How Virtual Care Can Lower Cost and Improve Service Delivery
Article by Kurt M. Tamaru, MD, FAAFP
The U.S. health care delivery system has always remained largely a direct “person-to-person” interaction, but such thinking has been changing as the industry is adopting technologies that others have already pivoted towards, providing greater access, speed and efficiency. The banking industry is a great example familiar to those who can recall the days of bank tellers and account managers, whereby customers accessed physical locations for most of their financial transactions. As technologies like ATMs and mobile banking emerged, banks quickly realized that large physical locations were no longer needed, and the speed of transactions untethered from brick and mortar could now allow for banking services to occur at the speed of electronic transmissions. As such, financial institutions today are processing over 726 billion transactions a year.
I had the fortunate experience to practice medicine under the U.S. Navy early in my career. During that time, the U.S. military had been an early adopter of telemedicine and other technologies to solve the many logistic issues in delivering health care services across the globe under a wide range of circumstances and conditions. As global satellite, broadband and more reliable and accessible communication infrastructure emerged, many of these early capabilities began to find application in the commercial and private sectors. Often driven by economics, businesses like the financial services industry quickly realized the economic benefits, and now health care service organizations are beginning to use digital and virtual tools to provide medical-and health related care.
“Health care has similarly been looking to close this inefficiency, largely accelerated by needs under the COVID pandemic and with traditional brick-and-mortar care being challenged by more virtual constructs.”
Virtual care can be defined by interaction with a patient via indirect, non-physical means. Telemedicine or video can be one means of providing such care, but store and forward photo/video, remote patient monitoring, and text/voice communication could be other forms as well. Because health care is not a static process, but driven by time and need, it only makes sense that delivering care by virtual means could have a significant impact on the health care system, allowing greater responsiveness earlier in the spectrum of care.
Medical care in the U.S. has traditionally been a more “reactive” process, whereby you feel ill and seek care at that point in time. While more preventive care services have become the focus to reduce advancing disease, we still only spend about 2.9% of total health care cost on preventive care in the U.S. As such, our health care system has emerged to manage only more acute issues and requires more intensive resources, like hospitals and office-based care facilities. Unfortunately, these facilities have higher operating costs and traditional reimbursement for medical care is based upon in-person visits and time spent with a physician. As such, hospitals and physician services make up almost half of the entire health care spend in the U.S. today.
Coming out of COVID, interesting early data indicates that many services ceased or were dramatically reduced while prevalence of illness and disease continued to occur. Despite such, we have not seen massive spikes in complications of acute illness beyond COVID-related conditions or other age-related fatalities. Why is that? One might argue that the cost of services typically incurred might not have dramatically impacted the overall quality of life or outcome. As such, could such care have been conducted via a more efficient means and under a significantly lower delivery cost?
Virtual care under more popular team-based models with physician or clinical guidance and oversight is a far more efficient way to expend resources to meet the needs of a population where often risk prevention, guidance, education, and timely early treatments are all that are needed. In a recent conversation with a stroke prevention neurologist, I learned that a portion of catastrophic strokes have early precursor symptoms that often go unrecognized, but with proper monitoring could be detected and complications avoided. However, our brick-and-mortar model of seeking care does not allow for this rapid care capability and access. Virtual care has this ability as well as passive means to gather data points that might identify these and other risks earlier.
Beyond the speed of providing care, convenience and access, virtual care also has the ability to further identify non-medical issues occurring over time that an occasional office-based visit would likely miss. Current medical literature would identify these issues as social determinants of health (SDoH), but I would argue that virtual care in the home under a longitudinal model allows us to better understand and learn what drives health outcomes in an individual beyond the physiologic and social influences alone. Through early identification and intervention, more acute services can be completely avoided, such as emergency transportation, emergency room care and acute hospitalizations. In a senior population, where aggregated hospitalization and 23-hour admission rates run well above 225 total admits per 1000 patient per year, such reductions can have profound impact on overall health care spend in the population.
As we continue to see more “value-based” payment models emerging, including capitation and risk-based contracts, more focus and attention on reducing wasted medical spend and avoiding unnecessary or excessive acute care will need to be addressed. Some efforts promote placing the burden of care solely on the physician office, but without any means to offload the care to more convenient, lower-cost settings. Without any organized support capabilities, we are only asking our providers to work faster and harder. Virtual care that can manage patients longitudinally and outside of the office-based environment must be more encompassing beyond just a telemedicine visit or email conversation. As such, virtual models of providing comprehensive and total care capability are emerging and will likely disrupt how we deliver health care, much like how the banking industry evolved to where it is today.
About the Author - Kurt M. Tamaru is a board-certified family physician and innovator with over 25 years of experience in creating or managing integrated health care service companies with the goal of better care and quality for all. With extensive background in value-based care delivery, Dr. Tamaru is looking to create the next generation of health care services to better meet the growing needs of older adults under his privately funded company, Guardiant Health.
About Guardiant - Guardiant is a technology-enabled medical service company using monitoring and digital telehealth capabilities integrated under a single communications platform and clinical capability that provides an early warning and proactive intervention for better management of chronic medical conditions. The goal is not to replace traditional “brick-and-mortar” service delivery systems or family care providers, but rather to fill the gap between routine visits to the physician and home where many conditions first start to worsen. Early detection of these warning signs and immediate interventions can reduce unnecessary doctor visits, trips to urgent care clinics, emergency rooms and hospital admissions. Many of these early warning signs can be treated by the Guardiant clinical team from the comfort and security of a patient’s home. The utility of this technology is self-evident and has been dramatically demonstrated in the context of COVID and its health impact on seniors.
To hear more about virtual care for older adults and our model and approach, contact the Guardiant team at life@guardiantheath.com.
