Defining and Unlocking Value in Healthcare
By Peter McClennen, President, Best Doctors Division
How do you define value in healthcare? A quick Google search will result in numerous blogs, articles and discussions -- some recent and some dating back years -- with industry journals and healthcare leaders alike sharing their perspective on this topic.
According to a 2010 article from the New England Journal of Medicine, "Achieving high value for patients must become the overarching goal of health care delivery, with value defined as the health outcomes achieved per dollar spent." That same article also went on to say, "Yet value in health care remains largely unmeasured and misunderstood."
Fast forward to 2017, and health systems, health plans and vendors alike are all seeking to provide maximum value. In the realm of virtual care delivery, we are seeing digital technology, patient-centered care and tools for the delivery of population health management converging, and enabling us to produce tangible value for stakeholders. But what does that value look like? It's threefold, in the forms of 1.) financial savings, 2.) increased patient engagement and utilization, and 3.) improved health outcomes.
Financial ROI. An indisputable fact is that cost drives decisions. With redirection savings of up to $472 per healthcare visit, telehealth makes obvious sense. Colds and flu, upper respiratory infections, pink eye, and a long list of non-emergency medical conditions are proven to be effectively treated with telehealth, eliminating the need for costlier urgent care and emergency department visits. In addition to those tangible and obvious savings are the productivity savings realized by reducing absenteeism and its counterpart, presenteeism. The phenomenon of presenteeism -- where employees show up for work sick -- is actually costing businesses a hefty amount; in fact, according to a 2016 report, it is 10 times higher than absenteeism. By receiving care immediately, whenever and wherever it is needed, employees forego treks to and from doctor offices and are less focused on the research of aliments they or loved ones face while at work. In addition, employees ultimately feel better and are relieved to have immediate care for their family members, freeing them to focus on their daily work contributions.
Increased patient engagement. The statistics tell the story. With 90 percent of adults under the age of 65 having smartphones today, the "always connected" nature of this mobile world is fundamentally changing how they navigate their individual healthcare journeys. And with just a 5 percent utilization of a telehealth benefit, simple redirection from facility-based care to telehealth care offers a 2:1 savings. That's why employers are investing in advanced marketing services and creative ways to drive behavior change and increase engagement. As employers and their consultants design benefit plans to incent use, investment in marketing telehealth services builds awareness and drives utilization, in some cases inching towards 50 percent of employee populations. Can you then imagine how an increase in utilization to 75% -- which is the conceivable new norm -- could positively affect potential cost savings? What are the possibilities to close gaps in care and activate other chronic care management programs?
Improved outcomes. Today, the virtual delivery of care is dramatically improving health outcomes. As millions more gain access to its capabilities, the life-changing possibilities are becoming clearer. We're already seeing the evolution from providing care access for just episodic ailments to a full suite of medical conditions including chronic and critical health issues. With a central access point to a full continuum of care needs -- and the top-rated physicians -- patients can trust that they will get high quality care and expertise that is not standalone, but incorporated within the existing health system. This means that existing records are reviewed, and expert diagnoses and results are rapidly shared with a patient's primary care physician and treating specialists. With co-morbidities found in 29 percent of virtual care cases, the need is pressing for this integrated care, and telehealth possesses the unique ability to fill the gaps. Now, envision an expanded set of services that includes expert second opinions for everything from surgical procedures to a life-changing diagnosis. And add to that the assistance of advanced analytics and artificial intelligence to support the outcomes. Employees who have had the opportunity to benefit from this level of care have inspiring and heartfelt stories to share of their improved health outcomes.
When looking at providing value in healthcare, there are many examples to point to, especially in the worlds of telehealth and virtual delivery of care. From the financial value and costs savings for employers and the greater healthcare system, to the ability for patients to benefit from the ease of use of accessing care whenever and wherever they need it; to the not-too-distant future when a full spectrum of conditions can be addressed virtually -- from one central access point, telehealth not only defines value in healthcare, it achieves it.