorly controlled 50% of the time in the United States, meaning that half of the patients with hypertension in the United States are at risk of severe complications.
Kaiser Permanente takes a more customized approach to patients with chronic diseases like hypertension, using a combination of telemedicine and an emphasis on primary care and prevention. Kaiser Permanente patients in California and the mid-Atlantic region are 14% less likely to die from a stroke and 43% less likely to die from heart disease than the United States as a whole.
Health Care Disparities
As one might expect, Pearl and Wayling also highlighted the benefit we tend to see most often: telemedicine can be a huge help for those living in underserved communities. Intermountain notes that its ability to offer virtual visits to patients allows patients to have “prompt access to both emergency and routine care” and that Intermountain patients who received healthcare virtually reported a high level of satisfaction and were less likely to cancel their healthcare appointments than patients with in-person visits.
Specialty Care
Pearl and Wayling acknowledge the lengthy wait patients sometimes face when referred to a specialist by their primary care physician. They further note that primary care doctors often believe they have “95% of the expertise needed to accurately diagnose and treat but no easy way to obtain the other 5%,” and that sometimes they just need confirmation that their diagnosis or plan of care is appropriate. However, without that 5% of knowledge, their only option for complete patient care is to refer the patient to a specialist.
Kaiser Permanente, however, allows primary care physicians the ability to use telemedicine to consult dermatologists, while the patient is in the exam room with questions. For example, more than 70% of Kaiser Permanente patients who visit their primary care physician with a hard to diagnose rash have their problem resolved in 10 minutes or less with telemedicine.
It’s not limited to just dermatologists, though, as Kaiser Permanente uses the same “remote-specialist model” across various common medical and surgical specialties. 40% of the time, the patient’s problems can be resolved via telemedicine, with no specialist visit needed. If the patient does need to visit the specialist, the appointment is scheduled after the virtual consultation and no in-person consult is required.
Accessibility
Finally, Pearl and Wayling note that patients who suffer from rare diseases have multi-faceted problems with their healthcare – from having to visit multiple physicians for answers to long wait times for those visits to the pain and fear of having that rare disease.
In Northern California, Kaiser Permanente has opened access to a nationally renowned kidney cancer expert for patients. Patients who have been newly diagnosed with kidney cancer can meet with the expert virtually. During the virtual visit, the doctor educates the patients about their condition, walking them through relevant clinical information, radiological scans, and treatment options. He is able to share his screen with videos of the expected surgical procedure, and after the visit, many patients choose to have him perform the surgery – despite the extensive distance the patient may have to travel. His patient-satisfaction scores are “universally excellent.”
Intermountain does something similar for patients who suffer from complex neurological conditions, via its Neuro Fast Access Clinical Team Virtual Platform. On the platform, patients can receive treatment for migraines, low back pain, and neck pain from experts at a low cost. This also allows to free up in-clinic appointments for patients who need to see someone in person, such as those who need Botox injections for nerve and muscle diseases.
How to Do It
Pearl and Wayling realize that for telemedicine to become more widely accepted and beneficial to patients, there is a long road ahead. However, at the conclusion of their article, they outline several steps to take, including develop partnerships with employers and businesses and designate supportive healthcare leadership who can steer the telemedicine ship forward.