We’re witnessing large demographic and market shifts that may speed up the race to value-based healthcare. Working example: The Medicare Payment Advisory Commission (MedPAC) predicts that Medicare Benefit enrollment will quickly eclipse conventional Medicare for the primary time.
With more people becoming eligible for Medicare than ever earlier than, our healthcare system is experiencing the broad shift from a deal with quantity (precipitated by conventional Medicare, which operates on a fee-for-service mannequin) to worth (precipitated by Medicare Benefit, which incentivizes well being outcomes).
As these value-based cost fashions acquire momentum via the growth of Medicare Benefit, massive well being plans are more and more motivated to seek out progressive methods to maintain folks wholesome. This rationale led to CVS Well being’s $10.6 billion planned acquisition of Oak Road Well being and $8 billion acquisition of Signify Well being.
The identical rationale led to Cigna’s stake, alongside Walgreens, in VillageMD and Optum’s acquisition of Landmark Well being. However whereas easy in idea, the elevated emphasis on main care invitations important questions on capability. Given ongoing supplier shortages, particularly in main care, how can we presumably scale an method that requires sufferers to spend extra time with their main care doctor?
I imagine that the broad-based shift to value-based care and a extra proactive care expertise just isn’t solely useful, it’s mandatory. Utilizing hard-won classes from my experiences as chief product officer at Livongo and Teladoc, I’m satisfied we will mix present know-how with novel care fashions to scale entry to the medical providers that make value-based fashions profitable.
Reframing main care as a last-mile situation
Scaling entry to main care providers is a last-mile situation. Basically, how can we assist a restricted provide of suppliers take care of a big and extensively distributed affected person inhabitants? I imagine the reply could be discovered by analyzing probably the most impactful technological growth of this century – mobile networks.
Regardless of the well-publicized lack of access to broadband and high-speed web in underserved communities, together with rural areas, the adoption of cell telephones is comparatively constant throughout almost all populations. In keeping with Pew Research, broadband adoption amongst rural Individuals noticed a 9 share level improve from 2016 to 2021. Nevertheless, regardless of development, the 2021 survey discovered rural Individuals have constantly decrease ranges of know-how possession than those that reside in city or suburban areas, and have decrease broadband adoption.
So what’s resulting in the delta between the variety of folks with entry to high-speed web entry and cell telephones? Mobile networks successfully solved the last-mile situation.
Within the early 2000s, high-speed web was delivered via cable modems and DSL, which required web suppliers to run a bodily line to each residence requesting service. Consequently, high-speed web was slow to reach rural America due to the price required to cowl a geographically-distributed inhabitants. Even immediately, many rural communities have extraordinarily restricted hard-wired bandwidth attributable to the price of set up. In distinction, mobile know-how requires no bodily infrastructure, surpassing the last-mile downside all collectively.
The healthcare business is dealing with an almost equivalent last-mile problem. Regardless of important advances in know-how, care supply networks are nonetheless constructed round a central hospital system and its surrounding “feeder system” of clinics. Nevertheless, individuals who don’t reside close to their native well being system typically should journey many miles simply to entry care. For these people the last-mile situation requires hours of journey to see a supplier.
Arduous-fought classes from Livongo and Teladoc
Whereas no healthcare firm has overcome the last-mile situation totally, among the classes discovered all through the latest evolution of digital well being can inform our method.
At Livongo, we developed know-how that allowed folks to transmit blood sugar information to the cloud through mobile networks. Via a seamless information alternate, we may ship customized well being insights, which allowed our licensed diabetes educators to name members who have been at an elevated threat of an acute well being occasion. As a substitute of getting to see a doctor for each well being query, Livongo enabled folks to obtain real-time help from appropriately credentialed well being coaches and establish when additional medical help was wanted. We went on to increase these rules to the administration of hypertension, prediabetes and coronary heart failure — leveraging mobile networks to beat the last-mile challenges.
At Teladoc, we discovered that persons are keen to work together with their doctor through telehealth, whether or not by telephone or video. That is significantly true for folks’s pressing care wants, and a wide range of transactional care wants resembling prescription refills or routine aspects of care together with flu or chilly administration. Throughout COVID-19, we discovered that longitudinal care may be delivered utilizing telemedicine, and that ongoing care supply was simplest when there was already a trusted relationship in place. In truth, when telehealth visits spiked considerably in 2020, the majority of those visits have been with an individual’s personal physician.
There’s a cautionary story right here as properly: Within the years following COVID-19, we additionally noticed that within the absence of that trusting relationship, people went back to using telemedicine almost exclusively for transactional care, with the one notable exception being psychological well being care. A foundational lesson emerged: we should first set up belief earlier than pushing the know-how wanted to cowl the final mile on an ongoing foundation. This was one of many painful classes discovered at Teladoc over the previous yr, and is increasingly evident.
The 4 rules wanted to scale entry to world-class care
With these classes in thoughts, I imagine there are 4 key rules to assist scale entry to the preventative providers wanted to ship profitable value-based care fashions.
First, we should successfully align incentives throughout sufferers, payers and suppliers. That is an space the place digital well being corporations have struggled up to now, together with Livongo and Teladoc. At Livongo, we aligned incentives with sufferers and payers, and at Teladoc, we aligned incentives for sufferers and suppliers, however neither firm cracked the code on adequately supporting all three. The broad shift to value-based cost fashions necessitates that we ship significant worth to all three stakeholders.
Second, we should break via care silos and ship an incredible expertise from consumer-friendly wellness options right through advanced medical interventions. Individuals have very totally different care wants at totally different phases of their lives. Some days, we would like reliable data on train and weight reduction. On others, we have to see a heart specialist to handle congestive coronary heart failure.
Third, we should higher make the most of suppliers. Whereas there may be acceptable consideration paid to the general lack of physicians, we will alleviate that problem by positioning suppliers to maximise their work on the prime of their licensure. At present, medical doctors typically ship far too many routine medical providers and are burdened by administrative duties that may be handily accomplished by different credentialed suppliers, together with nurses and medical assistants. By leveraging know-how to route sufferers to the correct supplier on the proper time, we will upskill our complete workforce whereas delivering care at a decrease value.
Lastly, we will’t underestimate the worth of in-person care. Sure critically necessary medical providers can solely be delivered via in-person care. Whether or not that is constructing belief with sufferers who’ve excessive ranges of healthcare wants or administering reasonably advanced diagnostics or interventions, pure-play telehealth corporations threat exacerbating the last-mile situation by bouncing folks again into the normal well being system for his or her in-person care wants with out steerage — typically leading to larger value and inconvenience.
Whereas a lot has been made concerning the acceleration of healthcare know-how and the shift to worth over quantity, no single group has cracked the code on delivering a very pleasant, cost-efficient and clinically efficient value-based care expertise throughout populations. By making use of classes discovered all through the evolution of digital well being, and by constructing the robust know-how spine wanted to scale entry to the first care providers which can be important to a value-based cost mannequin, I imagine we will lastly ship the healthcare expertise folks deserve.
Amar Kendale is the president of Homeward, an organization centered on bettering entry to high-quality reasonably priced, complete care in rural communities. Beforehand, Amar served as chief product officer at Livongo. He helped take the corporate via its public providing in 2019 and its acquisition by Teladoc Well being for over $18B in 2020. Amar earned each his Bachelor of Science and his grasp’s levels in mechanical engineering from MIT and has eight issued patents.