Scott MacStravic, Ph.D.
Healthcare has long been a “hands-on” profession for individual practitioners and hospitals. It is delivered while providers and patients are in the same room, or at least the same building, and normally relies on the presence of both for there to be any care delivered. But there are growing numbers and types of exceptions to this rule, and both hospitals and physicians are taking advantage of many of them.
Telemedicine, for example, is one of the most obvious examples of remote patient care. Providers are often in different states or even countries, as words and images of patients are beamed back to providers, while enabling patients to be treated at least partly without having to travel to where patients are. And physicians are reviewing diagnostic scans and monitoring data on patients in ICUs, for example, without leaving their offices or homes.
E-mail “visits” are becoming common, with increasing numbers of insurers covering them, or providers able to charge patients via annual retainers or fees per consult. Online and phone monitoring of chronic disease or risk condition patients has been enabled by a wide range of monitoring devices that are automatically hooked to phone lines or computers for uploading to provider locations.
The growing variety of remote patient care options are simply repeating the developments in financial services, where ATMs and online banking enable customers to be served where they are and choose to be, rather than where providers are. The same is true with education, where countless universities and schools offer online courses and degree programs, where students may never need to visit a campus.
The remote “treatment” options are both more prevalent and more important in proactive health than reactive sickness care. Remote contacts can be used to prepare patients for sickness care pre-admission, via online web videos of procedures, pre-admission counseling, exchanges of information, etc. Patients can be asked questions, and advised what questions to ask providers pre-visit. Pre-admission remote contacts can reduce patient anxiety and even coach them in weight loss or nutritional preparation to reduce their risks.
After an in-person treatment experience, whether an inpatient stay, outpatient visit or extended episode of more than one, remote contacts can significantly expand and extend post-discharge instructions, guidance, and follow-ups. Monitoring of patients’ compliance with medications and behavioral instructions, as well as their progress in areas which can be measured at home can greatly improve the quality or speed of their recovery.
But the most effective and efficient use of remote contacts may be in proactive health care services, in disease or risk management or general health and fitness promotion, whether undertaken by hospitals, physicians, nurses, or other professionals in independent practice. Regardless of who pays for proactive health initiatives—employers, insurers, or patients, themselves, keeping the costs of proactive health services as low as possible is sure to be a key factor in success.
Employers and insurers will be looking primarily at their net ROI from proactive programs, and that means keeping their investment as low as possible, given the return. Remote interactions between patients and providers will almost invariably be significantly cheaper than face visits, though group visits can also reduce costs significantly, and be part of a low-cost approach. Online interactions are likely to be the most convenient for both parties, in addition to being far cheaper than phone options.
The entire range of proactive health interactions with patients – health/disease/risk assessments, goal and priority setting, action planning, implementation and progress monitoring, and evaluation of results – can be done via remote interactions, even all online, where necessary and appropriate. Face visits and even phone contacts may prove too expensive for some payers, and undermine either marketing efforts to attract clients, or proactive program viability. Providers will have to balance effectiveness and costs of different remote options, as well as remote vs. more personal options, of course, but both should be able to be mixed well.
Remote interactions, from patient visits to websites for gaining information or posting reports on their behavior and progress have proven to be close in effectiveness to face visits. Remote options are routinely used by vendors in proactive health efforts for patients whose potential for cost savings for their payer clients are too low to justify personal visits or even phone coaching. Hospitals and health care professionals cannot afford to invest more than will make them competitive in terms of the ROI they can promise and deliver to clients, nor to paying patients, where they have other options.
Remote input via online health and risk assessments, coupled with automated analysis of the input, and customization of feedback to patients has proven to be far more effective than many face-contact, but standardized proactive programs, for example. And it compares favorably in cost effectiveness with face contacts and phone coaching in many cases. Face contacts may prove more powerful in initial proactive contacts, to create a more personal relationship with patients.
Face visits with providers made for sickness reasons may be used to add to remote contacts, though when patients are sick with one problem, they may be unreceptive to counseling or even questions related to a separate proactive effort, unless closely related to their present problem and its treatment. And planned face visits with non-physician proactive team members, on a group basis perhaps, may add significant enough impact to be worth the costs.
With the exception of a few programs and providers paid by wealthy patients able to afford thousands of dollars a year in retainer or proactive health program costs, remote contacts are likely to be essential to cost-effectiveness, regardless of the payer. Employers can afford to pay the most, since they gain via productivity improvements and labor cost reductions when their employees are healthy. Providers who are not prepared to offer and deliver excellent remote interactions as part of their proactive health programs, and probably even in traditional reactive sickness care, will be at a distinct disadvantage in these increasingly competitive markets.
