There has been a spate of articles about health care organizations partnering with on-demand transportation services to improve access to appointments for office visits and procedures, reducing no-shows and cancellations, improving patients’ health and improving healthcare organizations’ operating efficiency. (Exhibit A: Medical Providers Try Uber, Lyft For Patients With Few Transportation Options.)
While I do not mean to detract from the positive experiences that result, rides to medical appointments have long been arranged through other means — some better, some worse — and the on-demand economy offers a mix compromises that merely supplement or supplant those of earlier iterations (including those operated and/or funded by state and local governments or their contractors, funded through Medicaid or otherwise). Earlier models may have been less efficient (higher cost per ride — but it’s covered by Medicaid!), and the perennial cost-cutting exercises at the federal, state and local levels are often conducted without a good understanding of the costs that will be created as a results of certain costs being cut. (The age-old balloon problem: Poke a balloon on one side, and it bulges out somewhere on the other side — or bursts.)
In an age when some visits are driven in part by the health care system’s familiarity with, and reliance upon, fee for service reimbursement, the focus on improving the experience of the in-person visit is understandable. However, given the rise of value-based payment systems for health care services, and the growing attention paid by IDNs and other health care providers to increased quality and efficiency — and by at least some to patient experience — the emphasis placed on using on-demand ride services is ripe for reconsideration. We will always need some in-person visits — but I’d like to see a broader focus on eliminating those that are unnecessary rather than simply figuring out how to get people to get themselves to those appointments in a way that ensures more optimized utilization of health care system resources within a pre-existing paradigm.
There are four modalities of telemedicine — synchronous, asynchronous, remote monitoring and mobile health — and each of them can reduce the pressure on the need for in-person appointments, thus improving the quality and efficiency of the health care system overall at the individual and population levels, and improving the experiences of both patients and health care professionals. (The Quadruple Aim.)
When most people think about telemedicine, they think of the synchronous (real-time) video physician visit. That certainly has its place, but intelligent uses of other modalities are likely to yield more significant gains in terms of cost savings and quality improvements. Just a couple of examples: Asynchronous video can help patients remember and understand their clinicians’ instructions, given at an office visit. (Some studies have shown that many, if not most, patients forget those written or oral instructions as soon as they’re out the door.) Remote monitoring of CHF patients’ weight post-discharge can identify the need to titrate diuretic prescriptions — which can be done by phone — thus preventing readmissions. Broader monitoring, combined with brief patient questionnaires administered via mobile device can combine into an FDA-approved chronic disease management app.
Looking beyond the traditional categories of telemedicine, it is worth examining the opportunities presented by the application of predictive analytics to the health care sector: artificial intelligence, trained through deep learning on large data sets, can deliver precision medicine to patients to meet their needs — before they or their clinicians have even articulated what those needs might be.
At this watershed moment for digital health, ride-hailing apps are surely not the best we can offer. I’m not looking for “The Uber of healthcare.” I’m looking for the ability to predict and answer the next question out of the patient’s or clinician’s mouth — before it is asked. That’s progress. That saves time, eliminates hassles and unnecessary trips to the doctor’s office. That will help manage care in a way that meets or exceeds the expectations of payors, providers and patients.
Care to come along for the ride?